
Qass 
Book 



COPYRIGHT DEPOSIT 



SPECIAL PATHOLOGY 



AND 



DIAGNOSTICS 



WITH 



THERAPEUTIC HINTS 



BY 



C. G. RAUE, M. D., 



Formerly Professor of Special Pathology and Therapeutics in the 
Hahnemann Medical College of Philadelphia. 



FOURTH EDITION 

REVISED AND AUGMENTED. 



JIM 



^\*ns-B-i 



PHILADELPHIA: 

BOERICKE & TAFEL 
1896. 







Copyrighted, 1896, 
By Boericke & Tafel. 



T. B. & H. B. COCHRAN, PRINTERS, 
LANCASTER, PA. 



fll>£ Stubents, 

near anfc far 
in wbose bebalf the ffirst BMtion was Elaborated 

ant) 

to tbe memory ot our mutual frienfc anfc teacber, 

Constantine Ibering, 

tbis tourtb edition is fcefcicatefc. 



PREFACE TO FOURTH EDITION. 



IN this, the fourth edition, there will be found a number of changes and 
revisions induced by the progress of medical science since the appearance 

of the last edition. A new chapter on Mental Diseases has been added, my 

object being to bring to the attention of the general practitioner and student 

in a concise manner the present state of this branch of medicine as developed 

in the last years by practical experience, experimental work in large hospitals, 

and the progress of psychology itself. 

Some changes have also been made in the classification of the acute 

diseases treated of, those of infectious origin being grouped into the chapter, 

"Acute Infectious Diseases." 

Hoping that with these additions and changes the entire work may have 

gained a new starting point in its practical worth to the student and busy 

practitioner, I again send it forth on its mission. 

C. G. RAUE. 
Philadelphia, 121 N. 10th Street, May ist, 1896. 



PREFACE TO THIRD EDITION. 



ATOW that I have finished this revision and can look over the task 
performed — I at last begin to realize a sense of satisfaction and com- 
fort. 

Not that I have made great changes in the text of the second edition — 
the pathology of to-day remains nearly the same as it was a few years ago, 
with the exception of increased efforts bestowed upon the cultivation of 
disease-germs, things already alluded to in many places of the second 
edition, but of little use as to curing disease — neither have I changed the 
therapeutic hints, although new experiences have been added; the main 
work done in this revision is the addition of a digest to all such chapters 
which present a list of therapeutic hints of three pages and over. These 
formidable lists appeared to me always as pretty hard lumps, that needed 
some aid for digestion — indeed required means which would make it easier 
for the practitioner to find out of the many the one remedy for a given 
case. 

A similar plan had been conceived and executed by Hering in his 
' ' Analytical Therapeutics of Typhoid Fevers, ' ' and in his first volume of 
' ' Analytical Therapeutics. ' ' Bell has given us a repertory on diarrhoea 
and dysentery, Gushing on leucorrhoea, Hggert on uterine and vaginal dis- 
charges, King on headaches, Wm. A. Allen on intermittent fevers, Minton 
on uterine therapeutics, Iyee on cough and expectoration, H. C. Allen on 
intermittent fevers and P. P. Wells on cholera — all very valuable contribu- 
tions to our therapeutics. 

My "digests," however, are not alphabetical repertories; each single 
one has been arranged according to the requirements of each single chapter. 
What belongs naturally together, or what is nearly related to each other, 
has been put together in order to facilitate comparison and choice between 
the different remedies. These digests further contain only what the preced- 
ing therapeutic hints contain, and are not made up artificially from the 
Materia Medica or existing repertories; they are not meant to present any- 
thing more or less than the preceding hints worked over and arranged meth- 
odically for ready use. 

This laborious task I have undertaken because I wished to accomplish 
two very important objects. First, to assist the accurate prescribe! 1 , as far 



XVI PREFACE. 

as it lies in the scope of this work, in his arduous task of finding the 
required remedy quickly and safely; and, secondly, to induce my young 
friends to study closely their cases, in order to keep out of the ruts, so 
easily trodden, of prescribing for a name. For in these digests they surely 
will find inducements for individualizing their cases, and although I do not 
promise that they will find in every instance what they are hunting for, I 
am sure they will be greatly aided in many cases. 

C. G. Raue. 
Philadelphia, August, 1885. 



PREFACE TO SECOND EDITION. 



OTVHE first edition had become old; it needed renovation. The pathologi- 
cal views had changed so grievously since its appearance, that a 
re-statement of the same throughout the work became a necessity. 

Not so, however, the therapeutic hints. They are as true to-day as 
they were when written years ago, and, I am happy to say, have been 
reliable guides at the bedside to many physicians, and also a fruitful source, 
acknowledged or not, to many writers in journals and of books. What I 
had to do with these hints was this: To express their meaning still more 
accurately, to enlarge their spheres, and to add such new facts as the exper- 
ience of others and my own would admit. This has augmented to a 
considerable extent even the therapeutic part of the work, and thus I may 
state in truth, that this second edition is re-written for the most part, that it 
is greatly enlarged, and, I hope, also greatly improved. 

Although I have given credit in the text to the several authors from 
whom I have drawn, it may be well to mention the principal sources for the 
pathological part: von Ziemssen's Cyclopaedia, French's Diseases of the 
Liver, Walton's work on the Eye, and von Trcelsch's work on the Ear. 
Compare also the introductory remarks to the first edition. The therapeutic 
hints I have selected from the entire homoeopathic literature, using all such 
indications as I deemed reliable and characteristic. 

The chapter on the eye has been kindly and carefully overhauled in the 
manuscript by Dr. G. S. Norton, and that on the ear by Drs. G. S. Norton 
and Henry C. Houghton; their valuable notes will be found credited to them 
in the text. 

The arrangement is the same as that of the first edition. 

Although great pains have been taken to avoid clerical errors, neverthe- 
less some have crept in, for instance, salycilic for salicylic and others. 
Wherever you find them, please correct them. 

C. G. RAUE. 
Philadelphia, September, 1881. 



INTRODUCTORY REMARKS TO FIRST EDITION. 



TTTHEN I was called upon to lecture on Special Pathology and Diag- 
* nostics, about four years ago, I looked around for a work which 
would furnish the essential points of these branches of medical education, 
together with Homoeopathic Therapeutics, in a concise manner and up to the 
latest researches; but I looked in vain. I was obliged to prepare my own 
materials. The result of these labors seemed, in the estimation of my pupils 
and indulgent friends, worthy of a more permanent form and a wider diffu- 
sion than oral teaching affords. 

In its preparation I have consulted the best recent as well as older 
works on the different subjects contained herein: Virchow, Rokitansky, 
Vogel, Griesinger, Hasse, Wintrich, Bamberger, Simon, Niemeyer, Bock, 
Bednar, Hiibner, Kuttner, Wagner, Skoda, Hebra, Wilson, DaCosta, 
Hughes, Barclay, Bryan. Hammond, Hahnemann, Hering, v. Boenning- 
hausen, Riickert, Oehme, Hartmann, Jahr, v. Grauvogl, Miiller, Meyer, 
Baehr, Kafka, Ludlam, Hale, Wells, Dunham, and others; New York 
Homoeopathic Transactions and various journals. I have made free use of 
all of them as far as they suited my purpose, but have not followed any one 
exclusively. The arrangement, selection and elaboration of the whole are 
my own. The composition, however, would have unavoidably contained 
many Germanisms had they not been expurgated. I am indebted to Dr. G. 
R. Starkey, formerly Professor of Surgery in the Homoeopathic College of 
Pennsylvania, for his kind offices in correcting the manuscript so as to render 
it more agreeable to the English ear. 

This book does not pretend to be a special Therapia, because as v. 
Grauvogl already remarks: " It is i77ipossible to prepare a complete, special 
Therapia for any so-called disease; just as impossible as to describe all human 
beings of all times, because the conditions of getting sick change constantly in 
the course of time." What the genius epidemicus requires, for example, in 
an epidemic of whooping-cough at this season may not answer at all for a 
like epidemic of the next year. Hence, my intention has been to give only 
therapeutic hints. These hints I have carefully selected out of the rich 
treasury of our Homoeopathic literature, and I have added the results of my 
own experience. But all this does not make it perfect. Many a colleague. 
on opening the book and glancing over this or that chapter, will miss one or 



XX INTRODUCTORY REMARKS TO FIRST EDITION. 

another remedy which he has been applying successfully in a certain form of 
disease. It lies in the nature of such a work that this must be so. On 
being informed, however, of such remedies and their characteristic indica- 
tions, the author would be happy to receive and apply them. 

This book does not give any prescriptions in regard to the dose, because 
that is still an open question, and must be left entirely to the free judgment 
of the practitioner. My hints are collected from all sorts of observations, 
with low, middle, high and highest potencies. I, myself, prefer the higher 
potencies; and it is possible that the more accurately we individualize the 
more we may become inclined to choose the highest. Others may think 
differently. So much is certain, that there are undoubted facts which seem 
to favor both sides of the question. Cases are recorded in which low poten- 
cies were given in vain, and a higher one of the same remedy at once effected 
a cure, and vice versa. Judge then for thyself. 

THE AUTHOR. 



ERRATA. 

Page 42 . ( ' Convulsions, ' ' read ' ' Convolutions. ' 
Page 137. " Hordeoleum," read "Hordeolum." 
Page 358. "Grabbet's," read " Gabbed s." 
Page 547. " Kchinococcus-cryst," read "cyst." 
Page 769. " Panaritum , " read "Panaritium." 



CONTENTS. 

MIND. 

MENTAL DISEASES. 

Introduction = 33 

I. The Sphere of the Intellect. 

Paranoia, Insanity, Verriicktheit 34 

Paranoia Inventoria seu Reformatoria 36 

Paranoia Religiosa 36 

Dementia Paralytica 40 

Senile Dementia ■ 41 

Checked Evolution of the Psychical Development 49 

Weak-Mindedness 50 

II. The Sphere oe Conation and Activity. 

Exultatio Furiosa, Frenzy, Tobsucht 52 

III. The Sphere of Feelings or Emotions. 

Melancholia 56 

Delirium Tremens 60 

Chronic Alcoholism, Dipsomania 62 

Opium Poisoning and Morphinismus 65 

HEAD. 
DISEASES OF THE BRAIN AND ITS MEMBRANES. 

Anaemia 67 

Hyperemia , 69 

Vertigo 74 

Sleep, Stupor, Insomnia ' 86 

Meningitis Tuberculosa, Hydrocephalus Acutus, Basilar Meningitis 91 

Leptomeningitis Infantum, Hydrocephalus Acutus Sine Tuberculis 93 

Simple Meningitis, Meningitis of the Convexity, Leptomeningitis ..... 93 

Hydrocephalus Acquisitus 101 

Hydrocephalus Congenitus 101 

Hydrocephalus Senilis 103 

Pachymeningitis, Inflammation of the Dura Mater 104 

Encephalitis; Abscess of the Brain; Red and Yellow Softening of the Brain . . 105 

Insolatio, Sunstroke, Thermic Fever 106 

Apoplexia Sanguinea 109 

Occlusion of the Cerebral Arteries; Embolism and Thrombosis; Softening of 

the Brain 113 

Aphasia 115 

Thrombosis of the Cerebral Sinuses 117 

Hypertrophy of the Brain 119 

Atrophy of the Brain 120 

Tumors of the Brain and Its Membranes 120 



XX11 CONTENTS. 

DISEASES OF THE CRANIUM AND ITS INTEGUMENTS. 

a. Abnormal Largeness of the Head. 

Dropsy of the Scalp 123 

Hypertrophy of the Skull 123 

The Bruised Head of a Child after Birth 123 

b. Abnormal Smallncss. 

c. Affections of the Skull without Enlargement. 

Atrophy of the skull 125 

d. Diseases of the Integuments. 

Eczema Capitis, Humid Tetter or Scald f . . 125 

Impetigo 126 

Dandruff 128 

Seborrhcea Capillittii 128 

Favus, Honey-comb Ringworm, Tinea Favosa or Maligna 129 

Tinea, Herpes Tonsurans, or Ringworm of the Scalp 130 

The Wen 130 

The Teleangiectasia, or Vascular Naevus, Mother's Mark 130 

The Hair 131 

EYES. 

General Observations 133 

Lids and Lachrymal Apparatus. 

Inflammation of the Eyelids 133 

Hordeoleum, Stye 137 

Tumors of the Lid , 138 

Dacryocystitis 139 

Blenorrhcea of the Lachrymal Sac 139 

Conjunctiva. 

Catarrhal Ophthalmia 140 

Purulent Ophthalmia 142 

Granular Ophthalmia 144 

Phlyctenular Ophthalmia 146 

Diphtheritic Conjunctivitis 150 

Croupous Conjunctivitis • 151 

Pterygium 152 

Cornea. 

Corneitis, Keratitis 152 

Abscess of the Cornea 153 

Onyx 153 

Hypopion 153 

Staphyloma 154 

Sclerotica. 

Scleritis, Sclerotitis 157 

Iris. 

Iritis 158 

Choroidea. 

Choroiditis 160 

Glaucoma 162 

Optic Nerve and Retina. 
Neuro-Retinitis Jk 164 



CONTENTS. XX111 

Hemiopia 166 

Hemeralopia, Night-Blindness 166 

Hyperaesthesia Retinae 167 

Lens. 

Cataract 167 

Sight 

Refraction and Accommodation 169 

Presbyopia, or Old Sight 170 

Hypermetropia 17 1 

Myopia, or Short Sightedness 17 1 

Astigmatism 17 2 

Asthenopia 173 

Muscles and Nerves. 

Mydriasis 175 

Myosis 175 

Ptosis 175 

Strabismus, or Squint 176 

Nystagmus, Trembling of the Eyeballs 177 

Luscitas, or Fixed State of the Eyeball 179 

Morbid Winking 177 

Twitching of the Eyelids 177 

Blepharospasm 177 

Neuralgia of the Eye 178 

Orbit. 

Orbital Cellulitis 179 

Basedow's, or Grave's Disease; Exophthalmic Goitre 179 

EARS. 

Analogy Between the P'ar and the Eye 182 

General Observation on the Ear 183 

Auricle. 

Eczema 184 

Auditory Canal and Drumhead, or Membrana Tympani. 

Examination of the parts .... 184 

Earwax, Diminished or Increased 186 

Furuncles of the External Canal 188 

Otitis Externa, or Diffuse Inflammation of the Auditory Canal 188 

The Middle Ear. 

Examination of the Middle Ear 190 

Otitis Media 193 

Chronic Forms of Otitis Media 197 

Polypi 206 

Nervous Deafness 207 

Meniere's Disease ■ 207 

Tinitus Aurium • 209 

Otalgia Nervosa. . . ' 209 

NOSE. 

General Observations 210 

Examination of the Cavity of the Nose 211 

Catarrh, Coryza, Cold in the Head 213 

Chronic Catarrh, Ozaena 217 



XXIV CONTENTS. 

Yearly Cold, Rose Cold, Hay Fever, Hay Asthma 224 

Epistaxis, Nosebleed 225 

Polypi in the Nose 227 

Inflammation of the Nose 227 

FACE. 

"General Observations 229 

Crusta Lactea, Milk Crust, Eczema 231 

Comedo, Acne Punctata et Rosacea 233 

Lupus 233 

Ulcus Rodens and Epithelioma • 234 

MOUTH. 

General Observations 233 

The Gums. 

Parulis, Gumboil, Inflammatory Swelling of the Gums 236 

Epulis 236 

Fistula of the Teeth 236 

The Teeth. 

Odontalgia, Toothache 238 

Swelled Face 252 

The Tongue. 

Its Color 253 

Its Humectation 253 

Its Temperature 253 

Its Covering, or Coating 254 

Its Form and Size 254 

Its Consistency 255 

Cracks and Fissures 255 

Paralysis 255 

Glossitis, Inflammation of the Tougue 257 

Cancer of the Tongue , 258 

The Salivary Glands and their Ducts. 

Saliva 259 

Ranula, Frog 260 

The Tonsils. 

Inflammation of the Tonsils; Amygdalitis; Tonsilitis; Angina Tonsillaris . . . 261 

The Uvula and Soft Palate. 

Angina Faucium, Angina Catarrhalis, Sore Throat 263 

Chronic Sore Throat, Angina Granulosa or Follicularis 265 

Ulcers in the Fauces; Ulcerated Sore Throat 270 

Retro-Pharyngeal Abscess 270 

Deep Inflammation of the Connective Tissue of the Throat; Angina Uudovici . 271 

The Mucous Membra?ie of the Mouth In General. 

Stomatitis 272 

Catarrhal Stomatitis 272 

Parasitic Stomatitis, Thrush 272 

Stomatitis Ulcerosa; Formation of Ulcers in the Cavity of the Mouth 274 

Noma, Gangrene of the cheeks 276 

NEOK. 

General Observations . ' ' 278 

Bronchocele, Struma or Goitre 279 



CONTENTS. XXV 

Oesophagus. 

Oesophagitis, Dysphagia Inflammatoria # 280 

Stenosis Oesophagi, Narrowing of the Oesophagus 281 

Dilatation of the Oesophagus 281 

Larynx and Trachea. 

Auscultation 284 

Laryngoscopy . 284 

Acute Catarrhal Laryngitis 286 

Laryngitis Catarrhalis Chronica 288 

Croup 292 

oedema Glottidis, Oedema Laryngis 296 

Perichondritis Laryngea 298 

Phthisis Laryngis, Tubercular Ulceration 298 

Syphilis Laryngis 300 

Neoplasms of the Larynx 300 

Neuroses of the Larynx 302 

Spasm of the Glottis 303 

THORAX. 

Inspection. 

General Observations ... 306 

Local Abnormalities 308 

Palpation. 

Temperature 308 

Form , . 309 

Resistance 309 

Fremitus 309 

Friction 310 

Pulsation of the Heart f : . 311 

Percussion. 

General Observations 311 

Tympanitic Sound 412 

Non-Tympanitic Sound of Skoda, the Resonant Sound of the Lungs 314 

Hyper-resonance 315 

Amphoric Resonance 125 

Cracked-pot Sound 315 

Auscultation. 

The Normal Sounds of Respiration 316 

Pathological Deviations from the Normal Vesicular Respiration 318 

Auscultation of Voice 323 

Auscultation of Cough 326 

Special Diseases of the Respiratory Orgrans 326 

Affections of the Bronchial Tubes. 

Bronchitis, Bronchial Catarrh 327 

Bronchial Asthma 340 

Affections of the Pulmonary Parenchyma. 

Lobular Pneumonia, Catarrhal Pneumonia 344 

Lobar Pneumonia, Croupous, Pueumonia, Lung Fever 345 

Pulmonary Tuberculosis, Phthisis Pulmonum, Pulmonary Consumption .... 354 

Emphysema Pulmonum 366 

Hyperemia and oedema of the Lungs 370 

Gangrsena Pulmonum 571 



xxvi CONTENTS. 

Haemorrhages of the Lungs, Haemoptoe, Haemoptysis 372 

Affections of the Pleura. 

Pleuritis, Pleurisy, Inflammation of the Pleura 374 

Pneumothorax 381 

Hydrothorax, Dropsy of the Chest 383 

Haematothorax 385 

THE HEART. 

Auscultation 387 

Diseases of the Pericardium. 

Pericarditis, Inflammation of the Pericardium 394 

Hydropericardium, Dropsy of the Pericardium 397 

Diseases of the Endocardium . 

Endocarditis 39S 

Insufficiency of the Mitral or Bicuspid Valve 401 

Constriction or Stenosis of the Left Auriculo- Ventricular Opening 402 

Insufficiency of the Aortic Valves 402 

Constriction or Stenosis of the Aortic Opening 403 

Insufficiency of the Tricuspid Valves 404 

Stenosis of the Right Auriculo- Ventricular Opening 404 

Insufficiency of the Pulmonary Valves 404 

Stenosis of the Pulmonary Opening 404 

Heart Clots 406 

Diseases of the Heart Muscle. 

Myocarditis, Carditis 407 

Hypertroph}- and Dilatation of the Heart 407 

Fatty Heart and Fatty Degeneration of the Heart 409 

Nervous Affections of the Heart. 

Nervous Palpitation of the Heart 410 

Angina Pectoris, Stenocardia 412 

Diseases of the Aorta. 

Aneurism of the Thoracic Aorta 415 

Diaphragm. 

Diaphragmitis 416 

Singultus, Hiccough 418 

Neuralgia of the Diaphragm 418 

Rupture and Perforation of the Diaphragm 418 

ABDOMEN. 

General Observations 420 

Stomach. 

Dyspepsia, Indigestion 423 

Vomiting 424 

Acute Catarrh of the Stomach, Gastritis 425 

Chronic Catarrh of the Stomach 428 

Gastritis Toxica seu Caustica 429 

Gastralgia, Cardialgia Nervosa, Cramp of the Stomach • ■ 430 

Ulcus Ventriculi Perforans, Round Perforating Ulcer of the Stomach 435 

Carcinoma or Scirrhus Ventriculi, Cancer of the Stomach 439 

Hemorrhage from the Stomach, Haematemesis 443 



CONTENTS. XXVll 

Gastromalacia, Softening of the Stomach 445 

Intestinal Canal. 

Catarrhus Intestinalis, Enteritis Catarrhalis, Intestinal Catarrh 447 

Chronic Intestinal Catarrh 449 

Typhilitis, Perityphlitis and Appendicitis 455 

Proctitis, Catarrhal Inflammation of the Rectum 458 

Periproctitis 459 

Dysentery 460 

Cholera Morbus, or Nostras 468 

Summer Complaint 469 

Hydrocephaloid . . 469 

Constipation 478 

Hernia 484 

Torsion or Twisting of the Bowels 487 

Intussusception, Invagination 487 

Ileus, Miserere 488 

Hsemorrhagia Intestinalis, Intestinal Hemorrhage, Malsena 490 

Haemorrhoids.. Piles 490 

Flatulency, Meteorism of the Abdomen 498 

Colica, Enteralgia • ■ 500 

Tuberculosis Intestinalis, Consumption of the Bowels , 509 

Cancer of the Intestines . -. 509 

Poh r pus of Rectum 510 

Fissura Ani 511 

Fistula Recti ..••• 512 

Prolapsus Recti 513 

Proctalgia 514 

Intestinal Worms, Bntozoa, Helminthes 514 

Tape Worms 516 

Trichocephalus Dispar 519 

Anchylostomum Duodenale, Dochmius s. Strongylus Duodenalis 519 

Trichina Spiralis 520 

Trichinosis 522 

Peritoneum. 

Peritonitis 526 

Ascites, Dropsy of the Peritoneum . 529 

Tympanites Abdominalis 532 

Liver. 

Physical Examination 533 

Pigment Liver, Melansemic Liver Resulting from Malaria Fevers 533 

Hypersemia, Congestion of the Liver 533 

Peri-Hepatitis, Inflammation of the Capsule of the Liver and of Glisson's 

Capsule 536 

Hepatitis vera circumscripta, seu Suppurativa 536 

Cirrhosis, Hob-Nail Liver, Interstitial Inflammation of the Liver 539 

Syphilitic Inflammation of the Liver 541 

Acute Yellow Atrophy 541 

Hepar Adiposum, Fatty Liver 543 

Colloid Liver, Lardaceous Liver, Waxy Liver, Amyloid Degeneration 544 

Carcinoma Hepatis, Cancer of the Liver 545 

Hydatids of the Liver, Echinococcus-cysts 547 

Catarrhal Inflammation of the Biliary Passages 548 

Cholelithiasis, Gall-Stones 549 



xxviii - CONTEXTS. 

Thrombosis and Occlusion of the Portal Vein; Pylethrombosis, Pylephlebitis 

Adhsesiva Chronica 552 

Pylephlebitis Suppurativa, Purulent Inflammation of the Portal Vein 553 

Icterus, Cholaemia, Jaundice 554 

Spleen. 

Physical Examination > . . 563 

Anatomical Peculiarities of the Spleen 564 

Hemorrhagic Infraction; Splenitis, Lienitis, or Inflammation of the Spleen . . 564 

Acute Tumor, or Hyperaemia of the Spleen 566 

Chronic Tumor, or Hypertrophy of the Spleen 566 

Cancer of the Spleen 567 

Echinococcus-cysts 567 

Rupture of the Spleen 567 

Pancreas. 

General Observations 568 

Pancreatitis, Inflammation of the Pancreas 569 

Fatty Diseases of the Pancreas 569 

Cancer of the Pancreas 569 

Kidneys. 

Examination of the Urine 569 

Diabetes, Mellituria, Glycosuria '. 576 

Diabetes Insipidus 583 

Hematuria, Passing Blood with the Urine 585 

Albuminuria 587 

Uraemia 588 

Bright's Disease 589 

Acute Parenchymatous Nephritis 589 

Chronic Parenchymatous Nephritis 593 

Interstitial Inflammation or Induration of the Connective Tissue of the Kidneys, 597 

Amyloid Degeneration of the Kidneys, Lardaceous or Waxy Kidney 600 

Suppurative Nephritis, Renal Abscess 601 

Nephrolithasis, Renal Gravel or Calculi; Nephralgia, Colica Renalis 601 

Pyelitis, Inflammation of the Renal Pelvis 604 

Perinephritis, Paranephritis, Inflammation of the Renal Capsule 605 

Morbus Addisonii 605 

Bladder. 

Cystitis, Inflammation of the Bladder 607 

Calculi Vesicae, Stones in the Bladder 612 

Hyperaethesia or Irritability of the Bladder; Spasms of the Bladder 613 

Atony, Paresis, Paralysis of Bladder , 614 

Eneuresis Nocturna 616 

Retention of Urine, Ischuria Vesicalis 617 

ORGANS OF GENERATION. 

MALE GENITALS. 
Venereal Diseases. 

Gonorrhoea 619 

Complications Sequelae 624 

Epididymitis; Orchitis 624 

Prostatitis Gonorrhoica, Inflammation of the Prostate 624 

Gonorrhoea Vesicae 625 



CONTENTS. XXIX 

Buboes 625 

Ophthalmia Gonorrhoica . . 625 

Gonorrhoea of Rectum 625 

Strictures of Urethra 625 

Gonorrhoeal Rheumatism 625 

General Contamination of the System in Consequence of Gonorrhoea 626 

Chancre 626 

Constitutional Syphilis 629 

Condylomata, Sycosis, Fig-Warts 637 

Inguinal Bubo . . . . • 638 

Syphilitic Skin Diseases • 540 

Syphilitic Affections of the Mucous Membranes 643 

Syphilitic Affections of the Periosteum 643 

Syphilitic Contractions of Muscles and Tendons 644 

Gummata in the Subcutaneous and Submucous Cellular Tissue 644 

Syphilitic Affections of Inner Organs 644 

Syphilis Congenita sive Hereditaria 645 

Testes. 

Hydrocele 646 

Orchitis, Inflammation of the Testicles 647 

Carcinoma Testis 648 

Varicocele 648 

Spermatocele 648 

Prostata. 

Prostatitis, Inflammation of the Prostata Gland 649 

Enlargement and Tumors of the Prostata . . . . 649 

Vesiculce Seminales. 

Pollutiones Noctunse et Diurnse; Spermatorrhoea 652 

Impotence; Sterility in the Male • • 655 

FEMALE GENITAL ORGANS. 

Examination of the Parts. . . • . • . . ■ 657 

Ovaries. 

Hydrops Ovarii, Ovarian Dropsy; Formation of Cysts in the Ovaries 661 

Uterus. * 

Endometritis, Catarrh of the Uterus, Leucorrhcea 663 

Parenchymatous Metritis 672 

Hydrometra, Hsemometra 675 

Displacements of the Womb, 676 

Anteversion and Anteflexion • 676 

Retroversion and Retroflexion 677 

Prolapsus and Procidentia 677 

Inversion of the Womb 67S 

Morbid Growths of the Womb 686 

Cancer of the Womb 687 

Hysteralgia 690 

Metrorrhagia, Haemorrhage from the Womb 691 

Menstrual Anomalies. 

Menorrhagia 694 

Amenorrhcea 700 

Dysmenorrhcea - ^ 

Vagina. 

Catarrh of the Vagina: Vaginitis y XI 



XXX CONTENTS. 

Vaginismus. 711 

Pruritus Vulvae 712 

Mai inner. 

Mastitis, Inflammation of the Breasts 713 

Scirrhus seu Carcinoma Mammae; Scirrhus, or Cancer of the Breast 715 

SPINE. 

Anaemia 718 

Hyperaernia 718 

Apoplexy 719 

Spinal Irritation 721 

Hydrorrhachis Congenita; Spina Bifida 723 

Leptomeningitis Spinalis 724 

Myelitis, Inflammation of the Spinal Marrow 726 

Myelomalacia, Non-Inflammatory Softening of the Spinal Marrow 728 

Multiple Sclerosis 728 

Tabes Dorsalis, Locomotor Ataxia 730 

Spasmodic Spinal Paralysis 734 

Polyomyelitis Anterior Acuta 735 

Polyomyelitis Anterior Subacuta, et Chronica 436 

Paralysis Ascendens Acuta 736 

Coccyodynia 737 

MOTORY APPARATUS. 

Rheumatism 739 

Rheumatismus Articulorum Acutus, Rheumatic Fever 739 

Rheumatismus Muscularis, Muscular Rheumatism 741 

Gout, Podagra, Arthritis 753 

Arthritis Deformans. . 755 

Rachitis, Rickets 756 

Malacosteon, Osteomalacia 758 

Progressive Muscular Atrophy 758 

9 Osteites, Caries, Necrosis 760 

Tuberculosis of the Joints. White Swelling 762 

Coxarthrocace, Coxalgia, Hip Disease * 763 

Gonarchrocace, Tumor Albus Genu, White Swelling of the Knee 765 

Bursitis 767 

Podarthrocace, Abscess of the Ankle Joint 767 

Malum Potii, Kyphosis, Angular Curvature of the Spine 768 

Panaritium, Paronychia, Whitlow, Felon • 769 

Bunion ■ ■ 771 

Ingrowing Toe-Nails 771 

NERVES. 

Anatomical Diseases of the Peripheral Nerves. 

Neuritis, Inflammation of the Nerves • 772 

Atrophy of the Nerves 772 

Hypertrophy and Neoplastic Formations of the Nerves 772 

Functional Diseases. 

Hyperaesthesia, Anaesthesia 773 

Neuralgia 774 



CONTENTS . XXXI 

Cephalalgia; Heinicrania or Migrsena 775 

Neuralgia of the Trigeminus or Fifth Nerve, Prosopalgia, Tic Douleuoreux. . . 784 

Cervico-Occipital Neuralgia 790 

Cervico-Brachial Neuralgia , 791 

Intercostal Neuralgia 791 

Lumbo- Abdominal Neuralgia 792 

Mastodynia, Neuralgia of the Mammae 792 

Sciatica 793 

Anaesthesia 798 

Anaesthesia of the Trigeminus 799 

Spasm, Convulsion, Cramp, Hyperkinesis 800 

Spasmus Facialis, Mimic Spasm 801 

Mogigraphia, Graphospasmus, Writers' Cramp 802 

Chorea, St. Vitus' Dance ' 802 

Hysteria 806 

Neurasthenia 810 

Catalepsy • 812 

Epilepsy 813 

Eclampsia Acuta 823 

Eclampsia Gravidarum, Puerperal Convulsions 823 

Eclampsia Infantum 825 

Tremor, Trembling 827 

Paralysis Agitans 828 

Paralysis, Akinesis 829 

THE BLOOD. 

Cyanosis 836 

Dissolution of the Red Blood-Corpuscles 837 

L,eucocythaemia, Leukaemia 837 

Hydraemia 838 

Plethora 839 

Symptomatic Anaemia, Oligaemia 839 

Progressive Pernicious Anaemia, Idiopathic Anaemia 840 

Chlorosis, Green Sickness 841 

Scurvy, Scorbutus 848 

Purpura Haemorrhagica, Morbus Maculosus Werlhofii 850 

Haemophilia, Haemorrhophilia 851 



ACUTE INFECTIOUS DISEASES. 

Fever 855 

Clinical Thermometry 855 

Crisis and Critical Days 857 

Intermittent Fever, Fever and Ague S5S 

Pernicious Intermittent; Remittent and Continuous Malarial Fevers; Congestive 

Fevers S75 

Yellow Fever 877 

Dengue, or Break- Bone Fever SS8 

Typhus S89 

Typhus Exanthematicus, Petechial Typhus SS9 

Typhoid Fever, Typhus Abdominalis, Enteric Fever S92 

Relapsing Fever, Typhus Recurrens 919 



XXX11 CONTENTS. 

Influenza, La Grippe 922 

Parotitis, Mumps 923 

Diphtheria, Diphtheritis 925 

Tussis Convulsiva, Pertussis, Whooping-cough 939 

Meningitis Cerebro-Spinalis Epidemica, Spotted Fever 943 

Acute Miliary Tuberculosis 948 

Anthrax, Malignant Pustule 950 

Hydrophobia, Lyssa, Rabies 951 

Tetanus 956 

Cholera Asiatica 959 

Erysipelas 969 

The Plague 972 

EXANTHEMATA. 

Measles 974 

Scarlatina 978 

Rubella, Rcetheln 994 

Variola, Small-pox; Variolois, Varioloid 995 

Varicella, Chicken-pox 1001 

SKIN. 

Hypertrophy of the Skin. 

Ichthyosis, Fish-Skin 1003 

Atrophy of the Skin. 

Rupia or Rhypia, Isolated Blisters 1013 

Hyperemia and Anczmia of the Skin. 

Dermatitis, Inflammation of the Skin. 

Erythema 1004 

Herpes 1005 

Urticaria, Nettle-Rash IOO y 

Eczema 1008 

Ulcus Varicosum ion 

Impetigo, Pustular Eruption ion 

Ecthyma; Isolated, Large Pustule 1012 

Pemphigus, Pompholyx, Isolated Large Bullae or Blisters 1012 

Furunculus, Boil 1014 

Carbunculus, Carbuncle , 1014 

Psoriasis 1015 

Lichen 1016 

Prurigo, Pruritus * 1017 

Scabies, Itch 10 18 

Prairie Itch, Prurigo Contagiosa 1020 

Burns and Scalds 1020 

Chilblains, Frostbites 1022 

Anomalies in the Secretions of the Skin. 

Sudamina 1024 

Foot-Sweats 1024 

Anidrosis 1026 

Comedo, Milium, Molluscum 1026 

INDEX ....• 1027 



RAUE'S SPECIAL PATHOLOGY. 



MIND, 



MENTAL DISEASES. 

We find very little agreement in the classification of mental diseases 
among the different authors on the subject. The difficulty to agree lies un- 
doubtedly in the varied combinations of psychical and physical symptoms 
which constitute these various and constantly changing affections. Are they 
purely mental, or are they merely the effects of somatic (cerebral or systemic) 
disorders ? 

In many cases it is certainly difficult to decide where the origin of the 
trouble lies. For instance, mania may be the effect of purely psychic causes, 
such as anger, chagrin or sorrow, especially if associated with emotions par- 
tially depressing and partially exciting like fear and love, sorrow and am- 
bition, great joy after great depression, enthusiasm even fanaticism after 
desperation and despondency. 

As regards somatic origin it may be caused by excessive heat or cold, 
fever, suppressed eruptions of all kinds, periods of evolution, excessive loss 
of vital fluids, of sleep, starvation, etc. And in some cases it may be the 
effect of both mental and bodily causes working together at the same time, 
for instance, when excessive intellectual or emotional excitations undermine 
the system upon the basis of which the continued nervous strain produces an 
outbreak of maniacal fits. 

All this proves merely that soul and body are very intimately connected 
and that in mental diseases the cause may rest on psychical as well as bodily 
ground and that, therefore, in treating such disorders we will have to look 
most carefully on both sides of the question. 

On the reciprocal relation between soul and body, I have treated in 
my " Psychology as a Natural Science," to which I here refer, especially to 
chapters 109 and no, and for the reason that this reciprocity establishes such 
great uncertainty between what might be a clear psychical or a clear somatic 
foundation, I shall dismiss the idea of classifying mental diseases into purely 
psychical and purely somatic affections. This cannot be done, because both 
are continually intermixed and the bodily cause is in most instances unknown. 
We will fare better if we establish our classification on a basis which the 
natural spheres of mental manifestations suggest, instead of attempting an 
3 



34 MENTAL DISEASES. 

artificial grouping of the subject. These spheres are the intellectual, the 
conative and the emotional spheres of psychic modifications. Even in this 
way we should not expect to escape all complications arising from the mixing 
of the different classes, but we at least build upon a ground which by its pre- 
dominant symptoms will clearly characterize the class to which these symp- 
toms belong. 

We must also take into consideration that all mental diseases, even the 
most violent and strangest, grow out of natural psychical developments, so 
that even in these disordered conditions there lies nothing of a foreign nature 
to the natural development of the soul. All are either exaggerations, or de- 
pressions or perversions of natural psychic developments, and there is no defi- 
nite line between a sound and a morbid mental development. The one may 
so gradually deepen or rise into the other that no one can say, here lies the 
boundary between the two. Insanity is therefore a term indefinable, and 
designates merely an abnormal or unsound state of the mind, either as an 
exaggeration or a depression of the mind in one or the other or several 
spheres of mental development. 

I. The sphere of the intellect or understanding may become deranged, 
first, by the excessive growth in strength of one or a group of mental modifi- 
cations, so that fixed ideas of various kinds grow to dominant or leading 
modifications of the mind and constitute all sorts of insane notions, as we find 
in Pa?'anoia (insanity, Verriicktheit) in its different forms, or secondly, by the 
great weakness of many or all mental modifications, which constitutes imbe- 
cility, dementia, stupidity, idiocy, cretinism either by an inborn weakness of 
the primary forces (idiocy, cretinism); or by a disturbed psychic development 
in consequence of bodily causes, such as epilepsy, apoplex}^, acute fevers of 
all sorts, excessive sexual indulgencies, or excesses in drinking spirituous 
liquors, excessive heat or cold, starvation, etc., or in consequence of psychical 
causes, such as fright, grief, anger, excessive joy, etc., or by a natural de- 
velopment during old age — dementia senilis. 

Paranoia, Insanity, Verrucktheit. 

This form of mental derangement is either acquired or inherited. In 
either case it grows to be of a chronic nature and its course goes often in 
leaps or jumps. Such aggravations are frequently attended by cerebral or 
psychical s}~mptoms. In both cases we have as main mental disorder delu- 
sive ideas which develop upon a prenatal tendency towards constitutional 
neuroses, such as neurasthenia, hysteria, hypochondria and abnormal or per- 
verse sexual desires and habits — commencing in the inherited form early in 
life, of which in one thousand cases Dr. Kraft-Ebing observed not a solitary 
cure, although frequently lucid intervals of varying duration and also long 
continued remissions with total latency of the delusive ideas of sensory de- 
ceptions have been observed. The acquired form is much more frequent 
than the inherited, and commences usually not before the 5th decennium, 
usually in females during the climacteric changes, although it may develop 
also at an earlier time of life. 



PARANOIA, INSANITY, VERRUCKTHEIT. PARANOIA SEXUAEIS. 35 

The main contents of the delirium of such patients are fixed ideas of 
being persecuted or of being grand or rich personalities. 

Dr. Kraft-Ebing gives in his Lehrbuch der Psychiatrie , a work from which 
most of the newer writers have drawn much of their information without giv- 
ing the source where the}- found it — a description of a typical form of acquired 
Paranoia: 

The victims are queer from childhood; they are quiet, irritable, sus- 
picious subjects. Their main trouble is the fixed idea of persecution, con- 
stantly imagining that they are wronged either by a particular enemy or a 
general conspiracy against their life, welfare or prosperity. 

Exciting somatic causes are catarrhal affections of the stomach, uterine 
troubles, climaxis, neurasthenia, in consequence of masturbation, constitu- 
tional hypochondriacal or hysterical neuroses. By degrees their surround- 
ings appear to change in their imagination against them, and they appear to 
themselves as the victims of all kinds of intrigues about them. By degrees 
also their own behavior toward the outer world changes to greater irritability 
until at last the height of the disease may slowly or more suddenly transform 
the patient into a most dangerous and aggressive maniac, who kills not 
secretly, but openly, that which excites his suspicion, in the fullest belief of 
necessary self-defence. 

This condition of the patient terminates either directly in imbecility or 
is transformed into a different kind of delirium, into the opposite of what 
the patient has thus far imagined to be. From a poor persecuted victim the 
patient rises in his own imagination to the dignity of a prince, emperor, 
prophet, God, Messias, ruler of the whole world; mother of Christ, etc., etc. 

' ' This interesting change of the personality is found at least in one- 
third of the cases, and, as far as my experience reaches, without exception 
in hereditary cases." Kraft-Ebing. 

The paranoia sexualis, a sub-division of the paranoia persecutoria, is 
found in the male almost exclusively in consequence of masturbation, which 
causes neurasthenia of the genitals or neurasthenia in general; in the female 
it may be brought about by the same causes or by diseases of the female 
organs, such as mal-positions of the uterus, etc. 

Its main features in both sexes are jealousy, with delusive ideas of being 
wronged and persecuted by their partners as well as by acquaintances and 
strangers. These delusive ideas are nurtured in both sexes by the slightest 
signs, or accidental incidents, which the jealous victim at once accepts in 
confirmation of his belief that his partner is false to him. By degrees it 
may be exaggerated to violent deeds toward the partner or the person who 
is supposed to be the rival. 

But just as the paranoia persecutoria frequentl} T turns into delusions of 
grandeur and riches, so does the sexual paranoia frequently change into the 
expansive form of erotomania, which consists of the fixed idea of being the 
favorite and the beloved of a person of the opposite sex of high rank. It 



36 PARANOIA IXVENTORIA SEU REFORMATORIA. 

culminates in the exposure of the foolishly imagined love affair, excites ridi- 
cule from all sides, ends in necessary confinement in an asylum and with 
intermissions goes on for life. "A cure," Dr. Kraft- Ebing says, " I have 
never seen." 

Besides the erotic form of expansive paranoia can be mentioned the 

Paranoia Inventoria Seu Reformatoria. 

Such patients are always persons burdened by inheritance with con- 
stitutional tendencies towards neuroses, and are cranky and one-sidedly 
gifted, with a great deal of self-esteem. According to the character of their 
tendencies and education they dream a phantastical future of grandeur and 
power, or are brooding over new inventions or new discoveries, live in 
delusive ideas of being great poets, artists, social reformers, disdain in their 
excessive self-esteem to associate with all commoner people below their 
dignity, have mostly sill}', absurd ideas, though occasionally they may show 
some originality, which on first sight may deceive the unsuspecting observer- 
It is quite remarkable how such a crank in stirring, excited times may turn 
a large number of people to partisans in a particular cause. Only subsequent 
observations will gradually detect the uselessness and foolishness of such 
fanatically eccentric ideas, and undeceive those who were caught unawares 
by the seeming originality and brilliancy of these paranoias. 

The termination of such disorders is the mad-house, where the poor 
insane creatures continue in their delusive ideas, hoping the future will make 
it all right, or gradually grow distracted and completely crazed, and at last 
imbecile, though not fully idiotic. 

Another variety of the expansive paranoia is the 

Paranoia Religiosa. 

"The representatives of this group," says Kraft-Ebing, "are almost 
always persons of weak minds, whose narrow understanding is not capable 
of grasping the ethic contents of religion, but who take the exterior, glitter- 
ing forms of a cultus for the essence of religion." Such constant exercises 
from childhood in misunderstood formalities must eventually color the whole 
mind in its wa}' of thinking and feeling, and we need not wonder when by 
the influence of eloquent missionaries and zelotic priests, who paint heaven 
and hell in the liveliest colors, these poor and weak minds are lost in religious 
entanglements. 

At times this result may be brought about by hard blows of fate, which 
entirely estrange the mind from material interests and throw it into the arms 
of blind faith and religious formalities. The mental excitation reaches by 
degrees a state of extasis which soon combines with hallucinations, in men 
with glorification and communion with the holy ghost, in women, often in 
consequence of sexual excitement, with fixed ideas of becoming mothers of 
God through the influence of the holy ghost. 

Frequently these sublime extases are interspersed with paroxysms of 
precordial anxiety and a sense of deepest contrition, or feelings of sinful un- 



PARANOIA RKLIGIOSA. 37 

worthiness, with a desire of clearing away the sins by self-punishment and 
to oppose the temptations of the devil by all means. 

Although in asylums for the insane, by isolating these poor creatures 
from religious exercises, their exaltations may be lessened, their morbid 
tendency still remains; long-continued confinement, however, may gradually 
change them into useful, industrious inmates of the institution. 

The main danger with these patients is, that in paroxysms of depression 
they may be driven to self-mutilation, or in paroxysms of fanaticism to 
attacks upon others. 

The termination of religious paranoia is imbecility, but not total apathic 
idiocy. 

Therapeutic Hints. 

The old school knows only of palliatives, to force sleep by subcutaneous 
injections of Morphium or other hypnotics, such as -Sulphonal, Chloral, etc., 
•which are all supposed to be means to induce sleep, whilst, in fact, they 
merely produce stupefaction. 

Bromides in large doses against sexual irritation and hallucinatoric 
deliria do certainly quiet these irritations, but they also gradually depress 
plrysical and psychical life to a degree that nothing but a wreck is left, unable 
to get up any kind of excitement at all. 

The best of all is the asylum for the insane, in which they may find, we 
hope, shelter and protection against the outside world and their own self. 
In this way, by well-directed methods, their mental confusion may be greatly 
lessened. 

As homoeopathic remedies I shall give only briefly the most important 
indications for their use and refer for closer study to Jahr's "Mental Diseases. ' ' 
. Aconite. Fixed ideas, worse at night, with restlessness and anxiety, 
fear of death; prediction of hour of death. 

Agaricus. Makes verses, sings; laughs, thinks himself immensely 
wealthy; appears very happy. 

Amm. carb. Anguish as if he had committed a crime; loathing of life. 

Aiiacardium. General insane notions; hallucinations of sight and hear- 
ing; sees a bier in next room, upon which he himself or a friend is lying as a 
•corpse; hears his name called by deceased relatives; timid and apprehensive; 
great loss of memory; swearing and cursing. 

Ant. crudum. Ecstatic love; sentimental, distrustful; gastricism. 

Apis mell. Paranoia senualis; jealous; nymphomania; pain, tenderness 
and dropsy of ovaries, especially the right. 

Argent. ?iit. Believes he is despised by his family; fixes da} T of death; 
always hurried, must walk very fast; suicidal sadness, but lacks courage. 

Arsen. Sees an absent person lying dead before him; sees ghosts; 
believes thieves to be in the house, for whom he searches; sees worms on his 
bed; jumps out of bed from fear and conceals himself; "perspiration from 
fear; kneeling and holding of the hands in an entreating manner ;" great 



38 THERAPEUTIC HINTS TO PARANOIA. 

anxiousness; ringing as of bells in the ears and vision of a person hanging 
by the neck, with inclination to hang himself. 

Aurum. Religious insanity with praying and weeping. Mercurial 
poisoning. 

Baptisia. Imagines he " cannot get himself together;" as if the pieces 
of his body were scattered about. 

Bell. Illusions of all the senses: beautiful images, or frightful visions 
of ghosts, insects, bats, black dogs that will bite, devils, soldiers and execu- 
tioners, who want to take away the patient; fixed ideas of journeying home, 
where he believes everything is destroyed by fire; buffoonish insanity , with 
ridiculous and foolish actions; conceals herself; tries to escape; walks about 
with busy, important looks; loquacious, lascivious; growling and barking 
like a dog; singing, whistling, trilling, hopping, dancing. 

Berberis. Urinar} T and menstrual, arthritic and hepatic derangements. 

Bry. Thinks himself in a strange place; wants to go home; dreams 
full of business. 

Calc. c. Fears to lose his reason; hallucinations of sight and hearing. 

Camphora. Puerperal rage; indecent language; strips himself naked; 
tries to jump out of window; lochia suppressed; erethism of sexual system. 

Cannab. Bid. Roaming hallucinations in grand style; happy or terribly 
horrifying; conception of time and space exceedingly exaggerated; dreamy, 
as if things were not real. 

Canth. Frenzied with sexual excitement; masturbation; inflammation 
of bladder with strangury. 

Cicuta. Everything about him appears strange and frightful; staring 
look; insane dancing, laughing, clapping of hands with hot and red face; 
childish, happy feeling about little things. 

Cimicifuga . ' ' Suspicious of everything; would not take medicine if she 
knew it; indifference, taciturn, takes no interest in household matters; fre- 
quent sighs and ejaculations." (Dunham.) Confused and wild; intense 
anxiety and pain about the heart; functional disorder, from mental depres- 
sion; puerperal melancholy and mania, with sleeplessness. 

Cocculus. Weakened, miserable subjects from onanism and other debili- 
tating causes, such as sickness, disappointment in ambition, from anger or 
grief. Changing with lively humor, etc. 

Conium mac. Consequences from not satisfied sexual desires. 

Crocus sat. Great cheerfulness, mirthful and witty; quarrelsome mood, 
followed by repentance and timidity; wants to kiss everybody; very affec- 
tionate; uterine haemorrhages. 

Cuprum. Foolish gestures of imitation and mimicry; full of insane, 
spiteful tricks; again, anxiety and despair, shrinks away from everybody. 

Cyclamen. Mental derangement at climaxis. 

Hyosc. n. Erotic hallucinations and jealousy are its main features. 

Ign. Sexual paranoia; thinks she is married and pregnant; suffers 
terribly from imaginary sins, and tries to escape and drown herself; is more 



THERAPEUTIC HINTS TO PARANOIA. 39 

quiet when left alone, but if interfered with her ideas becomes wild and crazy. 
(Gross. ) 

Lack. "Jealous insanity; ecstatic insanity; loquacious insanity after 
over-study, with long speeches, rapidly passing from one idea to another, 
and pride and mistrust toward those about him; religious insanity, believes 
himself to be predestinated by God to be everlastingly damned." ( Jahr.) 

Lilium tig. Religious paranoia; doubtful of her salvation, worse by 
consolation; sexual paranoia; strong sexual desire, obscene talking. Uter- 
ine disturbances. 

Merc. sol. BufFoonish insanity; does all kinds of absurd things and sees 
frightful visions at night when in bed; uncovers himself at night, throws 
bedclothes around and uses abusive language. (Jahr.) Suicidal inclina- 
tion, after suppression of foot-sweat; syphilitic taints. 

Nux vom. After allopathic drugging; abuse of coffee, mental exertion, 
loss of sleep; fixed ideas of wounded pride; domestic worries; constantly 
talking about one thing. 

Opium. Fantastical and sexual insanity, both with audacity or great 
fear; indifference to joy or suffering; effects of being stunned psychically by 
hard blows of fate. 

Phosphor. Imagination of grandeur; satyriasis and nymphomania in 
old people, with insane shamelessness; want to expose themselves and go 
naked; excitement of sexual desires and destructive tendencies; somnambu- 
listic states. 

Platina. Pride, arrogance; thinks himself above everybody; and again 
low-spirited; fearful; precordial anguish with violent weeping and fear of 
death; sexual excitement; bodily symptoms alternate with mind symptoms. 

Plumbum. Fixed ideas of being persecuted; hears voices and sees 
frightful things; maniacal rage with cries, brawling and convulsions. 

Pulsat. Anxious and tearful; terrible visions which throw her into 
great fear; think they will not be saved; feel tired of life; think of drowning 
themselves. The psychic derangement is mostly in connection with bodily 
irregularities during pregnancy, child-bed or monthly troubles. 

Sabad. She considers herself pregnant; he fears that his sexual parts 
are shrinking; maniacal rage better from the application of cold water to the 
head. 

Secale. Insanity with senseless actions and inclination to treat his rela- 
tions contemptuously and sarcastically; inclination to drown himself. 

Strammonium. Excited state; sometimes abusing others; more fre- 
quently constant talking, foolish laughing and acting, restlessness and desire 
to go away; visions of ghosts and fighting with them; visions of animals; 
sexual irritation; wants to be kissed, and indecent, lewd talk; great agility 
in muscular motions. Depressed states are changes sometimes with the 
excitement, thinking that he is not worthy of salvation, etc.; proud, lascivi- 
ous, enthusiastic, religious, buffoonish insanities. 

Sulphur. Fearful; unconsolable about all she does as bad and wicked; 



40 DEMENTIA PARALYTICA. 

religious insanity about his soul's salvation; indifferent about the lot of 
others; foolish, happiness and pride; everything, even rags, appear beauti- 
ful; inclined to decorate himself with gaudily colored rags, believing to have 
everything in abundance, though emaciated to a skeleton. Everything has 
a disgusting smell to him, as if coming from his own body, without having 
soiled himself. 

Tarantula hisp. Paranoia sexualis; sudden insane paroxysms with 
fox-like and destructive efforts. 

J r iratr. alb. " The excited state of mind showed itself in raving, laugh- 
ing, singing, whistling, and constant indecent talking, with sexual excite- 
ment . \ ' — Riikerf s Klin . Erf ah rn?ige?i . 

DEMENTIA PARALYTICA 

Is understood as " a diffused disease of the brain and often also of the spinal 
cord, which is characterized by a peculiar combination of physical changes 
with motor disturbances in the muscles of different parts of the body, which 
has a chronic course and ends in death." (Hitzig.) 

In the protracted cases post-mortem always shows atrophy of the brain, 
which can be recognized by inspection and frequently by weight. The dura 
lies in folds over the frontal lobes; the pia is either locally or universally 
cedematous; the ventricles are enlarged; the dura often adheres so firmly to 
the skull that it cannot be removed without injuring the brain; it may pre- 
sent all varieties of dulness, thickening and deposits upon its surface, also 
innumerable larger or smaller flattened extravasations, which have all shades 
of color between yellow, red and black; even large haematomas have been 
found; yet there are numerous other cases in which the dura appeared intact. 
The brain tissue by microscopical examination reveals a chronic or sometimes 
a subacute interstitial (peri) encephalitis, which in course of time leads to 
destruction of the ganglion cells and to atrophy of the brain. The spinal 
cord presents gray degeneration of the posterior columns or granular cell 
myelitis; the membranes of the spinal cord undergo, though more rarefy, 
changes similar to those of the brain. 

As predisposing causes heredity has been mentioned. Probably the 
combination of excessive labor with excesses in Baccho and Venere is the 
most common cause, although injuries of the head, constitutional syphilis 
and the influence of acute febrile diseases may also give rise to the develop- 
ment of this disease. It scarcely occurs under the age of twenty; is most 
frequent between thirty and forty-five or, according to some authors, between 
fifty and sixty years of age. 

Its Prodromal Symptoms, which sometimes for years precede the final 
outbreak, are the most important for the physician, because then and there 
lies his only chance of preventing greater mischief. Spells of dizziness, 
which pass over quickly ; of headache, more or less severe and worse in the 
morning; of rheumatic pains, especially in the lower extremities, changing 



SENILE DEMENTIA. 4 1 

location and coming and going suddenly, worse at night. With these chance 
symptoms appear an unusual irritability of character entirely foreign to the 
patient's former behavior, and a weakness of memory, especially for recent 
events, while past ones are well remembered; he often forgets his hat, his 
cane, or pocket handkerchief, etc., the muscles around his mouth occasionally 
are seen to tremble either spontaneously or when other facial muscles are in 
action. The patient is unconscious of it, and recognizes the fact only when 
he sees it in the mirror; his speech becomes nasal, or difficult and imperfect, 
especially in regard to the labials and sibilants; a kind of lisping as if 
slightly intoxicated; the tongue trembles, and the voice changes. Apoplectic 
attacks are often the commencement of the disease. 

In its furthei progress the patient shows peculiar exaggerated ideas of 
his own importance or greatness, he possesses a thousand or a million horses, 
a thousand million dollars, etc., and although now it may be proved to him 
that he is wrong, he immediately forgets all about it, and gradually falls into 
an idiotic silliness from the weakness of memory, which was one of the very 
first symptoms of the disease. He also gradually loses his affection for his 
family, and before his friends may have become aware of his unaccountable- 
ness he may have squandered away the very subsistence of his family. 
Sometimes there are outbursts of anger amounting to blind rage, making 
him dangerous to those around him, and in other cases we meet with depress- 
ing, hypochondriacal, melancholic states of mind, which again may inter- 
change with conditions of excitation. So also is kleptomania of frequent 
occurrence; the patients pocket things without in fact knowing it, or carry 
them away openly, because they believe they are making use of their own 
property. 

The motor changes consist either of disturbances of co-ordination — 
staggering when the eyes are shut; jerking, uncertain gait, difficulty of 
turning round, peculiar trembling, jerking handwriting — when there is gray 
degeneration of the posterior columns — or shuffling, awkward, helpless gait, 
unsteadiness on attempting to turn quickly, but no increased swaying of the 
body when the eyes are shut — when there is granular cell myelitis. More 
or less complete, persistent, unilateral facial paralysis is often noticed, and 
if apoplectic attacks repeat, they leave behind hemiplegia which may dis- 
appear again, while the intelligence degenerates so much more quickly; or 
the attack is often combined with unilateral or general epileptiform spasms, 
ending occasionally in death. Ansethesia, persistent and extreme, is found 
in all cases, when far enough advanced. 

SENILE DEMENTIA. 

"To be perfectly candid, we must confess that there is not a single 
symptom which is so pathognomonic of general paralysis that it may not be 
found also in senile dementia, and excepting the peculiar weakness of mem- 
ory, in alcoholism also; and even the grouping of the sj'mptoms as a whole 
may, in the two latter diseases, be such as to afford an entire analogv with 



42 SENILE DEMENTIA. 

undoubted cases of general paralysis. In senile dementia the course of the 
affection itself often enough furnishes no definite conclusion, while alcoholism 
certainly affords a much more favorable prognosis. ' ' 

' ' Only those cases can with certainty be considered as senile dementia 
in which advanced age, want of motor disturbances, or the presence of very 
marked hemiplegia, and, finally, absence of the extravagant delirium of 
grandeur, are all found associated. The delirium of old age is, as a rule, 
almost invariably of a more childish nature, while it is concerned with the 
most diverse subjects. Besides, epileptiform attacks almost never occur in 
the dementia of age, and the apopletic attacks of these old people are accom- 
panied with serious permanent paralysis, if the}' do not end in death. Finally, 
the course of senile dementia is regular, less broken by remissions and inter- 
missions. Nevertheless, that is an uncertain criterion, and the same may be 
said to a still higher degree of all the other diagnostic points mentioned 
above." (Hitzig. ) 

The anatomical changes in dementia senilis are atrophy of the hemis- 
pheres of the brain and at the same time an atherosis of the arteries. The 
atrophy is most clearly seen in the cerebral convulsions. Microscopically there 
are found changes in the ganglion cells of the cortical portions of the brain. 
Corresponding to these alterations we find thickening of the skull, collec- 
tion of serum in the arachnoideal space and in the ventricles, pachymenin- 
gitis externa and interna, oedema of the pia. 

The course is always chronic, taking years to end the same, which 
usually ensues in consequence of cerebral complications, pneumonia, bladder 
affections, decubitus, colliquative diarrrhoeas. 

Therapeutic Hints. — Of great benefit in the course of this disease, as 
well as'of dementia paralitica, may be the following remedies: 

Amm. card., gloomy and uneasy mood, aggravated by cloudy weather; 
low spirits, with considerable excitement; verj^ forgetful, and headache when 
reflecting; absence of mind, with anxiety; speaks and writes incorrectly; 
women lose all taste for dress and nearly their intelligence; weight and con- 
fusion of the head; vertigo, as from intoxication; great lassitude, and disin- 
clination to all work; most severe muscular contractions, spasms; violent 
rheumatic drawing pains through all the limbs, hands, feet, nape of the 
neck, head, etc. (Lilienthal.) 

Aurum. — We here find hypochondriasis, but not melancholia so much; 
the epilepsy rests upon a very material basis; the exhaustion is a natural 
consequence of premature senility, hence the disgust of life, and we mention 
it only as having many symptoms in common with the prodromal stage, but 
the causes being so often different, it will be only in rare cases of real benefit. 
It maj 7 alleviate, but will not stay the ravages of this disease. 

Bcllad., after excessive fatigues, bad nourishment, loss of sleep, pros- 
trated, enfeebled, imbecile; dilatation of pupils. (Gallavardin.) 

Caustic, great melancholy, looking on the dark side of everything; 
facial neuralgia and facial paralysis; weakness of voice, and other paralytic 



THERAPEUTIC HINTS TO DEMENTIA. 43 

affections. Hypochondriac depression of spirits; peevishness; dull, gloomy; 
pressure on the brain making the head feel obtuse; vertigo; incipient amau- 
rosis; roaring and buzzing in the ears; rheumatic and arthritic affections of 
all kinds; tremulous weakness; epileptic convulsions; prosopalgia; para- 
lytic affections, especially of one side. Tearing, lancinating pains of the 
extremities; muscular twitchings, and excessive weariness in both limbs, 
especially in the morning in bed; attacks of spasms, in the morning in bed, 
sometimes with consciousness, at other times with unconsciousness; peevish, 
irritable mood, fretfulness, indolence; slow succession of thoughts, absence of 
mind with loss of ideas; weakness of memory; vertigo, forward and sideways, 
at night in bed; vertigo, almost like a loss of consciousness, while sitting he 
nearly fell; constrictive pressure in the forehead; tensive headache arising 
from the nape of the neck; indistinct vision, it seems as though a thick cloud 
hovered before the eyes; spasmodic sensation in the lips, etc. (Lilienthal. ) 

Cuprufn — What Zincum is for later stages Cuprum might be for the 
prodroma. According to Schmid, of Vienna, all the cerebral disorders cured 
by Cuprum are of the reflex order, which would limit the applicability of 
Cuprum in dementia paralytica to very rare cases; still, Rademacher's in- 
dication, when there is premature exhaustion of strength in illness, may point 
towards its use in patients of neurotic temperament, especially where heredity 
can be shown. 

Laches. , for persons with a melancholic or choleric temperament, with 
a phlegmatic, spong\ T constitution; with dark eyes and disposition to lowness 
of spirits and indolence; for acute and chronic rheumatism, recurring every 
year; for emaciation and exhaustion; for hemiplegia; for convulsions and 
epilepsy. Among its symptoms we read: Indolent, taciturn, brooding and 
melancholic; he considers himself too feeble to do anything, with aggrava- 
tion of the symptoms every other day; great absence of mind; great weak- 
ness of memory, he forgets entirely what he had been hearing a moment be- 
fore; frequent mistakes in writing; vertigo, with staggering to the left side, 
early in the morning after rising; deep stinging through the whole head 
deep-seated headache; sensitiveness of the eyes to light; dim and weak eyes 
very sensitive to noise; prosopalgia; distortion of mouth and lips; difficulty 
of speech, as if the tongue were too heavy; rheumatic pains extending from 
the back to the limbs; difficulty of falling asleep for weeks; no sleep in spite 
of great lassitude; constant exhausting sleeplessness; aggravation of all com- 
plaints after sleeping; painful wandering of the pains from one part to another; 
awkward, stumbling gait ; hemiplegia; t} T pical recurrence of the aggravations. 
(Lilienthal.) 

Natr. mur., "brain fag from overwork; difficulty in thinking; sad; 
angry at' trifles; called up all the past grievances and loved to dwell upon 
them; headache as though the head would burst, worse in morning 011 awak- 
ing, from thinking and reading; sweating at times; neuralgic pains occasion- 
ally running up back of neck, like stitches; frequent attacks of uncontrol- 
able weeping, during which any attempt at consolation is met by a violent 



44 THERAPEUTIC HINTS TO DEMENTIA. 

outburst of anger; flares up at the merest nothing, followed by weeping; 
forgetful; omits words in writing; tells the same story over and over again. 
Eyes sensitive to light; blur as soon as he attempts to read; eyeballs feel 
stiff when moving them; humming in the ears; speech drawling, with numb- 
ness and stiffness of tongue, especially in the morning; appetite good, often 
ravenous; sometimes cramp in stomach, better from tightening clothes; 
tongue slightly coated white, in morning feels dry and sticky (but is not so), 
and burns, especially at tip; more or less loss of taste; posterial nasal catarrh 
with loss of smell and hawking of clear mucus in the morning; when first 
awaking mouth is dry, burns a little and feels sore; lips dry; very thirsty, 
especially towards night; wants all his food very salt; empty eructations, 
especially after eating; bowels constipated; stools light brown or yellow, 
crumbling, very difficult owing to actual contraction of anus, as well as in- 
activity of rectum, followed by burning and smarting at anus; urine clear, 
light-colored and passed too frequently; any excitement causes immediate 
desire to urinate; bruised, lame pain in small of back, as though he could 
not stand straight, relieved by pressing something hard against it; hands tend 
to go to sleep; unrefreshed and dizzy in the morning; itching and pricking in 
various parts, skin unhealthy; sweats very easily with great relief; skin of 
face has greasy look. Attacks intermittent; painful sensations in various 
localities; better in open air." (F. F. Laird, Hah?ie?nan?iia?i Monthly , April, 
1882.) " Haggard eyes, dull features, just intelligence enough to ask me to 
cure him, in senile dementia; formerly subject to haemorrhoids." " Begin- 
ning general paralysis; unjustifiable antipathy against certain persons, with 
increasing awkwardness . " ( Galla vardin . ) 

Nux vom. exactly suits such cases which owe their origin to sexual 
excesses and immoderate intellectual exertion, and also to persons of middle 
age, especially when they have changed their former busy life for a quiet one. 
Among its symptions we find: Periodical affections of the nervous system; 
tearing, drawing-tensive rheumatic pains, with weakness and feeling of numb- 
ness in the affected parts; hyperesthesia of the nerves of the senses; tonic 
spasms and convulsions; emotional epilepsy; central softening of the spinal 
cord (here also the gray matter); paralysis of the upper and lower extremi- 
ties; periodical headache, gradually increasing, and after reaching its acme, 
gradually decreasing; dulness of mental powers; obscuration of sight; pa- 
ralysis of the tongue, with difficult and indistinct speech, in consequence of 
cerebral apoplexy. The irritable temper of Nux is well known, and even 
for the second stage of the disease we find corresponding symptoms, as awk- 
wardness, he easily stumbles against something; makes mistakes in speaking 
and writing (certainly cerebral functions); compression of the head as from 
nightly revelling; chronic vertigo, with obscuration of sight and buzzing in 
the ears; twitching of the facial muscles; distortion of the mouth to one side, 
etc. (Lilienthal.) 

Phosphor, is the grand remedy for a weak, exhausted brain. Here we 
have to deal with a disease whose whole tendency is to degeneration of the 



DIGEST TO DEMENTIA PARALYTICA. 



45 



nerve-mass, to atrophy of the brain, and we might with certainty expect 
some benefit from a remedy which causes fatty degeneration throughout the 
bod}\ Among its symptoms we find: Great lowness of spirits; great irrita- 
bility; forgetful and dizzy; vertigo; dull, stupefying headache; constrictive 
headache every other day; frequent attacks of sudden blindness in the day- 
time, and sensation as if a gray cover were hanging over the eyes; constant 
buzzing in the ears; pale, sickly complexion; great weariness in the extremi 
ties; sleeplessness and restlessness; heaviness of mind and body; exaggerated 
ideas of his own importance; monomania le grandeur et de la richesse; for- 
gets names and what has happened recently; unconnectedness of ideas when 
writing or talking; lastly silliness; idiocy. 

Silic. Carroll Dunham, in his usual masterly manner (N. A.J. of H. y 
xx, 361), thus describes the action of Silicea on the nervous system: " With 
evidence of exhaustion, furnished by sensation of weakness, paralysis, etc., 
there is an exalted condition of susceptibility to nervous stimuli; the special 
senses are morbidly keen, the brain cannot bear even moderate concussion, 
and the whole surface is unnaturally tender and sensitive; cold aggravates 
and warmth relieves. There is an erethism, conjoined with exhaustion, 
which is not evanescent, but endures for some time." Certainly such a 
remedy promises much in the prodromal stage of our disease, and carefully 
studied and applied in the right case may fulfill this promise and lead to a 
cure . ( Lilienthal . ) 

In addition I may recommend to compare corresponding chapters, pre- 
viously treated of, and also chronic alcoholism. 



Digest to Dementia Paralytica. 



STAGES. 

For prodromal stage: Cuprum, Nux 
vom., Silic. 

For the second stage with symptoms 
like: awkwardness, he easily stumbles 
against something; makes mistakes in 
speaking and writing; compression of 
the head as from nightly revelling; 
chronic vertigo, with obscuration of 
sight and buzzing in the ears; twitching 
of the facial muscles; distortion of the 
mouth to one side: JSfux vom. 

For later stage: Zincum. 

Loss of memory: Arg. nitr. 

Weak memory: Carb. veg., Caustic. 

for what has happened: Graphit., 

Natr. mur., Phosphor., Sulphur. 

for words and names: Baryta, Lycop. , 

Phosphor., Sulphur. 

on awaking: Stannum. 

with debility: Nitr. ac. 

with headache: Kalmia, Moschus. 



Forgets entirely what he had been hear- 
ing a moment before: Laches. 

Forgetfulness : Amm. carb., Capsic, 
Caustic, Mezer., Moschus, Natr. mur., 
Viol. od. 

Forgetfulness, and dizzy: Phosphor. 

Unconnectedness of ideas when writing 
or talking: Phosphor. 

Speaks and writes incorrectly: Amm. 
carb. 

Frequent mistakes in writing: Laches. 

Omits words in writing: Natr. mur. 

Incapable for doing business: Arg. nitr. 

Awkwardness : Natr. mur. 

Great absence of mind: Laches. 

Loses the train of ideas: Amm. carb., 
Caustic. 

Absence of mind, with anxiety: Amm. 
carb. 

Tells the same thing over and over again : 
Natr. mur. 

Calls up all past grievances to dwell upon 
them: Natr. mur. 



46 



DIEGST TO DEMENTIA PARALYTICA. 



Heaviness of mind and body: Phosphor., 
Phosph. ac. 

Slow succession of thoughts: Caustic. 

Obtuseness of intellect with obscuration 
of eyes: Carb. veg. 

Dlllness of mental powers: Xux. vom. 

with prostration: Alum, Anac, 

A u rum.. Digit. 

Difficulty of thinking: Xatr. mur. 

Mental listlessness and nervous affection: 
Xux mosch. 

and physical prostration in the morn- 
ing: Laches., Phosph oi'. 

Nearly loses intelligence: Alum, carb., 
Xatr. mur. ,^ 

Bodily and mental infirmity: Xatr. carb. 

Silliness, idiocy: Phosphor. 

Prostrated, enfeebled, imbecile after ex- 
cessive fatigues, bad nourishment and 
loss of sleep : Bel I ad. 

Idiotic condition before the attacks: 
Caust. 

exaggerated ideas of his own impor- 
tance, monomania le grandeur et de la 
richesse: Phosphor. 

Doxoniania, conceited mania: Platina, 
Cuprum, Hyosc, Laches., Lycop., Stra. 
mon., Veratr., Alum., Arnica, China, 
Conium, Ferrum, Lpec, Paris, Phos- 
phor., Secale. 

Mania de grandeur: Cuprum, Platina, 
Lycop., Laches., Stramon., Veratr. 

Periodical mania: Arg. nitr. 



Weeping" spells, during which any at- 
tempt at consolation is met by a violent 
outburst of anger: Xatr. mur. 

Kleptomania: Sulphur, Pulsat., Arsen., 
Bryon., Kali, Lycop., Xu.v vom., Sepia. 

Extravagance: Amnion., Bel I ad., Caus- 
tic, Chin in., Iodine, Petrol., Phosph. 
ac, Platina, Stramon., Sulphur, Veratr. 

Indisposed to work or walk: Ziiicum. 

Great lassitude and disinclination to 
work: A mm. carb. 

Lassitude with irritability: Ambra,Calc 
carb., Carb. veg., Caustic. 

No ambition, soon tires: Xux vom. 

Loses all interest in work and business: 
4 Irg. nitr. 

Indolence : Caustic 

taciturn and brooding: Laches. 

Sad: Xatr. mur. 



Great lowness of spirits: Phosphor. 
and indolence; with dark eyes: 

Laches. 
with considerable excitement: A mm. 

carb. 
Women lose all taste for dress: Amm. 

carb. 
Melancholy: Arg. nitr., Laches. 
looks on the dark side of everything: 

Caustic. 
with a phlegmatic spongy constitu- 
tion: Laches. 
Gloomy and uneasy mood, aggravated by 

cloudy weather: Amm. carb. 
Hypochondriasis: Aurum. 
Fear, by noise in the street: Caustic. 
Disgust of life: Aurum. 
Great irritability : Xux vom., Phosphor. 

and discontented: Xux vom. 

Peevish, irritable mood, fretfulness: 

Caustic. 
Fretful, discontented, complaining: 

Arsen. 
Angry at trifles: Xatr. mur. 
Flares up at the merest nothing, followed 

by weeping: Xatr. mur. 
Antipathy against certain persons: Xatr. 

mur. 



Vertigo: Arg. nitr. 

Vertigo on walking with shut eyes: Arg. 
nitr. 

on seeing high houses; it makes him 

stagger: Arg. nitr. 

as from intoxication: Amm. carb. 

almost like a loss of consciousness, 

while sitting he nearly fell: Caustic. 

dull, stupefying headache: Phosphor. 

forward and sideways, at night in 

bed: Caustic. 

with staggering to the left side, early 

in the morning after rising: Laches. 

and unre freshed in the morning: 

Xair. mur. 

Congestions to the head: Arg. nitr. 

Headache with diminished intellectual 
power: Phosphor., Nux mosch., Sarsap. 

with ill-humor, and especially in the 

forenoon: Amm. carb., A'reos., Platina, 
Petrol., Stannum (gradual increase and 
gradual decrease), Calc. phosph., Phos- 
phor. 

from reflecting: Amm. carb. 



DIGEST TO DEMENTIA PARALYTICA. 



47 



as though head would burst: Natr. 

mur. 

worse in morning on awaking: Natr. 

mur. 

worse from thinking or reading: 

Natr. mur. 

worse from reflecting: Amm. carb. 

Periodical headache, gradually increas- 
ing, and after reaching its acme gradu- 
ally decreasing: Nux vom., Stannum. 

Deep-seated headache: Laches. 

Pressing pain all over the head, some- 
times only on the left frontal bone, bet- 
ter by external pressure: Arg. nitr. 

Pressure on the brain making the head 
feel obtuse: Caustic. 

Constrictive pressure in the forehead: 
Caustic. 

headache every other day: Phosphor. 

Tensive headache arising from the nape 
of the neck: Caustic. 

Weight and confusion of the head: Amm. 
carb. 

Deep stinging through the whole head: 
Laches. 

Sensation in forehead as if the skin were 
too tight, with anxiousness: Phosphor. 

The brain cannot bear even moderate 
concussion: Si lie. 



Eyeballs feel stiff when moving them: 

Natr. mur. 
Dilatation of pupils: Bellad., Calcar., 

Crocus., Hyosc, Nux vom., Opium. 
The special senses are morbidly keen: 

Silic. 
Sensitive to light: Arsen. , Laches., Natr. 

mur. 
Dim and weak eyes: Laches. 
Indistinct vision, it seems as though a 

thick cloud hovered before the eyes: 

Caustic. 
Blurr as soon as he attempts to read: 

Natr. mur. 
Sees objects cloudy, sometimes double: 

Arg. nitr. 
Obscuration of sight: Nux vom. 
Frequent attacks of sudden blindness in 

the daytime, and sensation as if a gray 

cover were hanging over the eyes: 

Phosphor. 



Capsic, Caustic, Petrol., Pulsat. 
Very sensitive to noise: Laches. 

with ill-humor: Bellad., Phosphor. 

Humming' in ears: Natr. mur. 
Roaring and buzzing in ears: Caustic. 



Posterior nasal catarrh with loss of smell: 
Natr. mur. 



Face looks old, and of earthy color: Arg. 

nitr. 

emaciated, colorless: Arg. nitr, 

Haggard eyes and dull features: Natr. 

mur. 
Pale, sickly: Phosphor. 
Greasy look: Natr. mtir. 
Prosopalgia: Caustic, Laches. 
Distortion of the mouth: Bellad., 

Graphit., Laches., Lycop., Nux vom., 

Opium, Phosph. ac, Secale., Stramon. 
Spasmodic sensation in the lips: Caustic 
Lips dry: Natr. mur. 



Oversensitiveness of hearing: Carb. veg. 
Noise unbearable, with anxiety: Aurmn, 



Mouth dry; burning and sore in morn- 
ing: Nat?, mur. 

Tongue feels dry and sticky; but is not 
so: Natr. mur. 

burns at tip: Natr. mur. 

slightly coated white: Natr. mur. 

Loss of taste: Natr. mur. 

Speech drawling, with numbness and 
stiffness of tongue, especially in morn- 
ing: Natr. mur. 

Difficult speech: Bellad., Caustic, 
Laches., Nux vom., Opium, Sulphur, 
Stramon., Verat. 

Paralysis of the tongue, with difficult 
and indistinct speech, in consequence 
of cerebral apoplexy: Nux vom. 

Cannot move the tongue right, with anx- 
iety: Caustic. 

As if tongue were too heavy: Laches. 

Cannot talk: Arg. nitr. 

Hawking of clear mucus in morning: 
Natr. mur. 

Hoarse voice: Arg. nitr. 



Appetite good, often ravenous: Natr. 

mur. 
Craves all food very salt: Nat/ . mur. 
Very thirsty, especially toward night: 

Natr. mur. 
Empty eructations after eating: Natr. 



48 



DIGEST TO DEMENTIA PARALYTICA. 



Cramp in stomach, better from tighten- 
ing clothes: Natr mur. 

Constipation: Natr. mur. 

Stools light brown or yellow, crumbling, 
very difficult owing to actual contrac- 
tion of anus, as well as inactivity of 
rectum, followed by burning and smart- 
ing at anus: Natr. mur. 

Haemorrhoids formerly: Natr. mur. 

Desire to urinate from any excitement: 
Natr. mur. 

Urine clear, light colored and frequent: 
Natr. mur. 



Rheumatic pains extending from the 
back to the limbs: Laches. 

Violent rheumatic drawing pains through 
all the limbs, hands, feet, nape of the 
neck, head, etc.: Amm. card. 

Rheumatic and arthritic affections of all 
kinds: Caustic. 

Acute and chronic rheumatism, recur- 
ring every year: Ladies. 

Tearing, drawing tensive rheumatic 
pains, with weakness and feeling of 
numbness in the affected parts: Nux 
vom. 

Tearing, lancinating pains of the ex- 
tremities: Caustic. 

Painful wandering of the pains from one 
part to another: Laches. 

Great weariness in the extremities: Phos- 
phor. 

Bruised, lame in small of back, as though 
he could not stand straight, better from 
pressing something hard against it: 
Natr. mur. 

Periodical affections of nerves: Nux. 
vom. 

Creeping as of ants in arms and legs: 
Arg. nitr. 

Hands tend to go to sleep: Arg. nit. 

Entire insensibility of the body, except 
against cold air: Arg. nitr. 

The whole surface is naturally tender 
and sensitive: Silic. 

Hyper aesthesia of the nerves of senses: 
Nux vom. 

Neuralgic pains like stitches up back of 
neck: Natr. mur. 

Intercostal neuralgia: Arg. nitr. 

Muscular twitchings and excessive weari- 
ness in both limbs, especially in the 
morning in bed: Caustic. 



Most severe muscular contractions, 
spasms: Amm. card. 

Attacks of spasms, in the morning in 
bed, sometimes with consciousness, at 
other times with unconsciousness: 
Caustic. 

Tonic spasms and convulsions: Nux vom. 

Convulsions with or without conscious- 
ness: Kati card., Lycop., Nux vom., 
Platiua, Plumbum. 

and epilepsy: Laches. 

Epileptic convulsions, paralytic affec- 
tions, especially of one side: Caustic. 

fits as complication: Arsen. , Bet lad. , 

Calcar., Cuprum., Hyos., Lgnat., 
Laches., Mercur., Opium, Nux vom., 
Plumbum, Pulsat., Sulphur. 

Emotional epilepsy: Nux vom. 

Weakness of the whole left side: Arg. 
nitr. 

Beginning general paralysis: Natr. mur. 

Constant trembling of the hands: Arg. 
nitr. 

Trembling of limbs: Arg. nitr. 

Tremulous weakness: Caustic. 

Awkward, stumbling gait: Laches. 

Cannot walk with shut eyes: Arg. nitr. 

Exhaustion, sensation of weakness, pa- 
ralysis, etc., with an exalted condition 
of susceptibility to nervous stimuli: 
Silic. 

Hemiplegia: Laches. 

Paralysis of the upper and lower ex- 
tremities: Nux vom. 

Paralytic affections: Caustic. 



Sleepy in daytime, sleepless at night: 

Arg. nitr. 
Sleep disturbed by restless dreams: Arse?i. 
No sleep in spite of great lassitude: Laches. 
Difficulty of falling asleep for weeks: 

Laches. 
Sleeplessness before midnight: A rsen., 

Kali carb., Pulsat., Verat. 
Constant exhausting sleeplessness: 

Laches. 
Sleeplessness and restlessness: Phosphor. 
Aggravation of all complaints after 

sleeping: Laches. 



Sweating at times: Natr. mur. 
Sweats easily with great relief: Natr 



CHECKED EVOLUTION OF THE PSYCHICAL DEVELOPMENT. 



49 



Itching" and pricking in various parts: 
Natr. mur. 

Skin unhealthy: Natr. mur. 

Tired: Arg. nitr. 

Lassitude in the limbs, with indisposition 
to work: Amm. carb. 

He considers himself too feeble to do any- 
thing, with aggravation of the symp- 
toms every other day. Laches. 

Emaciation: Arg. nitr., Laches. 

AMELIORATION, AGGRAVATION 
AND CAUSES. 

Wants fresh air, windows open, yet to be 

covered: Arg. nitr. 
Feels worse in open air: Natr. mur. 
Cold aggravates and warmth relieves: 

Silic. 



Intermittent attacks: Natr. mur. 

Typical recurrence of the aggravations: 
Laches. 

Brain-fag" from overwork: Natr. mur. 

From immoderate intellectual exertion: 
Nux vom. 

Persons of middle age, especially when 
they have changed their former busy 
life for a quiet one: Nux vom. 

After excessive fatigues, bad nourish- 
ment, loss of sleep : Bet lad. 

Exhaustion: Laches. 

Premature exhaustion of strength in ill- 
ness: Cuprum. 

Exhaustion is a natural consequence of 
premature senility: Aurum. 

From sexual excesses: Nux vom. 



CHECKED EVOLUTION OF THE PSYCHICAL DEVELOP- 
MENT. 

During the whole period of development any detrimental influence 
which checks the natural growth of the brain, or single parts of it, does last- 
ing injury to the working of the psychical organ, and may produce 

Intellectual Idiocy. 

The causes for such insufficiencies may lie in the germ cells of the new 
product, when the parents, one or the other or both, are burdened with epi- 
leptic tendencies or cerebral maladies; also by continued intermarrriages 
between consanguineously related persons, or by drunkards, or even by 
cohabitation when drunk. 

During pregnancy the foetus may be checked in its natural brain-growth 
by inanition and high degrees of anaemia, or deep emotions and mental 
troubles of the mother, or violent concussions of the mother by a fall or kick 
upon her abdomen; also syphilis of one or both parents. 

It is not always the case that the child shows signs of idiocy immedi- 
ately after birth; the development of it may be delayed until the third or 
seventh year of age. 

Besides these prenatal causes idiocy may be brought about also by trau- 
matic injuries during birth from instrumental injuries of the head, or a fall 
upon the head from the mother during a precipitated birth. 

Most cases, however, are contracted in early age by a great number of 
various noxious and pernicious influences, such as falls upon the head, 
miasma in the surroundings, uncleanliness, insufficient and unsuitable nour- 
ishment, acute exanthematous diseases with cerebral complications, etc., 
which may make the brain unfit for sound psychical actions. 

Cretinism is the consequence of certain telluric influences which are not 
4 



50 CRETINISMUS. 

yet fully known. The disease is endemic, and found especially in Europe in 
the Alps, in Asia in the Himilayas, and in America in the Cordilleries. 

As cretinism can be propagated by inheritance, it proves that it must be 
already an infection of the germ-cells, and the inhabitants of such infected 
regions show by a less degree of psychical as well as corporeal strength and 
endurance and a shorter duration of life that the entire population of such 
districts is more or less affected by this detrimental telluric influence. 

The check of growth may anatomically be characterized as an abnormal 
smallness of the whole brain, although proportioned in its single parts 
(microcephalus) ; or as a smallness only of certain parts, either of the front 
or posterior lobes, or of one hemisphere, or of the medulla oblongata. 

If there is a deficiency in the development of the convolusions and of the 
centrem semi-ovale, causing a chasm to the ventricle, which fills with serum 
(a so-called porencephaly), the wall bulges out like a bladder on that place. 
This is mostly accompanied with paralysis and contracture of the opposite 
side. 

In some cases there is an actual absence of certain parts of the brain, 
such as the cerebellum, the pineal gland, or the corpus callosum. 

There is also frequently found a chronic hydrocephalus, either inherited 
or acquired, with fontanelles remaining open, and enlargement of the skull 
(makrocephalus) . 

Kncephalitic processes, especially with consecutive sclerosis of the brain 
and atrophy of the parts affected, are mostly attended with half-sided paresis, 
contracture, and frequently also with epilepsy. 

The deepest grade of idiocy is characterized by a complete absence of 
mental processes, nothing but the lowest requisites to sustain life, hunger 
and thirst, which to assuade is the only activity of the poor soul; it is 
apathic idiocy, which not even is capable of forming sensory psychic modifi- 
cations and to select the proper food, as any animal is able to do by instinct. 
He puts everything of which he can get hold of into his mouth, and is as 
helpless as a new-born child. 

Idiocy in a milder degree is 

Weak-mindedness. 

The primitive forces are not produced in a normal strength, conse- 
quently the formation of psychical modifications is much less in quantity 
and quality, and correspondingly the associations and reproductions of the 
mental modifications for judgment are much poorer than in normal minds. 
The language of such persons is poor, and wanting naturally in expressions 
for transcendental ideas which they do not possess. 

Some of these persons are singularly gifted by talents to mechanical 
working, music, drawing, and sometimes by remarkable memory for num- 
bers and words. 

These psychical insufficiencies are in many cases attended w T ith somatic 
disturbances, such as spasms of different forms, chorea, epilepsy, con- 



THE SPHERE OF CONATION AND ACTIVITY. 5 1 

tractures, paralysis, impotence, respectively sterility; in lighter grades 
masturbation. 

Trophic anomalies such as a dwarfish growth, a thick, fleshy tongue, 
puffy lips, bad, easily decaying teeth are not unfrequently found. 

The prognosis of idiocy depends entirely upon the various anatomical 
processes which are the cause of it. Where prenatal insufficiencies which 
do not progress any further are the cause, the trouble is usually a stationary 
idiocy-. 

If caused by epilepsy or hydrocephalus the disease goes on progressively 
to the final destruction of all mental activities. 

In general, idiots do not attain old age. Kndemic cretinism shows 
perhaps most favorably amongst this class of cases, although an age of sixty 
years is even here of rare occurrence. In rare cases lasting improvement 
has been observed. 

Therapeutic Hints. 

It is self-evident that a part of the brain which is wanting cannot be 
produced by any mode of treatment, and it is only that the newest develop- 
ment of mechanical ingenuity has imagined to also entice the growth of a 
brain, by opening the skull, entirely forgetting that the small and narrow 
skull is not the cause of the small brain, but that the small brain is the cause 
of the narrow skull-box. 

Medicine in idiocy will often be indicated by the accompanying somatic 
symptoms, but the main help which can be given to these unfortunate beings 
is careful nursing and untiring efforts to educate them and to remove all 
telluric, atmospheric and hygienic conditions unfavorable to a healthy 
growth as far as possible. 

H. THE SPHERE OF CONATION AND ACTIVITY. 

The disturbances of this sphere consist of an exaltation of natural im- 
pulses or emotions, resting upon a base of pleasurable psychical modifications. 
These exaltations are known under the name of mania. 

They cover a wide field of mental life, but as long as they keep in the 
boundary of innocent exaltations of natural desires, inclinations, propensi- 
ties, it is scarcely worth the while to describe them as separate mental dis- 
orders. All hobby-horse riders all cranks, dudes, etc., belong to this class; 
worse are the immoral traits if aggravated to passion and obscuration of 
sound judgment. 

The highest development of mania, however, is that raging, fury-like 
exaltation of psychical processes, where the regulating Ego-perception has 
lost all control in the process of mental excitations, where, like a cyclone, 
the natural and perpetual alternation and resuscitation of mental modifica- 
tions run wild without aim or end in heated explosions. This is the case 
mostly in the terrible form of acute "furious mania." In chronic forms 
there exist occasionally some relaxations in which conscious and rational acts 



52 MANIA. 

are interspersed between the forced movements of excited psycho-motoric 
centres. 

Mania. — Mania is an exaltation of the entire psychical life, characterized 
especially by a heightened activity of the conative sphere. It is the psycho- 
motoric life of the soul which is exalted, showing itself as a stronger will 
and more lively impulse to action. 

The motives for such actions are still clearly conscious perceptions and 
mental modifications corresponding to a normal mental development, only 
more conspicuous in this way, that they show a character of too great a hurry, 
indiscretion, unsuitableness, mischievousness, offensiveness and even im- 
morality, without a sign of real insanity. 

There are, however, actions in the psycho-pathological sphere which do 
not exhibit clear conscious motives, but appear as abrupt, impulsive acts, as 
if they sprang forward from the deep unconscious life of the soul like a con- 
vulsive motion. 

Such impulsive acts, among which we find perverse sexual actions, 
rape, suicide, murder, incendiary, with some forms of melancholic affections 
and maniacal incentives to actions, which cannot be checked in consequence 
of the absence of the rational Ego-consciousness — all these various and 
numerous maniacal utterances of psychical life have given rise to that great 
class of so-called monomanias. 

Besides these many shades of psychical morbid impulses with or with- 
out the presence of clear conscious motives, there is a still higher degree of 
maniacal exaltation, and that is 

EXULTATIO FURIOSA, FRENZY, TOBSUCHT. 

In this affection the psychical processes are in such a degree accelerated 
that the entire psychical life appears convulsed. The normal consciousness 
of the Ego has so lost all power of control that it cannot check or direct the 
process of psychical activity as in normal life, and with this utter confusion 
of impulsiveness there is connected an accelerated process in the becoming 
conscious of mental modifications with a rapidity which does not allow a 
single one time enough to combine with any other to a logical judgment; 
the entire psychical fabric seems convulsed. The apperception is during this 
giddy chase of mental modifications imperfect and illusive. Hallucinations 
may occur in any of the senses, and delusive ideas crop out r mostly of an 
expansive nature, e. g., the ideas of being rich, great, etc.; in women when 
attended with sexual excitement or religious feelings, of being the mother of 
God, etc. 

But the most characteristic of this mental disorder is the uncontrollable 
haste and acceleration with which all psychical acts roll off, combined with 
constant muscular activity in which no set of the voluntary muscles is ex- 
cepted. Only during pauses of complete exhaustion this agitation ceases for 
a while. 

It is a forced motion from cerebral irritations which , during the height of 



EXUI/TATIO FURIOSA. 53 

the disease does not show any similarity to rational actions; it is a continued 
urgency from stimulated psycho-motoric centres for all kinds of movements 
induced by pleasurable or painful sensations, but without sufficient conscious- 
ness for a rational control. 

During an attack of exultatio furiosa there is frequently a great excite- 
ment of the sexual instinct which, when occurring in the male, has been 
named "Satyriasis," when in the female " Nymphomania." 

Somatic Symptoms. — The inability to sleep, sometimes for weeks with 
frequent congestions to the brain, is of frequent occurrence. 

The pulse is not materially hastened, but in violent cases even slower 
and smaller than normal. 

The bodily warmth is normal, sometimes even below the normal point, 
because the greater amount of heat caused by the greater amount of muscular 
movements is spent again by a greater loss of heat from insufficient covering 
of the body. If there should be a rising of normal heat without a sufficient 
other bodily cause for it, it is likely that the cause is not mania but the con- 
sequence of some other organic brain lesion. 

During an attack of furious mania the patient usually appears at the com- 
mencement younger and fresher; soon, however, digestion and assimilation 
fail and the patient loses in flesh and strength. Frequently the urine be- 
comes saturated with phosphates and at times salivation sets in with exacer- 
bation of the disease. 

During the remissions of the attacks the patient occasionally complains 
of headache. Insensibility against external cold temperature is a peculiar 
symptom which probably has its origin in central lesions. 

Sensorial hyperaethesia is occasionally present and partial cramps, jacti- 
tation of muscles and grimaces of the face occur at times. 

Frenzy, if not an independent form of mental disorder, is occasionally 
attending dementia paralytica and different brain diseases, hysteria and other 
forms of insanity. 

Mania exists either in an acute or chronic form. 

The acute form sets in suddenly as a maniacal exaltation which soon 
mounts up to frenzy. The more acute the attack the greater is the disturb- 
ance of consciousness. Its acute outbreak is often characterized by irascibil- 
ity or irritability when its duration is usually short, but liable to aggravations 
with angry explosions and remissions of exhaustion and irritableness. 

The chronic form lasts longer, for months and over a year; has usually 
as a forerunner melancholia of varying duration. Its turn into frenzy is 
usually sudden, sometimes, however, the melancholy and frantic spells fight, 
so to say, for supremacy, when after a shorter or longer duration the melan- 
cholic exaltation reaches the degree of Tobsucht with its flight of mental 
modifications, expansive ideas, unceasing, uncontrollable movements of all 
the voluntary muscles, increasing disturbance of consciousness, deliria and 
hallucinations. Its course is remitting, alternating with spells of milder 
maniacal exaltations, with occasional angry explosions; also with regular 



54 MANIA PERIODICA. 

interpositions of melancholia, and then again with nearly normal states of the 
mind, on account of which this form of maniacal excitement has been termed 
mania periodica, and by some French physicians folie circulaire. The dura- 
tion of these alternating attacks is very variable, it may be short or long; 
but the cycle returns and returns, so that the prognosis of periodical mania 
is very unfavorable. The termination of mania in general is either gradual 
recovery, or a gradual sinking into lasting imbecility, or idiocy, or death by 
exhaustion or intercurring diseases, such as fat-emboly of the lung vessels or 
brain lesions. 

Therapeutic Hints. 

No matter how kindly we may feel towards the unfortunate, and how 
much we may dislike the idea of separation and putting the patient into 
an asylum, the nature of the disease imperatively demands his removal to 
such an institution, because there alone he can find the necessary protection 
against the outer world and against himself. Most families are not capable 
of taking care of such unfortunates who have become uncontrolable. 

Yet here we meet with a great desideratum which only by the indomit- 
able energy of our successors will at last be called into fulfillment — the 
foundation of homoeopathic asylums for the insane. Although we have a 
few of them already, they are by far not sufficient for the need. We must 
have many more. The existing allopathic institutions do not come up to 
the standard where experiment and experience in the treatment of such dis- 
eases has placed Homoeopathy. 

Although palliative Allopathy has abandoned the former cruelties of 
treating the insane with ropes, jackets, revolving tables and the like obsolete 
cruel machinery, and although it is a fact that the violence of frenzy has 
decidedly decreased since the ' ' no restraint ' ' method has more and more 
been employed, yet it is equally a fact that the old custom of forcing methods 
is still lingering in the minds of a new set of scientifics in a disguised form. 
Instead of tying with ropes and holding quiet by the jacket, they use injec- 
tions of Morphium ; instead of frightening by the revolving table, they 
nauseate by continued doses of Tartarus emeticus ; instead of reducing the 
excitement of the nerves and circulatory system by repeated blood-letting, 
they induce torpidity and physical inertness by large doses of Bromide of 
potassium. 

We might well ask here what is preferable: The old cruel treatment ot 
applying brutal force, or that sly, insidious demolishment of vital structure 
and force ? 

If the former shows unblushingly the naked beast, is not the latter, so 
to speak, a disguised fiend in the attire of a good Samaritan? Who has not 
seen the agonizing consequences of such palliation, making recovery in most 
cases impossible ? 

We need institutions from which all this open and sly inhumane treat- 
ment is absolutely banished, and I hope that in the second century of 



THERAPEUTIC HINTS TO MANIA. 55 

Homoeopathy we will be blessed with abundant means to demonstrate con- 
clusively to those then living the grand blessing which Homoeopathy has 
bestowed upon the unfortunate insane. 

The following homoeopathic therapeutic hints include only a few of the 
main remedies frequently indicated in the different forms of mania, and I 
refer again for further particulars to Jahr's excellent work on mental diseases: 

Aeon. Furious, stubborn, quarrelsome; bold, lively; running away; 
fitful mood, now full of mirth, soon followed by weeping and great mental 
anxiety. 

Agaricus. Fur} 7 , as if intoxicated; daring, revengeful, threatening 
against others and himself; fancies, extases, prophesying, versification. 

A?iacard. Wrathful, violent in quarrel; cruel, wicked, cursing, swear- 
ing; laughing at serious, serious on ridiculous matters. 

Bell. All senses very acute; irritable, with howling, sobbing; quarrel- 
some, insulting others; cursing, with staring looks; raving, with barking, 
growling, grinding of teeth, convulsions, burning heat; violent, cunning; 
inclined to bite, to spit, to strike, tear everything to pieces, to get hold of 
others by the hair; singing, whistling, silly mad laughing; loquacious, las- 
civious; visions of all kinds of beautiful and terrible images. Aggravation 
by kind words. 

Camphora. Senseless talking and acting, fury with foaming at the 
mouth, frenzy; fits like epilepsy. After having used many days. 

Canth. Paroxysmus with convulsions, and recurrence of fits by touch- 
ing the throat and at sight of water, as in hydrophobia; loss of reason, illu- 
sions of feeling and hearing; satyriasis. Coldness of body. 

Hyosc. Feels well and strong; nothing the matter with him; loquacity; 
senseless laughter, quarrelsome; jealousy; would like to murder those who 
approach him, with open eyes and wild look; strips himself naked, runs 
away; stumbles against everything, with open eyes; lascivious, sings amor- 
ous and obscene songs; furious shouts, ungovernable fury, for days and 
nights; shameless, violent, jealous with rage; sees persons who are not 
present. 

Laches. Loquacious, constantly jumping from subject to subject; sings, 
whistles, makes odd motions; proud and jealous, suspicious; cannot bear 
pressure of neck-cloths; all worse after sleep; after mental emotions, or 
abuse of alcohol, at climaxis. 

Nux vom. Blames and reproaches others, jealous abuse, shouting, 
bursts of passion; looks maliciously, quarrelsome; full of malice and 
mischief. 

Opium. Exaltation of mind; thinks she is not at home; imbecility of 
will as though annihilated; nervous and irritable; from excessive joy, or 
fright, anger or shame, violent emotions, like a blow upon the entire mental 
frame; frightful visions; alternate fury and dread. 

Platina. Everything seems strange and horrible; thinks all persons 
are demons; everything around her is very small and even'bod}^ inferior in 



56 THE SPHKRE OF FEELINGS OR EMOTIONS. 

mind and body; over-estimation of self; haughtiness, voluptuousness and 
cruelty; great pride; fault-finding; unchaste talk; physical symptoms disap- 
pear and mental symptoms set in, and vice versa; mental disturbance after 
fright, grief and vexation. 

Stramonium. Terrifying hallucinations; sees ghosts, hears voices back 
of his ears; sees strangers, or imagines animals jumping sideways out of 
ground, or running at him; thinks herself tall, double, lying crosswise, one 
half of body cut off, etc.; prays, sermonizes; ecstatic; wants light and com- 
pany, cannot bear to be alone; runs about; rage; proud, haughty or merry. 

Veratr. alb. Thinks himself distinguished, squanders his money; rage 
with desire to cut and tear, especially clothes; with lewdness and lascivious 
talk; praying, religious talk; longevity; disposed to talk about faults of 
others; irritated, scolding, calling names; impudent; cursing; despair of 
salvation, with suppressed catamenia; consequences of injured pride or 
honor. 

Veratr. vir. Excessive physical unrest; depressed, but comparatively 
careless of the future; cerebral congestion, purplish redness of face, or if 
cold it has a pale bluish cast; muscles relaxed and restless, nausea, retching 
and vomiting. 



m. THE SPHERE OF FEELINGS OR EMOTIONS. 

The disturbances of this sphere are characterized by excessive depres- 
sion. Instead of pleasurable elation as in mania, we meet here with unpleas- 
ant feelings of all descriptions, which in fully developed cases may be 
associated with difficulty or even impossibile intellectual activity, and all this 
without sufficient apparent causes. This mental state is known under the 
name of "Melancholia," and may have a great variety of origin and charac- 
ter. In consequence of the weakened state of psychic life any little irritation 
may act like an over-excitation, and cause wild, extravagant, angry spells, 
even insane hallucinations as interspersed manifestations, and thus frequently 
all three spheres of mental activities may be greatly disturbed and disordered. 

Melancholia. 

Such excessive mental depression may be caused in consequence of 
somatic disturbances from material influences, or from suppressions of bodily 
evolutions in consequence of psychical influences; the most frequent causes 
are unhappy love, disappointed ambition, fear of disgrace, sudden impoverish- 
ment, fright, nostalgia, debauchery , and excess in sexual indulgences; also 
climaxis, haemorrhages, etc. The characteristic depressed states of the mind 
amount often to attacks of desperation and despondency; it is often such an 
unbearable state of psychical pain and discomfort which is caused by mixt- 
ures of psychical anaesthesia, hyperesthesia, want of thinking power, forced 
and fixed ideas and complicating bodily bad feelings, precordial anxiety, 
frightful sensorial delusions and delusive ideas, that suicidal or even mur- 



MELANCHOLIA. 57 

derotis tendencies against the surrounding people seem almost natural prod- 
ucts. In such aggravated states the patient's agitation is maniacal. How- 
ever, this is not found in all cases. Some of them wind up without any 
delirious excitement; there is only a state of gloominess, irritability and ill- 
temper, which may appear as mere consequence of .a chronic catarrh of the 
stomach or of neurasthenia. 

In other cases there is an aggravated precordial anxiety which is really 
one of the most essential elements in melancholia. In still other cases there 
are delusive ideas and sensory delusions the most prominent features. These 
delusive ideas may be of a religious nature or may assume the character of 
hypochondriasis. 

Still other cases are of a heavier type and are characterized by a dis- 
turbance of consciousness; the patients appear to be entirely absorbed in 
themselves, seemingly disconnected with the outer world, and deprived of 
spontaneous action, appearing almost like idiots. This state of mental dis- 
order is usually the consequence of a vulnerable brain (after typhus, puer- 
perium), or a suddenly appearing cause (shock, fright, etc.). F,ven during 
such helpless stupor the patient may be liable to sudden acts of self-destruc- 
tion or dangerous insults upon others. 

The course of melancholia may be continual, sub-acute, or chronic. In 
all cases there are remissions and exacerbations. The remissions are usually 
in the afternoon and evening; the aggravations are most prominent in the 
early morning hours. The entire sickness may last months, and even years. 

The prognosis in mild cases is favorable; the heavier cases may end in 
mental weakness. 

The therapeutic hints consist, according to Kraft-Ebing: 

i. In perfect bodily rest. 

2. In guarding the patient against hurting himself or others. 

3. In watching closely the patient's strength and his partaking of 
nourishment. 

4. In fighting against insomnia, for which he recommends lukewarm 
baths and Opium, or Sulfonal and Trional, and in anaemic cases spirituous 
liquors, wine and beer. 

Therapeutic Hints. 

Aconite. Fear of approaching death, telling the hour of its occurrence; 
fear of darkness and of being alone; starting, dread of ghosts; great restless- 
ness and irritability; acute cases. 

Act<za racem. (Cimicifuga). Desire to be alone, to wander about from 
place to place; does not answer questions, or is loquacious; declares she will 
go crazy or is going to die; worse from mental emotion, business failure, dis- 
appointed love. 

Alumina. Constant weeping, sobbing, with sighing and moaning; 
dread of losing his reason; fears at the sight of a knife or blood, with 
thoughts of suicide, although he abhors the latter. 



58 THERAPEUTIC HINTS TO MELANCHOLIA. 

Arscn. Terrible anxiety and restlessness; suicidal thoughts; when the 
bodily symptoms correspond: emaciation, no appetite, constant thirst, with 
taking little drink at a time; tongue dry and red; shrivelled skin; haggard, 
evidently a great sufferer; debilitated, from overwork, loss of sleep and dis- 
eased condition of mucous membranes. 

Aurum. Suicidal tendency "during climaxis, with dislike of seeing 
men," " patients in tolerable health, but having experienced some unfortu- 
nate disaster of the affections, or have had trouble with friends; they fancy 
they have been slighted, persecuted and wronged, and out of disgust for this 
irksome life seek an untimely end by their own hands. ' ' After abuse of 
Mercury. 

Bell. In furious outbreaks during melancholy; headache; sleepiness; 
starting during sleep; wants to sleep and cannot fall asleep. Tenderness of 
abdomen; violent bearing down, worse on sitting bent and walking, better 
on standing and sitting erect. In stupid states of melancholy, with great 
heat of head, dilated pupils, congestion of eyes, full pulse, and persistent 
sleeplessness. In this torpor Bell, was required in the first potency, or even 
in the tincture. (Wm. M. Butler, Horn. Asylum for the Insane, at Middle- 
town, N. Y.) 

Calc. carb. Despondent, fear of some impending misery, of losing his 
reason, of being seized by misfortune; weakness of memory, with dulness 
and confusion of mind. Palpitation of heart, especially after eating and 
exertion, scrofulous and leuco-phlegmatic diathesis. 

Digitalis " Dull, lethargic condition; pupils dilated to their widest ex- 
tent, yet all sensibility to light and to touch seems lost; the pulse is full, 
regular, or but slightly intermittent and very slow. Relief speedily follows 
the bursting of the lachrymal fountains." (Dr. Talcott.) 

Cham. "For constant groaning, moaning and muttering, walking 
about all the time, looking down. Disinclined to talk, and angry if any one 
speaks to her; tries to get away from her fiiends if they seek to console her. 
Sleepless at night and uneasy during the day." (Worcester.) 

Hyoscyamus. " Insensibility and loss of consciousness; does not recog- 
nize those about him; great mental excitement, with constant foolish talk- 
ing, laughing and singing, or rage, with attempts to strike and bite; sexual 
excitement, with inclination to remove the clothing and go about naked; 
obscene talking; jealousy; apprehensiveness, fear when alone, with fear of 
being poisoned or bitten by animals. Stupefying headache; red, wild, 
sparkling eyes, with dilated pupils; objects look red or too large; face red or 
pale, twitching of muscles of face. Deep sleep or sleeplessness; dryness of 
mouth, tongue and throat, with difficulty of swallowing; micturition fre- 
quent or scanty, or retention of urine, or involuntary urination; increased 
sexual desire; general muscular twitching and jerking." (Dr. Butler.) 

Ignatia. Passive, and concealed inward grief, sighing and inclination 
to think about unpleasant things. Great aversion to every amusement, 
seeking solitude; great indifference and apatlw toward everything, with fre- 



THERAPEUTIC HINTS TO MELANCHOLIA. 59 

quent weeping and repugnance to work; great changeableness of disposition. 
(Jahr.) 

Lachesis. "Depression, with tendency to look constantly upon the 
dark side; nightly fear of disease, death, robbers; mistrust and suspicion, 
with fear of being poisoned; peevish, irritable and quarrelsome, with dispo- 
sition to find fault with others; great mental activity, with excessive 
loquacity, wandering constantly from one subject to another, or confusion of 
mind; weakness of memory and difficulty in listening to others. Unilateral 
headache, blue vision preceding headache; worse after sleep; dimness of 
vision, with black nickering before eyes." (Butler.) 

Lilium tig?-. Depressed, inclined to weep; thinks is suffering from ter- 
rible inward disease, is becoming insane; suicidal thoughts, profane, hurried 
and unable to perfect anything; sexual excitement; inability to work and 
appl} T the mind steadily. Sleepless or restless sleep. Bearing down in 
uterine region, has to press with the hand to genitals to prevent the contents 
to fall out. (Butler.) 

Natr. mur. " Much crying, continuous weeping; difficulty of think- 
ing; absence of mind; weakness of memory and will-power; dwelling on un- 
pleasant trifles; joyless, indifferent and taciturn. Hasty, shuns labor; much 
excited; afterwards numbness of limbs; hopeless, despairing about the future, 
with dryness of the mouth, irritable mucous membrane, sore tongue, chronic 
constipation; w T eariness in the head; vertigo, as if a cold wind were blowing 
through the head; debility and emaciation." (Worcester.) 

Nux vom. Obstinate, cross, irritable, ugly and quarrelsome; violent 
upon the least contradiction; extraordinary anxiety and restlessness; over- 
sensitive to noise, music, singing, talking, strong odors or light; obstinately 
taciturn, hypochondriacal, inability for mental work. Headache as if one 
had not slept enough, pain above left eye. Sleepiness in the evening; wake- 
fulness in the middle of the night, later, troubled sleep, waking late, and 
feeling worse after it. Ineffectual attempts at stool, constipation. Seden- 
tary habits; long subject to mental strain, and " high livers " suffering from 
chronic weakness of digestive organs. (Worcester.) 

Platina. ' 'Arrogant and proud, every thing and person seem ssmall and 
inferior, etc. ; morose and tired of life with great dread of death, which she 
believes near at hand. Cramp-like, drawing constriction in the head, com- 
mencing slight, increasing until violent and ending slight; numb pain on top 
of head. For hysterical females, afflicted with melancholy, delusions of 
greatness and grandeur with menstrual derangements." (Butler.) 

Pulsat. Always tearful, but easily comforted and as easily back again in 
gloominess. Troubles in business; loss of fortunes in business, etc. For 
women with scanty and delayed menstruation and leucorrhcea. 

Sepia. Sad, depressing, sometimes suicidal, greatly averse to work or 
exercise, and yet hard exercise often relieves greatly many ailments. Uterine 
lesions, such as prolapsus. 

Stramon. Delusions of men, ghosts, dogs, cats, rabbits, bugs and flies, 



60 DELIRIUM TREMENS. 

Springing up around him; tries to escape; wants light; hallucinations of 
hearing music, dancing with constant incoherent talking, screaming, laugh- 
ing or crying. 

Sulphur. Fears for her salvation; dwelling on religious subjects; con- 
stant heat on top of head; drowsiness during the day and wakefulness at 
night. Faintness in pit of stomach about n a. m. 

Veratr. alb. Sad, despondent, full of grief, and despairs of her salva- 
tion. Mind dull and stupid with obstinate taciturnity, with head bent for- 
ward, answering scarcely an}*; don't eat when fed; skin blue and cold, pulse 
weak and intermitting. Fainting spells with temporary unconsciousness and 
suspension of the heart's action. (Butler.) 

To these forms of mental diseases I shall add two forms of chronic 
poisoning by the much-abused drugs : Alcohol and Morphium. 

The acute form of the abuse of alcoholic drinks long continued is 



DELIRIUM TREMENS. 

' ' As the name implies, its main symptoms are delirium and tremor, as- 
sociated with sleeplessness and sensory delusions. It is always the consequence 
of habitual abuse of spirituous liquors, one debauch alone, even if severe, 
never causes it; it requires an alcoholic poisoning of the brain before it can 
develop, but may also be occasioned by numerous other exciting causes, such 
as: want of accustomed alcoholic stimulation, insufficient nourishment in 
consequence of catarrh of the stomach, violent mental emotions, serious ill- 
ness, especially pneumonias, profuse diarrhoea, suppuration, loss of blood, 
night walking, painful diseases and injuries, especially fractures." 

Its onset is never sudden, but is preceded by gastric complaints, sleep- 
lessness with frightful hallucinations, or restless dozing with anxious dreams, 
starting from sleep, increasing irritability and disturbance of the thinking pro- 
cess, inability to collect the thoughts, confusion and delirium, which finally 
ends in hallucinations of the most noxious kinds. At the same time the 
motor disturbances show themselves in tremor of the entire bod}* and at times, 
in consequence of reflex actions, a throwing about of the whole body in bed, 
and twitching of the extremities, amounting sometimes to convulsions. Pulse 
and respiration are usually accelerated; perspiration is profuse, urine scanty, 
saturated with earthy salts, in some cases with albumen; stool constipated. 

These febrile states during an attack of delirium tremens are mostly the 
consequences of disturbances in the vegetative organs, which complicate the 
disease, and which may cause even a fatal termination from exhaustion or 
by complication with cerebral oedema and convulsions, or by pneumonia; it 
also may end in chronic mental disturbances, such as insanity, protracted 
stupor, mania and melancholy. 

According to Kraft-Ebing the fatal cases amount to about fifteen per 
cent. 



therapeutic hints to delirium tremens. 6 1 

Therapeutic Hints. 

If the attack sets in during debauch it may be well to apply the stomach 
pump, in order to ease the stomach of its alcoholic contents. It is beneficial 
also to urge the patient to drink cold water or skimmed milk as much and 
as often as possible, in order to thin the alcoholic poison. Sometimes it is 
found beneficial to stimulate the exhausted stomach with strongly peppered 
broth of mutton or beef. One or the other of the following remedies will 
then act so much the more favorably: 

Act. rac. Restlessness and fear of death. Hale: "Nausea, retching, 
dilated pupils, tremor of limbs, incessant talking and changing from one 
suject to another; sleeplessness; imagines to see strange objects, as rats, 
sheep, etc.; quick, full pulse, and peculiar wild look out of the eyes." 

Agar. No clinical confirmation as yet, but its symptoms call loudly for 
its mention in this place. 

Arsen. Great restlessness, anxiety and oppression with cold perspira- 
tion; halucination, especially at night; pale or yellowish color of face; eyelids 
with red edges; no appetite, great thirst, vomiting every morning; region of 
liver painful and swollen, stool retarded and as if burned, or violent diarrhoea. 
For sots who have had attacks before. 

Bellad. Young persons with congestion to the head and excitability 
of the sensorium; want of memory; sparks like lightning before the eyes; 
anxious and unsteady, walks about as if busy and cannot be persuaded to 
desist of doing different things; imagines he sees water running over the 
table, or panes of glass, cats, etc. ; wants to extract a tooth and reaches for 
that purpose in his mouth; stammering, indistinct speech with a constantly 
smiling face; dry feeling in the throat, with difficult deglutition and violent 
thirst. Jerking of limbs; cramps in the calf of the leg; trembling of hands. 

Calc. carb. Hallucinations of fire, murder, rats, mice, etc.; red face, 
dilated pupils; hallooing, screaming, restless; pulse soft, full and frequent; 
skin moist; tongue coated whitish; constipation. 

Cann. ind. When the illusions both of sight and hearing are charac- 
terized by taking the form of tremendous magnitude, so that a step appears 
to him as an enormous distance, or a small noise as a tremendous sound. 

Coffea. Thinks he is not at home; walks restlessly about; no sign of 
feeling sleepy; quick pulse and trembling hands. 

Crotal. Constant drowsiness, with inability to sleep, after Hyosc. had 
failed. 

Digit. In cases which come on slowly with gradually increasing pain 
in pit of stomach, continuous nausea, thirst, palpitation of the heart, gastric 
headache, vertigo and paleness of face. 

Gelsem. Produced sleep, after Morphia had failed. 

Gratiola. Successful in cases where the delirium assumes the character 
of anger rather than of anxiety, in subjects not yet greatly exhausted. 

Hyosc. Epileptiform fit precedes the attack; continuous talking at night; 



62 CHRONIC ALCOHOLISM. 

wants to run away for fear of being persecuted by the police; tremor of 
limbs. 

Ignat. Chorea-like and epileptiform convulsions; paresis; anaesthesia 
combined often with hyperesthesia of the legs; subsultus tendinum; jerking 
of the limbs; trembling of the tongue. 

Kali brom. In first stage with horrid illusions, flushed face, red eyes 
and hard and quick pulse. (Crude doses.) 

Nux vom. Most frequently applied. Indescribable anxiety; finds no 
rest in an}' place; sees different images; congestion to the head; face pale 
and bloated; tongue coated white or brown, dry and thirst} 7 ; nausea and 
bitter vomiting; vomiting in the morning; pressing pain in stomach and 
reoion of liver; trembling, cannot bring the glass to his lips without spilling 
its contents; aversion to coffee; constipation or diarrhoea. 

Opium. Preceded by epileptiform fits; imagine they see frightful ob- 
jects, and are in great fear; believe themselves to be murderers or criminals 
who shall be executed; want to run away. Staring look; twitching of the 
muscles of the face and mouth; lockjaw; tremor. Reduced subjects. 

Stramon. Frightful visions of animals, which appear to jump up at 
his side; imagines one-half of his body being cut off; hallucination of hear- 
in o-, as if on the right side of the occiput a loud voice were abusing and in- 
sulting him; wants to run away; uses wrong words when talking; glisten- 
ing, staring eyes, with enlarged pupils; tremor of all the limbs. 

Tart. emet. After excessive drinking of young persons; gnawing pain 
in the stomach. 

Zincum. Great fear, as if persecuted b} 7 men or the devil, on account 
of crimes which he has never done; is afraid of becoming imprisoned, or 
poisoned, or shot, or buried alive, with great excitation, pappy taste, whitish 
coated tongue, eructations, loss of appetite, retarded stool, vertigo and heat 
in head and face. 

CHRONIC ALCOHOLISM, DIPSOMANIA. 

The habitual abuse of alcoholic drinks causes first a failing in good 
grace, decency and attachment to the family; the drunkard becomes an 
egotist, brutal and cynical, is irritable and irascible, the slightest occasion 
throws him into a furious passion. This excited state alternates frequently, 
especially in the morning, with terrible misery, moroseness, weariness of life, 
which miserable state, however, is soon relieved for a time hy the renewed 
use of stimulants. Herein lies the vicious circle. Momentary relief, succeed- 
ing aggravation of the chronic complaint. This great weakness of fortitude 
and want of will power to do his duty as a father of a family or a citizen is 
an early symptom of the disease. The best intentions remain unfulfilled, 
there is a constant relapse into the old bad habit. 

Dipsomania. This weakness is associated with inability for intellectual 
work, loss of memory, slow flow of thoughts, and dull apperception gradu- 
allv bring the victim into a state of enfeeblement near that of idiocv. 



THERAPEUTIC HINTS TO CHRONIC ALCOHOLISM. 63 

There is also frequently a delusive idea taking possession of the drunk- 
ard, namely the false belief in the unfaithfulness of wife. At the beginning 
of alcoholism the sexual desire is heightened and coitus very often exacted; 
but latei ejaculati tardiva, as the necessary result of over-indulgence, which 
makes sexual intercourse a source of annoyance to the wife. Having lost 
the power of actual reasoning, the degraded man seeks the cause of this in 
his wife, and jealousy, another insane passion, takes hold of him and destroys 
all family ties. 

The cerebral disturbances are the necessary consequence of hyperaemia 
from the abuse of spiritual stimulants and cause headache, dizziness, con- 
fusedness and indisposition to mental work, restless sleep with anxious 
dreams. 

The sensory disturbances are mostly affections of sight and hearing, first 
of a hyperaemic nature as sparks and flames before the eyes and noises in the 
ears, later of an anaemic character with hallucinations of terrible animals, 
spectres, apparitions, ghosts, devils, etc. 

The vegetative organs suffer likewise in the course of time. We soon 
observe an early getting old of the drunkard, his nutrition and circulation 
fail to sustain life's necessities, and in consequence of this there originate 
atherosis of the arteries, paralysis of the blood vessels, fatty degeneration of 
the heart, chronic catarrh of the stomach, degeneration of liver and kidneys. 

The prognosis is a poor one. The drunkard having lost the control of 
his own life, sinks continuously lower and lower, psychically as well as 
physically; he is a wreck which, if not taken care of by others, goes cer- 
tainly down to destruction. 

Therapeutic Hints. 

Confirmed drunkards are no doubt hard cases to manage. Some we 
will not be able to reform, unless we can take them entirely out of their 
wonted associations and submit them to moral treatment and total abstinence; 
others probably may be approached if we succeed in producing in them a 
disgust for whisky, and accustom them to the use of milk as main diet. 
Still others, perhaps all, will be relieved of many of their symptoms by a care- 
ful selection of one or the other of the following remedies : 

Angelica. In fifteen drop doses of the tincture, three times a day, has 
caused disgust for liquor. 

Amm. carb. et canst. In nervous, torpid asthenic cases; in periodical 
hallucinations; in amblyopia. 

Arnica. During the delirium, when he imagines that he will be arrested; 
also when, after the cessation of trembling, formication and subsultus teudi- 
num, there still remains a weakness or sense of being asleep of the whole 
muscular system, slowness of comprehension, ringing in the ears or fog be- 
fore the eyes. Taken in the first dilution, it has also caused a decided dis- 
gust for liquor. 

Arsen. Cachectic paleness; habitual redness of the conjunctiva; sud- 



64 THERAPEUTIC HINTS TO CHRONIC ALCOHOLISM. 

den loss of strength; anxiety in pit of stomach; great restlessness; affections 
of the heart; oppression of the chest, even suffocative spells, especially on 
moving and at night; emphysema of the lungs; dry cough, or difficult, tough 
expectoration. Xausea and vomiting; great thirst; tongue dry and intensely 
red at least on point and edges, or whitish coated; watery diarrhoea, worse 
after midnight. Tobacco chewers. 

Card. veg. Digestive troubles, with burning in stomach; heartburn, 
acidity, belching of rancid taste, all worse after eating; retarded stool, hard 
and insufficient; cachectic paleness of face; chilliness. 

Caustic. " A great smoker and lover of coffee and liquors; morose, un- 
obliging, stingy, making his wife's life miserable." (Gallavardin.) 
China. Lienteric diarrhoea; dropsical affection; exhaustion. 
Ferr. met. Earthy paleness of the face, or bloated face, easily flushing; 
roof of mouth always pale. Vomiting of food undigested; hydraemic condi- 
tions. 

Kali bichr. Especially in complaints of beer- drinkers. 
Kali brom. Headache, with dizziness; staggering as if intoxicated; 
stupefaction; sopor; muscular weakness; anaesthesia of pharynx and velum 
palati and external skin; sight weakened and hearing impaired. Gastralgia; 
vomiting; colic; constipation. 

Kreos. Habitual vomiting of undigested food; of large quantities of 
sour, acrid fluid, or of white, foamy mucus; diarrhoea profuse, colorless, or 
greenish watery, fetid. 

Laches. Worse in the afternoon or after sleep; constant talking and 
jumping from one subject to another; cannot bear anything tight around the 
neck; great weakness; tremor of hands; liver affections. " Wicked, sullen, 
jealous, neglects business and children." (Gallavardin.) 

Natr. mitr. Hypochondriacal melancholy; headache (migraine) ; thin, 
nervous individuals prone to outbursts of passion; craving for liquor; diges- 
tion easily disturbed by slight dietetic or mental causes, with furred tongue, 
or map tongue; great thirst, slow digestion; vomiting of clave}' substances; 
stool hard and retarded; venous congestion of liver, pancreas and uterus; 
fluttering of heart; cutting pain in urethra after urination. 

Nux mosch. Dulness, heaviness and pressure in the head; dizziness 
and sleepiness; heavy sleep, with clairvo}-ance and performance of accus- 
tomed work without any recollection when awaking; mind absent, knows 
not where he is or what to answer; dryness of skin, nose, mouth and throat; 
flatulency; retarded stool, or diarrhoea; liver troubles; strangury after beer; 
dyspnoea; chilliness. Worse from cold and damp air. 

Phosphor. Great mental and physical exhaustion; trembling of the 
limbs when trying to use them; jerking of single muscles; arms powerless, 
legs paralyzed; vertigo, with loss of consciousness; indifference even towards 
the dearest friends; forgetfulness and stupidity in a measure that the patient 
does something else than what he intended; monomania de grandeur et de la 



OPIUM POISONING AND MORPHINISMUS. 65 

richesse; idiocy. Inclined to diarrhoeic stools and flatulency; dry, scaly 
skin. Worse in cool and damp weather. 

Pulsat. Is a better antidote to whisky than even Nux vom. (Hering.) 

Selen. Craving for liquor. When Sulphur seems indicated and does 
not help. 

Sulphur. Very important for many complaints, as its known symptoms 
of the head, stomach, intestinal canal, liver and kidneys abundantly show. 
Drinking on the sly. 

Sulph. ac. Vomiting in the morning; acidity of stomach; burning in 
oesophagus and stomach; sour, acrid or foul eructations. It has been suc- 
cessfully used in subduing the craving for liquor by taking for two or four 
weeks, daily three times, from ten to fifteen drops of Acid. Halleri, which is 
a mixture of one part of sulphuric acid with three parts of alcohol. 

Tart. em. Gastric catarrh with great uneasiness in stomach; nausea 
and vomiting of tough, slimy, fibrous matter; watery diarrhoea in small 
quantities; fulness of pit of stomach and abdomen with pressure as of stones; 
great thirst, loss of appetite, even disgust for any nourishment; tongue moist 
and whitish coated, bad taste and frequent eructations. Bronchial catarrh 
with mucous rattling, tough and difficult expectoration; oppression of the 
chest necessitating the patient to sit up in bed. 

OPIUM POISONING AND MORPHINISMUS. 

The habitual use of Opium has in thousands of cases been brought about 
by the criminal ignorance and recklessness of physicians, who know not what 
they are doing, when they prescribe Laudanum or Morphine for any or every 
little pain, or use it as hypodermic injections. The habit of Opium eating 
has so alarmingly increased that it is necessary to mention here also this arti- 
ficially induced misery of frail human nature. It is not necessary to go into 
the details of Opium symptoms; they can be found in our provings. Its 
chronic effects may be summed up in the following: " General emaciation, 
pale, shrivelled complexion, dry skin, looking like fish-scales, relaxation of 
the muscles, failure of appetite, disturbed digestion; at the commencement 
obstinate constipation, followed later on by dysenteric diarrhoea. Superadded 
are fanciful, discontented temper, giddiness; headache, sleeplessness, all pos- 
sible eccentric neuralgias, failure of memory, understanding, energy and will; 
patients become untrustworthy and are very regardless of truth, especially 
when they are questioned about their habit; also paralysis and diseases of the 
bladder. ' ' All this is gradually produced by the direct influence of Opium 
upon the substance of the nerves, and it is therefore in accordance with the 
nature of Opium action, when post-mortems do not show any particularly 
characteristic anatomical changes. Hyperemia of the brain is most constant; 
sometimes an accumulation of fluid is found in the subarachnoid spaces and 
in the ventricles; sometimes, also, sanguineous effusions of greater or less 
extent in different parts of the brain. The bladder is generally found dis- 
tended. All other anatomical conditions seem accidental and not due to 
Opium poisoning as such. 
5 



66 therapeutic hints to opium poisoning. 

Therapeutic Hints. 

In acute poisonings the stomach-pump is a safer and surer means to 
remove the poison than any of the usual emetics, because the latter often 
fail to produce vomiting on account of the insensibility of the nerves of 
the stomach caused by Opium, and also because the patient escapes 
by its application a possible gastritis, which often follows the admintration 
of Tart. emet. and other irritant substances. By its means the stomach 
can be washed out with green tea, coffee or sage tea, by which a less 
poisonous compound (tannate of morphine) is formed. In order to prevent 
complete narcosis it is well to make the patient walk about for hours, or to 
apply painful stimulation to the skin, the cold douche-bath and the like. 
After sopor has set in the walking about forbids itself; we should, however, 
conduct as much fresh air to the face and head as possible. In this state in- 
jections of a tea of oats have been recommended. Recently Dr. Sell, of New 
York, applied and recommended concentrated tincture of oats (Ave?ia sativa) 
in 12 to 20-drop doses, three or four times a day. " A fulness at the base 
of the brain will indicate that the dose must not be increased and a pain in 
that region suggests that an overdose has been given." 

Bellad. Is no doubt the best antidote against acute poisoning. Even 
the old school acknowledges it and uses hypodermic injection of Atropine. 

Chamom. When after abuse of Morphine to lull pain, sleeplessness 
ensues and the suffering grows intelerable notwithstanding. 

Ipec. Only lately shown as efficient for the cure of the habit of Opium 
eating. Fifteen drops of the tincture were given at a time until improve- 
ment set in. 

Nux vom. Often indicated in cough and diarrhoea after previous use of 
so-called cough and diarrhoea mixtures, all of which most generally contain 
opiates. 



HEAD. 

DISEASES OF THE BRAIN AND ITS MEMBRANES. 



ANEMIA. 



A deficiency in the proper quantity of blood in the brain in general, or 
of arterial blood in particular. Inspection shows the grayish substance to 
be paler, or nearly white; and the white substance still whiter than normal 
on account of the absence of the usual blood-points. The blood-vessels are 
not entirely empty, though they contain comparatively less blood than usual, 
while in most cases an increased quantity of serum' has been found between 
the subarachnoid spaces. 

As Causks, may be mentioned: 

i. All influences which bring on general anaemia: blood-letting, haemor- 
rhages, loss of vital fluids by too long-continued lactation or exhausting 
diarrhoeas, especially summer-complaint; long-continued fevers, hepatization 
of the lungs in weakly persons from the constant wasting away of blood and 
muscles; and starvation, which cuts off all recuperation of the lost vital 
fluid. 

2. Congestion or fluxion of blood to other organs. So may Junod's cup- 
ping-boot, an instrument which has been invented in imitation of the cup- 
ping-glass, to be applied to a whole limb, in order to cause an artificial afflux 
of blood into it, when used incautiously, produce anaemia in the brain, and 
for the same reason do we find persons of weakened activity of the heart 
faint more easily in a standing than in a lying position, because then the 
propelling force is not sufficient to overcome the natural gravity of the blood. 
We may add the effects of "shock," where, according to H. Fischer's theory, 
a reflex paralysis of the vasomotor nerves, especially the splanchnic, causes a 
collection of blood in large quantity in the distended vessels of the abdomi- 
nal cavity; the fainting away sometimes after the sudden expulsion of the 
foetus, where the hitherto compressed abdominal vessels fill quickly after the 
compressing cause is removed; the fainting in consequence of too rapid with- 
drawal of the ascitic fluid for the same reason. 

3. Compression or obstruction of the carotid or vertebral arteries — by 
artificial ligation, tumors or emboli, which prevent the normal afflux of blood 
to the brain. 

4. Spasmodic contractions of these vessels, as is evident in emotions of 
the mind, from which not only paleness of the face, but also swooning and 
unconsciousness may result; nervous apoplexy of some writers? 



68 THERAPEUTIC HINTS TO ANEMIA. 

5. Exudations, extravasations, tumors, depressions of the skull, whereby 
the internal capacity of the skull becoming diminished, the necessary supply 
of blood to the brain is impossible. 

Anaemia, when it consists in a deficiency of arterial blood in the brain, 
is caused by 

6. All those states of the system which prevent the normal oxygenization 
of the blood, such as different heart and lung diseases. It has been shown 
by Kussmaul and Tenner that by sudden suppression of respiration , whereby 
the blood ceases to receive oxygen, the same symptoms are produced which 
a depletion will bring on. 

In accordance with these causes the Symptoms vary. In case of sudden 
depletion we have: sudden paleness of face with cold perspiration on fore- 
head; gaping; slow breathing; ringing in the ears; dimness and flickering 
before the eyes; nausea, even vomiting; fainting away, which may be at- 
tended or followed bj- epileptiform convulsions. 

In the gradual development of anaemia the symptoms differ in individ- 
ual cases more widely; alf, however, are characterized by a great paleness of 
the face. The cerebral disturbances take either the form of depression 
(mental torpor, drowsiness, somnolence, coma), or excitation (restlessness, 
sleeplessness, delirium, a condition mostly observed in cases caused by star- 
vation, and in persons whose general state of anaemia is excessively aggravated 
by exhausting diseases or loss of blood). Vertigo is frequently present and 
headache occasionally. Specks and dimness before the eyes are common, and 
commoner still the ringing and buzzing in the ears; total amaurosis is rare. 
As regards the motor apparatus, we have either great weakness of all the 
muscles amounting to temporary paralysis, or epileptiform convulsions. The 
latter rarely happen in the gradual form, while the first, at least as general 
weakness, is present in almost all cases. 

The anaemia consequent upon summer-complaint was first and well 
described b} T Marshall Hall, who appropriately named it hydro cephaloid, on 
account of the great similarity of its symptoms to those of hydrocephalus 
acutus, and by him was divided into two stages — the irritable and torpid. 

In the first the children are restless; throwing themselves about in bed; 
starting frequently in sleep and giving piercing shrieks; they grate their 
teeth; their face looks red; the pulse is frequent, and the skin hot; and 
spasms even may occur; thus making the whole resemble very much an 
acute attack of hydrocephalus. 

In the .second stage, however, the children collapse, become apathetic; 
do not look at objects held before their eyes; their eyelids are half closed; 
pupils do not react against the light; their respiration becomes irregular; 
pulse very frequent and small; they gradually grow cold all over, first in the 
face; and, in fatal cases, die with symptoms of coma. 

Therapeutic Hints. 
In the first place, where the patient suffers with general anaemia, we 
ought to provide for him a diet which will best supply the lost vital fluids. 



HYPEREMIA. 69 

Especially in summer-complaint, wine and mutton-chops often do more good 
than medicine. Beef-tea, which principally consists of Potassa, combina- 
tions, produces, according to Pfliiger's experiments in small doses, an in- 
crease in the frequenc}^ and force of cardiac contractions; in large doses, it 
acts as a poison, causing death by apparent paralysis of the heart. " Mr. G. 
F. Masterman, in the L,ondon Lancet, called attention to the chemical analy- 
sis of beef- tea, which shows that it is analogous to urine, except that it con- 
tains less urea and uric acid. The analysis also proves that the tea, even 
when most carefully prepared, does not contain, including alkaline salts, 
more than from 1.50 to 2.25 per cent, of solid matter, and that such matter is 
composed mainly of urea, kreatine, kreatinine, isoline, and decomposed 
hsematine, exactly the animal constituents of the urine, except that there is 
but a trace of urea." — Boston Journal of Chemistry. It ought to be used, 
therefore, with great caution. 

In the second place, where the heart's impulse has become weakened, 
we ought to take care that the patient should lie quiet in a horizontal posi- 
tion, not to allow him to leave the bed too soon, or even to rise for the pur- 
pose of using the chamber. 

The special treatment must be dictated by the conditions of each case; 
success is possible only when we take each case asa " unicum," and search 
for its corresponding remedy in the Materia Medica. The symptoms indi- 
cating the remedy may lie entirely outside of the group of those symptoms 
which constitute the diagnosis. 

In general, however, the following remedies may be mentioned as the 
most important in anaemic states after loss of vital fluids: Calc. carb., Card. 
veg., China, Ferrum, Kali card., Mercnr., Nnx vom., Phosphor., Phosph. ac, 
Pulsat., Sepia, Silic, S tap his., Sidphur. 

Dizziness, vertigo, better in a horizontal position, after eating; worse in 
the morning, and in the open air; complaint of old people: Ambra., Bar. 
carb., Graphit, Lycop., Phospor., Silic. 

Delirium in consequence of great loss of blood: Arnica, Arsen., /gnat., 
Laches., Lycop., Phosphor., Phosph. ac, Scilla, Sepia, Sulphur, Veratr. 

Convulsions in consequence of loss of blood: Arsen., Bellad., Calc. carb., 
Cina, Co7iium, Ignat., Lycop., Nux vom., Pulsat., Sulphur, Veratr. 

Summer-complaint will find particular mentioning under the head of 
abdominal disorders. 

HYPEREMIA 

Of the brain is that state in which it is overcharged with blood, either by 
active congestion, rush of blood, or fluxion to the brain, or by stagnation of 
blood in the brain, passive hyperemia, or hyperemia by stasis. 

Post-mortem examination frequently reveals a large quantity of blood in 
the vessels and sinuses, especially of the dependent parts of the cranial cavity. 
This may be a mere post-mortem result, since in other cases nothing of the 
kind is to be seen. The gray substance appears swollen and darker than 



70 HYPEREMIA. 

usual; the white substance presents, in exceptional cases only, a reddish 
hue. The subarachnoidal meshes contain no fluid. 

In chronic cases the blood-vessels are almost always dilated; the sub- 
stance of the brain is atrophied, and the subarachnoid spaces are filled with 
a large quantity of fluid, especially in the bodies of drunkards. 

In some cases, however, post-mortem examination does not reveal any 
such objective signs. On the contrary, the brain appears entirely empty of 
blood, although during life every symptom pointed to hypersemia. This fact 
has not yet been fully explained, and shows that appearances in the dead 
body do not always clearly reveal what has been going on in the living. 

Here the question may be asked: Is hypersemia possible at all? As the 
brain is encased in an unyielding capsule, how can more blood enter than 
there is flowing off ? To answer this question we have to point to the cerebro- 
spinal fluid as a means of regulating the intracranial circulation. This fluid 
easily recedes when the cerebral vessels become distended and enters again 
whenever the pressure subsides, and thus we find it always absent when 
there is a greater afflux of blood, and present in considerable quantity within 
the meshes of the textus cellulosus subarachnoidealis, where there is an 
anaemic state of the brain. Onl} 7 when the brain is atrophied, there is also 
an increase of this fluid besides hyperaemia; and it is wanting again even if 
there be anaemia present, when the room of the skull is filled by tumors or 
effusion in the ventricles. As still other means for the regulation of the 
intracranial circulation recent researches consider: the perivascular lymph- 
spaces, the thyroid gland, the peculiar arrangement of the cerebral sinuses 
and the mechanism of the circle of Willis. 

Congestion takes place — 

i. In consequence of an undue activity of the serous membranes which, 
enveloping the brain, act like a suction-pump within the skull. This seems 
to be the condition of those persons who are subject to " rush of blood to the 
head. ' ' 

2. In consequence of obstructions to the flow of blood to other and different 
portions of the body, whereby it is diverted with increased force towards the 
brain. We see examples of this condition in compression of the aorta ab- 
dominalis by tumors, effusions, or enlarged abdominal viscera; in the con- 
traction of the capillaries of the skin during the chilly stage of intermittent 
fever; and in the suppression of menstrual and haemorrhoidal discharges. 

3. In consequence of dilatation of the capillaries within the brain; gen- 
erally the result of the abuse of Opium and alcoholic drinks and other narcotic 
substances; of the exposure to the rays of the sun; of long-continued irrita- 
tion of the brain by mental overexertion. 

4. In consequence of paralysis of vasomotoric nerves. For example: 
after cutting through the cervical portion of the sympatheticus we find that 
the blood vessels of the corresponding side dilate. So have also certain emo- 
tions similar effects; by them the normal innervation of the walls of the ves- 
sels is altered, they dilate and thus convey a larger mass of blood. This may 



HYPEREMIA. 71 

be the key for the explanation of some sudden deaths which ensue in conse- 
quence of violent mental emotions, fright or joy. 

Stagnation or hyperemia by stasis may be caused — 

1. By compression of the jugular veics from strangulation; by goitre, 
glandular tumors in the neck, or by aneurism of the aorta pressing upon the 
vena cava descendens. 

2. By violent expiratory movements, as take place during violent fits of 
coughing, straining, and the blowing of instruments; to which also belongs 
Dr. Bon will's method of producing a transient state of anaesthesia for the 
purpose of drawing teeth and performing minor surgical operations, by caus- 
ing the patient to make rapid aud deep inspirations. 

3. By diseases of the heart; such as tricuspid insufficiency, stenosis of the 
venous orifice, and insufficiency of its valves. 

4. By some lung diseases, as emphysema, extensive pneumonia, cirrhosis, 
and large pleuritic exudations; also diseases of the larynx, such as croup, 
oedema of the glottis and presence of foreign bodies. 

The Symptoms of fryperaemia are best arranged under two heads, in 
accordance with its two stages: that of excitability and depression. 

To the first belong headache, sensitiveness to light, noise and touch; 
flickering before the eyes; singing and ringing in the ears; pain and formi- 
cation in the flesh; restlessness; jerking and automatic motions of the limbs; 
grating of the teeth; convulsions; dizziness; hallucination; sleeplessness and 
vivid dreams. 

To the second, the stage of depression, belong insensibility to light, 
noise or pressure. In this stage also the limbs go to sleep, lose their mobility, 
and feel heavy as lead; the pupils become dilated; the pulse frequent, and 
the respiration quite slow, irregular or snoring; and there is frequent vom- 
iting. 

These are the general symptoms which vary, however, greatly in indi- 
vidual cases. In some, signs of irritation predominate, such as headache, 
great sensitiveness of the senses, flickering before the eyes and ringing in the 
ears; restless, dreamful sleep; redness of face, injected conjunctiva, quick 
and full pulse. In some persons a cup of coffee or glass of wine brings on 
such a condition. In place of these external signs of hyperaemia there may 
be paleness of the face. In other cases, especially those of children during 
dentition, convulsive motions predominate, from the mere jerking, twitching 
of single muscles to general convulsions with loss of consciousness, vomiting, 
constipation, contraction of pupils, etc. Other cases are characterized by 
headache, sleeplessness, restlessness, a feeling as if they should go crazy, 
delirium, symptoms, mostly brought on by overexertion of the brain. In 
still other cases we find this mental irritation increased to mania and rage 
after exposure of the head to the rays of the sun and the abuse of alcoholic 
drinks, especially in such individuals as use them periodically and then to 
excess. Still other cases are characterized by depression and paralytic symp- 



72 THERAPEUTIC HINTS TO HYPEREMIA. 

toms, which it is often difficult and sometimes impossible to distinguish from 
apoplectic fits. 

Therapeutic Hints. 

Hush of blood to the head indicates : 

Aeon. Dry and hot skin; the patient is very restless and beside him- 
self; cries and complains much; is impatient and full of anxiety. 

Amy I. nitr. Heat, throbbing and feeling of intense fulness in the head; 
protruding, staring eyes, throbbing in the ears; flushing of the face, choking 
feeling in the throat, along the carotids; tumultuous action of the heart. 

Apis. Jerking, crying out in sleep; frightful visions with fear and 
trembling; drowsiness; apathy; \i Bellad. did not help. 

Arnica. Head hot, remaining body cool; after a blow or fall. 

Aurum. Heat and roaring noise in the head, fiery sparks before the 
eyes, worse after mental exertion; fearful and longing for death. 

Bellad. Hot and red face, sparkling eyes, and dilated pupils; throb- 
bing of the carotids; drowsiness with inability to sleep, or drowsy sleep with 
starting; fearful mood; symptoms are aggravated \yy motion, leaning the 
head forward, or lying down; by light or sounds. 

Bryon. The patient feels as though his brain would burst through the 
forehead; nosebleed; puffed, red face; great irritability and fits of anger. 

Calc. carb. The patient is worse in the morning, with puffiness of the 
face; palpitation of the heart after eating; swelling of the pit of the stomach; 
after mental overexertion. 

Chamom. Flickering before the eyes, often followed by headache; 
stopped-up feeling in the ears with humming noise, often when awaking in 
the morning; exceedingly irritable, fits of anger; dizziness. Stagnation in 
the portal system with disposition to piles; disagreeable feeling in the small 
of the back. 

China. The slightest touch of the scalp is unbearable; earthy color of 
the face. Headache worse from moving the eyes or shutting them; better 
when sitting still in an upright position. 

Ferrum. The face is hot and red, with swollen blood-vessels, accompa- 
nied by beating and humming in the head, and great sensitiveness of the 
scalp to touch. 

Gelsem. When, during dentition, children become drowsy, comatose 
and convulsive; or when from the effects of heat there is dizziness, enlarged 
pupils, dimness of sight and a dull, confused headache, spreading from the 
occiput over the whole head. Sleeplessness in delirium tremens. 

Glonoin. Throbbing headache, great restlessness; inclination to run 
away; violent pulsations of the carotids; after exposure to excessive heat or 
cold. 

Hyosc. The patient is unconscious and delirious, with red, sparkling 
eyes, and bluish-red face; or drowsy, jerks in sleep, cries out in sleep, grates 
his teeth; subsultus tendinum. After Bellad. 



THERAPEUTIC HINTS TO HYPEREMIA. 73 

Kali hydr. Weakly constitution; disposition to tuberculosis; hammer- 
ing pain in forehead; anxiety, restlessness, sleeplessness; sensation as though 
the head were larger; even if there is delirium and high fever. 

Nux vom. The patient is worse in the morning, in the open air, after 
the use of coffee, liquors or opium; with constipated bowels and suppression 
of hsemorrhoidal discharges. 

Opium. Stupefaction; snoring and rattling; slow breathing; slow 
pulse; sighing and moaning; bluish-red and bloated face; throbbing of tem- 
poral arteries; cold perspiration in face; falling of lower jaw. 

Phosphor. Heat on the top of the head, dizziness, buzzing and throb- 
bing in the head; swelling under the eyes; and palpitation of the heart from 
mental emotions; emphysema. 

Pulsat. The face looks yellowish, and yet feels hot, with constant chil- 
liness; worse in a warm room; better in the open air; no thirst; scanty or 
suppressed menses. 

Rhus lox. Humming, formication and throbbing in the head; glisten- 
ing redness of the face, and restlessness, which keeps the patient moving 
about. 

Spigel. Palpitation of the heart; violent headache; dizziness and stu- 
pefaction; frightfulness; oppression of the chest. 

Spongia. Pressing, beating in the forehead; redness of face with anx- 
ious features; better in a horizontal position; goitre; heart disease. 

Stramon. Unconscious and senseless; loss of sight and hearing; face 
turgescent; convulsive motions of the head; wild or stupid expression; 
great thirst with hydrophobia; or furibund delirium; greatest restlessness, 
wants to run away; sleeplessness. 

Sulphur. Flying heat in the face; diminished hearing; burning, throb- 
bing and buzzing in the head; better in the room, worse in the open air; in 
hsemorrhoidal complaints; and after the suppression of cutaneous eruptions. 

Ver. vir. Sense of fulness, weight, distention in the head; giddiness, 
intense headache, throbbing arteries, stupefaction, double, partial, luminous 
visions; nausea; vomiting; tingling, numbness in limbs; mental confusion, 
loss of memory, convulsions or paralysis; during dentition; congestion from 
alcoholic stimulants. 

In summing up as to the various causes, the following scheme may be 
of some use, although it must not be considered as exhausting the subject. 

From mental emotions: Aeon., Amyl. nitr., Coffea, /gnat, Opium, Ver. 
■vir. 

From mental overexertions: Aurum, Calc. carb., Nux vom., Phosphor., 
Sulphur. 

From teething : Aeon., Bellad., Calc. carb., Gelsem., Ver. vir. 

From suppression of hemorrhoidal discharges: Aeon., Chamom., Calc. 
carb., Carb. veg., Nux vom., Pulsat., Sulphur. 

From suppressed or scanty menses : Aeon., Apis, Bellad., Bryon., Calc. 



74 VERTIGO 

card., Ca?-b. an., Chamom., Con/urn, Dulcam., Ferritin, Graphit., Laches. , 
Lycop., Merc, sol., Phosphor., Pnlsat., Sepia, Silic, Sulphur, Veratr. 

From hypertrophy of the left heart: Aeon., Auru?n, Cact. grand., Glo- 
?ioi?i., J odium, Kalmia, Spigel., Spo7igia. 

From insufficiency of the tricuspidalis : Bellad., Hyosc, Kali carb. y 
Pulsat. 

During a chill: Aeon., Arnica, Arsen., Bellad., Bryon., Calc. card., 
Cha7uo77i., Digit., Fe7-ru77i, Hyosc., Ipec, Lycop., Mercur., Nitrum, Rhus 
tox., Sabad., Stra?7ion., Sulphur, Veratr. 

From alcoholic drinks: Aeon., Arsen., Calc. carb., Gelsem., Laches., 
Nuxvo77i., Pulsat., Opiiwi., Ver. vir. 

From straining: Aeon., Arnica, Bryon., Rhus tox. 

In chronic cases: Aurmn, Calc. carb., Fcin-iun, Phosphor., Spongia, 
Sulphur. 

VERTIGO. 

This symptom, so conspicuous in anaemia as well as in hypersemia of the 
brain, and in many other quite different affections of the body, has been de- 
fined by F. Niemeyer as " a hallucination, consisting of the vivid conception 
of a motion of the body or of the surrounding objects, which the patient 
imagines to see and to feel, although he himself and his surroundings are in 
perfect rest." This definition is undoubtedly defective. For if vertigo is a 
hallucination, colic and all other subjective symptoms would be. Kafka 
calls it " a sensation of seeming motion which, by full consciousness, is per- 
ceived to take place in oneself or in the surrounding objects, with a feeling of 
loss of balance of the bod} 7 and an uncertainty in standing, walking, sitting 
or lying." He considers it as a peculiar affection of motor-nerves, caused 
either by the brain itself, or the cranial nerves or by some more remote gan- 
glia or organs. This definition, too, wants correction. Let us consider a 
simple instance in which vertigo is produced in even quite health} 7 persons — 
the swift swinging around of the entire bod}* in a circle. If we observe 
closely, we find that vertigo in such a case is experienced not exactly during 
but at the sudden cessation of this motion. Why? Because so long as the 
whole body moves in a certain direction, all its parts move with it, fluids and 
solids, just as you may, by means of a sling, swing water in an open vessel 
in a circle without losing a single drop; but stop its motion suddenly and 
vessel and water will fly to the ground. So when the rotary motion of the 
body is suddenly stopped, the fluid parts of the body and especially the large 
collection of blood in the cranial sinuses must necessarily recoil and assume a 
motion in disharmony with the whole body. It is this commotion of the 
blood in the brain which is immediately felt and designated by the name of 
vertigo. Vertigo, then, we should say, is the sensation of an actual commo- 
tion of the blood within the cranial cavity. This separate, disharmonial mo- 
tion affects the sensient nerves and is perceived by the sensorium , from which 
again, by reflex action, motor nerves are excited, hence the tottering, reeling 



VERTIGO. 75 

or grasping for something, or the falling down, when the undue excitement 
should bring on momentary unconsciousness, or the seeming motion of the 
surrounding objects, etc. Thus we experience vertigo by all such motions of 
the body which are capable of producing a disharmonial motion of the blood 
within the cranial cavity, for instance, concussions of the body, dancing, bend- 
ing forward or backward and rising, looking up or turning around quickly, 
swinging, sailing in vessels, etc. In regard to this latter it is a known fact, 
that one gets seasick more readily on the lakes than on the ocean, because 
here the waves are shorter and more irregular than there, causing a much 
more abrupt shaking of the passenger. When the body of a passenger is 
thus suddenly concussed, the blood in the sinuses cannot follow the sudden 
motions of the solid parts of the body in equal tempo; it is caused to vibrate 
a tempo of its own, and this perturbation or commotion of the blood within 
the vsinuses we feel as vertigo, or seasickness. Seasickness, therefore, does 
not abate until a person exposed to being constantly tossed about, becomes 
so thoroughly accustomed to the motions of the ship, that he unconsciously 
anticipates all the pranks which the unruly waves may play, and harmonizes 
his motions with those of the vessel, preventing in this way any further per- 
turbation of the blood within the cerebral sinuses. 

We have still to consider, however, other cases in which the unwonted 
motion of the blood within the cranial cavity is not so apparent a cause of 
vertigo as in the above mentioned instances. We also see vertigo produced 
under circumstances where such external concussions do not exist, as for in- 
stance by exudations within the brain, by tumors, tubercles, cancer or ather- 
omatous degeneration of the cerebral blood-vessels, eye and ear diseases, by 
great heat, mephitic exhalations, aromatic odors and above all by almost 
every one of the drugs proved, with but few exceptions, for instance, Fluor, 
ac. Does our view hold good even in these cases ? 

In the first place we should say that concussions of the body, swinging, 
sailing, etc., do not produce vertigo in all persons. There must, then, some- 
thing still deeper be considered before we shall be able to fully understand 
the phenomenon of vertigo. And here I must draw attention to the arach- 
noid membrane which envelopes the brain and, like other serous membranes, 
is a shut sac. The fundamental action of this and all other like membranes 
may, according to C. Hering, be likened to that of a suction-pump. When 
excited it draws a greater amount of blood into the cranial cavity than when 
in a state of relaxation. It is thus one of the principal means by which the 
circulation within the brain is regulated. But its influence extends not only 
over the amount of blood in the brain, it at the same time controls more or 
less also the movement of the blood within the sinuses. The more healthful 
its action, the more readily it will regulate this flow and check any undue 
commotion, while during a relaxed state the slightest functional or mechani- 
cal cause may bring on perturbation, and this explains why some persons do 
not feel dizzy from turning, dancing, sailing, etc., when others do. And it 
we further take into consideration that exudation, tumors, tubercles, etc., in 



76 THERAPEUTIC HINTS TO VERTIGO. 

short various kinds of morbid processes within the brain, and also numerous 
drugs when taken during a state of health, must necessarily affect the arach- 
noid, either excite or relax its action, we have sufficient reason to assume 
that in either case the regular flow and circulation of the blood through the 
sinuses must also be more or less disturbed, which would account for the feel- 
ing of vertigo in all such cases. We come thus to the conclusion that vertigo, 
even in those instances where its cause is not so apparent as in cases of ex- 
ternal concussion, etc., is nevertheless the feeling of an undue commotion of 
the blood within the sinuses, which is produced, or which, at least, is not 
checked by the arachnoid in consequence of its own excitation or relaxation. 

Authors have .spoken of hyper semic or congestive, of anaemic, nervous, 
toxic, epileptic, stomachic and psychic vertigo. All these different designa- 
tions have reference to morbid affections with which vertigo is frequently 
associated, or which are the cause of disturbance in the circulation of the 
blood within the brain. 

Vertigo may appear under the most varied conditions: in rest or motion, 
on stooping or rising, or turning the head; during lying, even in sleep; from 
dazzling or streaked light; from the quick motion of objects before the eyes, 
in passing a railing or riding in the cars; by the sight of an unpleasant ob- 
ject — bleeding wound, a surgical operation, etc. ; by looking down from a 
height or looking up to a height, and in many more other ways. It is rarely 
observed in. children, more frequently in adults and oftenest in old age. 

Its Prognosis depends entirely on the nature of those morbid processes 
W T ith which it is connected. 

Therapeutic Hints. 

Aeon. Congestive; heat and pain in head; red face; nosebleed; pulsa- 
tion of carotids. When trying to sit up in bed the patient tumbles over; he 
is afraid to rise lest he might fall again; must take hold of something. Stop- 
page of menstrual flow from cold, fright, fear or vexation; after habitual 
blood-letting. 

Agar. Heaving and whirling of objects around; tendency to fall for- 
ward; partial amaurotic blindness, with floating muscse and vibrating spectra; 
partial numbness of left side of tongue. Hyperesthesia of smell; unusual 
sensitiveness to cold air; hysteria and nervousness brought on by exciting 
debate or by protracted mental application; by overexertion of the eyes; by 
strong light of the sun. 

Anac. Great forgetfulness; dim sight; on stooping and rising from 
stooping, he feels as if he were turning to the left. 

Apis. Headache; heat in head; red face; nosebleed; pulsation of 
carotids. Worse when sitting than when walking; extreme when lying 
down and closing the eyes. 

Arg. ni.tr. Chronic, as if everything were turning around; dyspnoea; 
palpitation of the heart; paralysis of diaphragm; left half of body very 
weak; left arm or hand heavy and numb; trembling weakness brought on 



THERAPEUTIC HINTS TO VERTIGO. 77 

by walking with shut eyes; by walking in streets with high houses, which 
seem to fall upon him. 

Arnica. As if everything were turning around or falling upon him; 
ears feel stopped up when speaking, swallowing or blowing the nose; better 
in lying, disappearing on stooping; after bodily overexertions or injuries. 
" Vertigo on entering an open place, which make his motions uncertain. ' — 
( Jousset. ) 

Ast. rub. Single case by Petroz. Man has fits of vertigo, as if the 
head were suddenly concussed; head always hot, face red, pulse hard, con- 
tracted and frequent; obstinate constipation by good appetite; constant con- 
tractions of the muscles of the lower limbs; gait uncertain, because the 
muscles do not obey the will; restless and sleepless. 

Arse?i, Hyperesthesia of hearing; burning in stomach and vomiting; 
malarial with loss of appetite, vomiting and headache; dilatation of right 
ventricle, emphysema, bronchial catarrh; sleeplessness. During pregnancy, 
with pale, bluish, puffed face, blue lips and nails and undulation of jugular 
veins. 

Aur. mur. Hypertrophy of left ventricle, with great congestion towards 
head and face. 

Bellad. Acute and chronic.; revolving; staggering, reeling, must take 
hold of something; transient unconsciousness, anxiety; shuns people, is 
bashful; head appears double; sees frightful things on shutting the eyes. 
Headache pressing, throbbing; gnawing pain in the bones of the' skull, face 
and teeth; rush of blood to head and. face; sometimes sensation as of icy-cold 
water streaming down from head to face; flickering and dimness before eyes; 
hyperesthesia of eyes; enlarged pupils; buzzing in ears, with dullness of 
hearing; nosebleed; pulsation of carotids; loss of appetite and vomiting; 
stitching pain in chest; slow pulse, weakness and trembling of limbs when 
walking; drowsy in daytime, sleepless at night; hysteria and general nerv- 
ousness; epileptic vertigo. Worse on rising from lying, sitting or stooping; 
in standing; after eating. After typhoid fever; taking cold; violent fright; 
overexertion of the eyes, with muscse volantes; from the smell of flowers, 
gas, etheric oils, tupentine, etc., with stupefaction. Some prefer Atrop. in 
some cases. 

Borax. A feeling as if pushed from right to left and somewhat forward; 
on descending or being moved downward. 

Bovista. In the morning with loss of consciousness and pressing pain 
in head. 

Byron. Like whirling. on sitting up, standing and walking; burning 
in stomach and vomiting; distention, passage of offensive flatus and consti- 
pation; bronchial catarrh; emphysema; dilatation of right ventricle. After 
suppressed haemorrhoids; bodily overexertion. % 

Calc. carb. Stupefying; epileptic; hyperesthesia of eyes; dimness of 
sight; abdominal congestion, distention, flatus, constipation; amenorrhoea, 
which has gradually developed; climaxis, with flushes of heat and sweat- 



TIIKRAPEUTIC HINTS TO VERTIGO. 

hypertrophy of left ventricle, with congestion towards head and face; hypo- 
chondria, hysteria and nervousness; sleeplessness; tuberculous disposition; 
rhachitis; scirrhous tumors. Worse in morning, walking out-doors, espe- 
cially on suddenly turning the head, on stooping and ascending. Brought 
on by mental overexertion; by reading, fine sewing, etc.; by sedentary life, 
high living, excess in venere. 

Calc. jod. Glandular swellings on neck, goitre. 

Card. ueg. Venous stagnation in abdomen, flatus, constipation; from 
sedentary life; mental exertion; high living; spirituous drinks, tea, coffee, 
tobacco, opium. 

Caustic. Attacks at n o'clock a. m., with stitches in top of head, pain 
in back and small of back when rising from a seat; on looking upwards, 
inclination to fall towards left side; on stooping, to fall backward. 

Chamom. Fits of anger; congestion in portal system; distention from 
wind. 

China. Anaemic from loss of blood or vital fluids; hysteria and nerv- 
ousness. 

Coccul. Intoxication, stupefaction; nausea, pressing and throbbing in 
temples; alternate going to sleep of either feet or hands; difficult speech; 
distention of abdomen from wind; constipation; chlorosis. Worse on rising 
and after eating. 

Coffea. Hysteria and nervousness; sleeplessness. 

Conium. Frequent drowsiness; on bending the head forward, heaviness 
in occiput; dimsightedness; nosebleed in spring; venous abdominal hyper- 
emia and amenorrhcea; acrid fluor albus; turbid urine with mucus; climaxis, 
with flushes of heat and sweat; rachitis and swelling of lymphatic glands. 

Cyclam. Dyspepsia; hyperaesthesia of the cutaneous nerves of the 
extremities; hysteria and nervousness. 

Ferritin. Anaemic from loss of blood. 

Gelsem. Intoxication, confusion, headache; dimness of sight; dilatation 
of pupils; general depression of system from heat. 

Glonoin. Congestive; forerunner of apoplexy; intoxication and heavi- 
ness of head, with bending the head forward; reeling, trembling, falling; 
headache; heat in head; redness of face; photophobia; injection of conjunc- 
tiva; flickering before the eyes; buzzing in the ears; pulsation of carotids. 
Worse on sitting up. 

Graphit. Hyperaesthesia of eyes; venous stagnation; constipation; in- 
carceration of flatus. From overexertion of the eyes by reading, sewing, etc. 

Hepar. Hyperaesthesia of smell; decreased peristaltic motion; hard 
feces. 

Hyosc. Stupefaction; depressing mental influences; hypochondriacal; 
from the smell of flowers, gas, etheric oils, etc. 

[gnat. Epileptic; gastric symptoms; gaping; abdominal congestion; 
flatus; tingling as of ants; jerkings; heaviness of right arm ; spinal affection; 
anaemia; sleeplessness; hystery and nervousness. Worse from slightest 



THERAPEUTIC HINTS TO VERTIGO. 79 

motion of head, especially stooping. Brought on by depressing mental influ- 
ences; fear, anxiety, fright. 

/pec. Malarial headache; loss of appetite and vomiting. In pregnancy, 
with pale, bluish, puffed face, blue lips and nails; undulation of jugular 
veins. 

Iodiun. Goitre; hypertrophy of left ventricle, with great congestion 
towards head and face; hysteria and nervousness. 

Kali card. Nausea and vomiting; after eating, with heat in head and 
red face; darkness before the eyes; sometimes one cheek hot, the other cold. 
Must lie down or he falls down. Before falling stitching pain in forehead, 
root of nose and eyes; fatty degeneration of heart. 
Kali brom. Goitre. 

Kali hy dr. Glandular swelling on neck; rhachitis. 

Laches. Epileptic; can't bear anything coming near him; venous 
stagnation; constipation; flatulency; burning in stomach, vomiting and 
diarrhoea. 

Lycop. Head heavy; scathing, roaring and noises in head; fears to lose 
senses; ebullitions from stomach to chest and- head; he gets hot, face reddens, 
eyes water and become dim; constant pain in back and small of back; venous 
stagnation in abdomen ; distention; constipation; incarcerated flatus. Worse 
on stooping; when drinking. 

Mercur. Headache, nausea, loss of appetite; in bed and out of bed; 
can't rise and sit up for fear of falling; must lie down; feels like swimming, 
lying in bed. Receded eruption. 

Merc. coi r r. Syphilitic tumors in the brain. 
Merc. jod. Syphilitic tumors in the brain. 
Mezer. Syphilitic affections of brain. 

Natr. mur. With feeling of fainting; periostitis of skull; dyspepsia; 
abdominal congestion; flatulency; constipation; suppressed hemorrhoidal 
discharge. From sedentary life; depressing mental influences; mental 
exertion; reading, sewing, etc.; high living; spirituous drinks, tea, coffee, 
tobacco, opium. 

Nitr. ac. Climaxis; syphilitic taint. 

Nux vom. Epileptic; malarial; revolving; sudden, like an electric 
shock; before vertigo, drawing headache with heat in forehead, yawning. 
Headache, loss of appetite and vomiting; burning in stomach after eating; 
dyspepsia; abdominal congestion; flatulency; constipation; haemorrhoids; 
hysteria and nervousness; hypochondriacs. Worse after dinner or eating; 
when stooping and rising; sometimes at nights, waking out of sleep. 
Brought on by mental exertion or sedentary habits; high living; alcoholic 
drinks; smoking, coffee, opium; from the smell of flowers, gas, etheric oils, 
etc., attended with nausea; suppressed flow of haemorrhoids. 

Opium. Stupefaction as after intoxication; drowsiness; red, glossy 
eyes; enlarged pupils; dimness of sight; pale face; decreased peristaltic 
motion, difficult defecation. Worse on sitting up in bed. After fright. 



80 THERAPEUTIC HINTS TO VERTIGO. 

Phosphor. Revolving, as if he would fall; malarial; headache; weight 
and throbbing in forehead on waking; rush of blood to the head; hyper- 
esthesia of smell; loss of appetite; nausea, vomiting; burning in stomach; 
abdominal congestion with flatulency; during pregnancy pale, bluish, puffed 
face, blue lips and nails, undulation of jugular veins; hypertrophy of left 
ventricle with congestion to head and face; dilatation of right ventricle; 
fatty degeneration of heart; emphysema; bronchial catarrh; sleeplessness; 
atrophy of brain in old age; scirrhous tumors; periostitis of skull. Worse 
morning and evening; after eating; during sitting. Brought on by over- 
exertion of the eyes, attended with musce volantes; by the smell of flowers, 
gas, etheiial oils, turpentine, attended with fainting; by loss of vital fluids. 

Phosph. ac. Hypochondriacs after excess in venere; climaxis with 
flushes of heat and sw T eat. 

Platina. Overestimation of self. 

Pulsat. Hot head; flickering before eyes; stitch pain in ears and tear- 
ing in head; pale face; painful crawling in stomach; tearing in limbs; shift- 
ing rheumatic pains; scanty, retarded or suppressed menses; sleeplessness; 
chlorosis. Worse when sitting and lying; on getting up from a seat. 
Brought on after anxiet3 T , fear and fright. 

Rhus tox. Tipsy feeling; in aged persons; dilatation of right ventricle; 
emphysema; bronchial catarrh; worse in morning after rising, w T ith uncer- 
tainty in walking, wants to be supported by a cane or another person; better 
from continued motion; worse on getting up from lying, on turning, stooping. 
Brought on by bodily overexertion. 

Ricta. Overexertion of eyes with muscse volantes; bodily overexertion. 

Sambuc. Fatt} r degeneration of heart. 

Sanguin. Vertigo during sleep. 

Sec. corn. Hyperesthesia of cutaneous nerves, especially of the spine. 

Sepia. Dyspepsia; venous hyperemia in abdomen; constipation; flatu- 
lency; gradual developing amenorrhea; hypochondriacs; climaxis with 
flushes of heat and sweat; sleeplessness. Worse when drinking. Brought 
on by mental overexertion; excess in venere. 

Silic. Stupefying; preceded by rush of blood to the head; oppression 
of chest and pit of stomach. Headache; menses too early; too protracted, 
too copious; after menses, fluor albus; venous stagnation in abdomen; con- 
stipation; incarcerated flatus; hypochondriacal; sleeplessness; tuberculous 
disposition; rhachitis; periostitis; scirrhous tumors. Vertigo during sleep. 
Brought on by overexertion of the eyes from reading, sewing, etc., by excess 
in venere. 

Spigcl. Stumbling and falling as if intoxicated; pressing pain in top 
of head, worse from stooping, walking and talking; better when lying; 
hypertrophy of heart; feeling of fainting. 

Spongia. Goitre; hypertrophy of heart. 

Staph is. Hypochondriacal; depressing mental influences. 



DIGEST TO VERTIGO. 



81 



Stramon. Twitching in face; spasm in chest; spasmodic laughing; 
worse at night on lying upon the side. 

Sulphur. Constant feeling of wavering in head and body, as if swing- 
ing and as if the bed were not wide enough to hold him ; feeling of tightness 
in head, as if bound; dimness of sight; venous stagnation, and feeling of ful- 
ness in abdomen, constipation, flatulency; suppressed haemorrhoids; receded 
or suppressed cutaneous eruption; occasional itching after itch; periostitis. 

Tart. emet. Venous stagnation of abdomen with flatulency; during 
pregnancy pale, bluish, puffed face; blue lips and nails, undulations of 
jugular veins. 

Therid. Nausea with vertigo on closing the eyes, worse from noise and 
motion. 

Thuja. Epileptic; hair dry and finger-nails ribbed. 

Ver. alb. Malarial with headache and loss of appetite; overestimation 
of self; hyperesthesia of hearing; burning in stomach; vomiting and diar- 
rhoea; venous stagnation in abdomen with flatulency; during pregnancy 
pale, bluish, puffed face, blue lips and nails, undulation of jugluar veins; 
dilatation of right ventricle; emphysema; bronchial catarrh. Brought on 
by spirituous drinks, tea, coffee, tobacco, opium. 

Zincum. In the occiput, with falling to the left when walking. 

Zingib. With heavy limbs. 

Digest to Vertigo. 



CHARACTER. 

Acute and chronic: Bellad. 

Chronic, as if everything were turning 
around: Arg. nitr. 

, as if everything were turning around 

or falling upon him: Arnica. 

Heaving" and whirling of objects around: 
Agar. 

As if the head were suddenly concussed: 
Ast. rub. 

pushed from right to left and some- 
what forward: Borax. 

Like swinging, lying in bed: Mercnr. 

Wavering in head and body as if swing- 
ing, and as if the bed were not wide 
enough to hold him: Sulphur. 

Like whirling on sitting up, standing 
and walking: Bryon. 

Sudden, like an electric shock: Nux vom. 

Anaemic: China, Ferrum, Ignat. 

Congestive: Aeon., Glonoin. 

Epileptic : Bellad. , Calc. carb. , Ignat. , 
Laches., Nux vom., Thuja. 

Forerunner of apoplexy: Glonoin. 

Malarial: Nux vom., Phosphor., Ver. 
alb. 

6 



Malarial, with loss of appetite, vomiting 

and headache: Arsen. 
, sometime at night, waking out of 

sleep: Nux vom. 
During sleep : Sanguin. , Silic. 
In occiput, with falling to the left when 

walking: Zi?icum. 
Revolving : Bellad. , Nux vom. 

, as if he would fall: Phosphor. 

Staggering, reeling, must take hold of 

something: Aeon., Bellad. 
Reeling, trembling, falling: Glonoin. 
Stumbling and falling, as if intoxicated: 

Spigel. 
Tendency to fall forward: Agar. 
Uncertainty in walking, wants to be 

supported by a cane or another person : 

Rhus tox. 
When trying to sit up in bed, the patient 

tumbles over; he is afraid to rise lest he 

might fall again: Aeon. 
Can't rise and sit up for fear of falling; 

must lie down: Mercur. 
Must lie down, or he tails down: Kali 

carb. 
Stupefying: Calc. carb., Silic. 



82 



DIGEST TO VERTIGO. 



Tipsy feeling* : Rhus tox. 

PRECEDED BY: 

Drawing" headache with heat in the fore- 
head: Nux vom. 
Rush, of blood to the head: Si lie. 

ATTENDED BY : 

Transient unconsciousness : Bellad. 
Loss of consciousness and pressing pain 

in head in the morning: Bovista. 
Feeling of fainting: Natr. tnur.. Spigel. 
Great forgetfulness: Anac, 
Sees frightful things on shutting eyes: 

Bellad. 
Intoxication: Coccul., Gelsem. 
and heaviness of head with bending 

the head forward: Glonoin. 
Confusion: Gelsem. 
Stupefaction : Coccul. , Hyosc. 

as after intoxication: Opium. 

Shuns people, is bashful: Bellad. 

Can't bear anything coming near him: 

Laches. 
Fears to lose senses: Lyeop. 
Anxiety : Bellad. 
Fits of anger: Chamom. 
Overestimation of self: Platina. Ver. alb. 



Headache : Apis, Gelsem., Glonoin, Nux 

vom., Phosphor., Silic. 

, malarial: Ipec. 

, pressing, throbbing: Bellad. 

, nausea, loss of appetite: Mercur. 

Head appears double: Bellad. 
Sometimes sensation as of icy-cold water 

streaming down from head to face: 

Bellad. 
Congestion towards head and face: 

lodum. 
Rush of blood to head and face: Bellad., 

Phosphor. 
Heat in head: Apis, Glonoin. 

and pain in head: Aeon. 

Hothead: Pulsat. 

, and face red: Ast. rub. 

Scathing, roaring and noises in head : 

Lyeop. 
Pressing pain in top of head, worse from 

stooping, walking and talking: Spigel. 
Stitches in top of head, pain in back and 

small of back when rising from a seat: 

( 'a ust 'ie. 
Stitching pain in forehead, root of nose 

and eyes, before falling: Kali card. 



Tearing in head. Pulsat. 

Feeling of tightness in head, as if bound: 

Sulphur. 
Heaviness in occiput, on bending the 

head forward: Conium. 
Head heavy: Lyeop. 
Weight and throbbing in forehead on 

waking: Phosphor. 
Syphilitic tumors in head: Merc. corr. y 

Mere. jod. 

affections of brain: Mezer. 

Atrophy of brain in old age: Phosphor* 



Injection of conjunctiva: Glonoin. 

Dilatation of pupils: Bellad., Gelsem. y 
Opium. 

Red, glossy eyes: Opium. 

Partial amaurotic blindness, with float- 
ing musc£e and vibrating spectra : Agar. 

Hyperesthesia of eyes: Bellad., Gale, 
carb., Graph it. 

Photophobia: Glonoin. 

Dim sight: Anac., Gale, carb., Conium y 
Gelsem., Opium, Sulphur. 

Darkness before the eyes: Kali carb. 

Flickering before the eyes: Glonoin. y 
Pulsat. 

and dimness before eyes: Bellad. 



Ears, stitch pain in: Pulsat. 

, feel stopped up when speaking, 

swallowing or blowing the nose : Arnica* 
— — , buzzing: Glonoin. 

, with dullness of hearing: Bellad. 

Hypersethesia of hearing: Arsen., Ver. 

alb. 



Nosebleed: Aeon., Apis, Bellad, 

in spring: Conium. 

Hyperesthesia of smell: Agar.,Hepar y 

Phosphor. 
Sometimes one cheek hot, the other 

cold: Kali carb. 
Face pale: Opium, Pulsat. 

red: Aeon., Apis, Glonoin. 

Twitching in face : Stramon. 



Partial numbness of left side of tongue: 

Agar. 
Difficult speech: Coccul. 
Goitre: Calc. jod., Lodum., Kali brom.* 

Kali hydro/., Spongia. 
and glandular swellings on neck: 

Calc. jod., Kali hydrojod. 



DIGEST TO VERTIGO. 



83 



Stitching" pain in chest: Bel lad. 
Bronchial catarrh: Arsen., Bryon., Phos- 
phor, Rhus tox., Veratr. 
Oppression of chest and pit of stomach: 

Silic. 
Dyspnoea : Arg. nitr. 
Spasm in chest: Stramon. 
Emphysema: Arsen., Bryon., Phosphor., 

Rh us tox. , I r eratr. 
Tuberculous disposition: Calccarb., Silic. 
Hypertrophy of heart: Spigel., Spongia. 

of left ventricle: Calc. card. 

, with great congestion towards 

head and face: Aur. mur., Iodum, 

Phosphor. 
Dilatation of right ventricle: Arsen., 

Bryon., Phosphor., Rhus tox. 
Fatty dgeneration of heart: Kali card.. 

Phosphor., Sambuc. 
Palp'tation of heart: Arg. nitr. 
Pulsation of carotids: Apis, Bellad,, 

Glonoin. 
Undulation of jugular veins: Arsen., 

Ipec, Phosphor., Tart, emet., Ver. alb. 
Puis 5 hard, contracted and frequent: Ast. 

rub. 
slow: Bellad. 



Gastric symptoms: Ignat. 

Dyspepsia : Cyclam. , Natr. mur. , Nux 
vom., Sepia. 

Loss of appetite: Phosphor. 

with headache: Ver. alb. 

and vomiting: Bellad., Ipec, Nux 

vom. 

Nausea and vomiting: Kali carb., Phos- 
phor. 

Nausea, with pressing and throbbing in 
temples: Coccul. 

Vomiting" and diarrhoea: Ver. alb. 

Burning in the stomach : Phosphor. , Ver. 
alb. 

after eating: Nux vom. 

and vomiting: Arsen., Bryon. 

and diarrhoea: Laches. 

Painful crawling in stomach: Pulsat. 

Ebulitions from stomach to chest and 
head; he gets hot, face reddens, eyes 
water and become dim: Lycop. 

Paralysis of diaphragm: Arg. nitr. 



Congestion in portal system: Chamom. 
Abdominal congestion: Ignat., Natr. 
mur. , Nux vom. 



Calc. 



with flatulency : Phosphor. 

, distention, flatus, constipation: 

carb. 
Venous stagnation: Graphit., Laches., 

Lycop., Sepia., Ver. alb. 
, and feeling of fullness in abdomen: 

Sulphur. 

with flatulency : Tart. emet. 

, flatus, constipation: Carb. veg., Silic. 

and amenorrhoea: Conium. 

Distention: Lycop. 

from wind: Chamom., Coccul. 

, passage of offensive flatus: Bryon. 

Flatulency: Ignat., Natr. mur., Nux 

vom., Sepia, Ver. alb. 
Incarceration of flatus: Graphit. , Lycop. , 

Silic. 

and constipation: Bryon. 

Constipation: Coccul., Graphit., Lycop., 

Natr. mur., Nux vom., Sepia. 

, flatulency: Laches., Sulphur. 

Obstinate constipation by good appetite: 

Ast. rub. 
Decreased peristaltic motion: Hepar. 

and difficult defecation: Opium. 

Hard feces: Hepar. 
Haemorrhoids : Nux vom. 
Turbid urine with mucus: Conium. 



Menses too early, too protracted, too 
copious: Silic. 

scanty, retarded or suppressed: 

Pulsat. 

Amenorrhoea which has gradually de- 
veloped: Calc. carb., Sepia. 

Afler menses, fluor albus: Silic. « 

Acrid fluor albus: Conium. 

Syphilitic taint: Nitr. ac. 

During pregnancy, with pale face, bluish 
puffed face, blue lips and nails and un- 
dulation of jugular veins: Arsen., Ipec, 
Phosphor., Tart, emet., Veratr. 

Climaxis : Nitr. ac 

with flushes of heat and sweat : Calc 

carb., Conium, Laches., Phosph. ac, 
Sepia. 



Spinal affection: Ignat. 

Constant pain in back and small of back: 

Lycop. 
Tearing in limbs: Pulsat. 
Shifting rheumatic pains: Pulsat. 
Alternate going to sleep of either feet or 

hands: Coccul. 



8 4 



DIGEST TO VERTIGO. 



Hyperesthesia of the cutaneous nerves 

of extremities: Cyclam. 
Left half of body very weak: Arg. nitr. 
Weakness and trembling of limbs when 

walking: Bellad. 
Trembling" weakness brought on by 

walking with shut eyes: Arg. nitr. 
Heavy limbs : Zingib. 
Heaviness of right arm: Ignat. 
Left arm or hand heavy and numb: Ai'g. 

nitr. 
Constant contractions of the muscles of 

the lower limbs: Ast. rub. 
Gait uncertain, because the muscles do 

not obey the will: Ast. rub. 
Periostitis: Silic, Sulphur. 

of skull: Natr. mur., Phosphor. 

Gnawing pain in the bones of the skull, 

face and teeth: Bellad. 
Rhachitis : Calc. carb., Kali hydr., Silic. 
and swelling of lymphatic glands: 

Conium. 



Hypochondriasis: Calc. carb., Hyosc, 

Nux zvm., Sepia, Silic, Staphis. 
Hysteria and nervousness: Agar, Bellad. , 

Calc. carb. , China, Coffea, Cyclam, Ignat. , 

Jodum, Nux vom. 
Jerkings: Ignat. 
Spasmodic laughing: Stramon. 
General depression of system from heat: 

Gel son . 
Anaemia: China, Ferrum, Ignat. 
Chlorosis : Coccul. , Pulsat. 
Gaping: Ignat. 
Yawning : Nux vom. 
Drowsiness : Conium, Opium. 
in day time, sleepless at night: Bellad. , 

Sulphur. 
Sleeplissness: Arscu.,Calc. carb., Ignat., 

Phosphor., Pulsat., Sepia, Silic. 
and restless: Ast. rub. 



Hyperesthesia of cutaneous nerves, es- 
pecially of the spine: Sec. corn. 

Unusual sensitiveness to cold air: Agar. 

Tingling as of ants: Ignat. 

Occasional itching after itch: Sulphur. 

Hair dry and finger nails ribbed: Thuja. 

Scirrhous tumors: Calc. carb., Phosphor., 
Silic. 

AGGRAVATED : 

In bed and out of bed: Mercur. 
On closing the eyes: The rid. 



On descending or being moved down 

ward: Borax. 
When drinking: lycop., Sepia. 
After dinner or eating: Bellad., Nux 

vom. 

heat in head, red face: Kali carb. 

On entering an open place which makes 

his motions uncertain: Arnica. 
On rising : Aeon., Kali carb., Mercur. 
On getting V. p from a seat : Pulsat. 
from lying, on turning, stooping: 

Rhus tox. 
On looking upwards, inclination to fall 

towards left side: Caustic. 
When lying down and closing the eyes: 

Apis, Therid. 
At night on lying upon the side : Stramon. 
Morning and evening: Phosphor. 
Attacks at ii o'clock a. m.: Caustic. 
In morning, in walking out-doors: Calc. 

carb. 
From slightest motion of head, especi- 
ally stooping: Ignat. 
From noise and motion: Therid. 
On rising from lying, sitting or stooping: 

Bellad., Pulsat. 

and after eating: Coccul. 

On sitting up in bed: Aeon., Mercut., 

Opium. 
On sitting up : Glonoin. 
Alter rising in morning: Rhus tox. 
When sitting and lying: Pulsat. 

more than when walking: Apis. 

In standing : Bellad. 
On stooping : lycop. 

to fall backward: Caustic. 

and ascending: Calc. carb. 

and rising from stooping, he feels as 

if he were turning to the left: Anac. 
Stooping and rising: Nux vom. 
On suddenly turning head: Calc. carb. 
By walking in streets with high houses, 

which seem to" fall upon him: Arg. nitr. 

AMELIORATED : 

After eating : Phosphor. 
When lying : Spigcl. 

In lying, disappearing on stooping: 

Arnica. 
From continued motion: Rhus tox. 
During sitting : Phosphor. 
CAUSED BY: 
Old age : Rhus tox. 
Habitual blood-letting: Aeon. 



DIGEST TO VERTIGO. 



85 



Loss of blood or vital fluids: China, Fer- 
rutn, Phosphor. 

Depressing mental influences: Hyosc, 

Igual., Natr. mur., Spigel., Staph is. 
Fear, anxiety, fright: Ignat., Pirfsat. 
Fright : Bel lad. , Opium. 
Mental exertion: Card, veg., Calc. carb,, 

Natr. mur., Nux vom., Sepia. 
Exiiting" debate or by protracted mental 

applications: Agar. 
Overexertion of the eyes, attended with 

muscse volantes: Be/lad., Phosphor., 

Ruta. 

strong light of the sun: Agar. 

reading, fine sewing, etc.: Calc. 

card., Graph it., Si lie. 
Bodily overexertion or injuries: Arnica. 
overexertion: Bryon., Rhus tox., 

Ruta. 
Excess in venere: Calc. card., Sepia, Silic. 
Hypochondriacs after excess in venere: 



Receded eruption: Mercur. 

or suppressed eruption: Sulphur. 

Suppressed haemorrhoids: Bryon., Natr. 

mur., Nux vom., Sulphur. 
Stoppage of menstrual flow from cold, 

fright, fear or vexation: Aeon. 
High living: Calc. card., Cai'b. veg., 

Natr. mur., Nux vom. 
Sedentary life: Calc. carb., Card, veg., 

Natr. mur., Nux vom. 
Smell of flowers, gas, etheric oils, etc.: 

Hyosc. 

with stupefaction: Bellad. 

with nausea: Nux vom-. 

with fainting: Phosphor. 

Spirituous drinks, tea, coffee, tobacco, 

opium: Card, veg., Natr. mur., Nux 

vom., Ver. aid. 
Smoking : Nux vom. 
After taking cold: Bellad. 
typhoid fever: Bellad. 



Phosph. ac. 

The following scheme was prepared by Kafka relating to nervous 
vertigo : 
Vertigo in the morning: Calc. carb., Nux vom., Phosphor, Rhus tox., Natr. 

mur. 

in the evening : Bellad., Pulsat., Cyclam., Sepia, Zincum, Laches. 

when lying down : Pulsat., Cyclam., Arsen., Aurum. 

when rising : Nux vom., Rhus tox., Coccul., Laches, Conium. 

when walking : Pulsat., Lycop., Conium, Capsic, Phosphor. 

when stooping : Calc. carb., Bryon., Sepia, Spigel. 

with an empty stomach : Phosphor., Iodum., Calc. carb., China. 

Vertigo after eating: Calc. carb., Nux vom., Natr. mur., Phosphor., Lycop., 

Sepia. 

after sleeping: Phosphor., Sepia, Ntix vom. 

in the fresh air: Nux vom., Silic, Coccul. 

in the room: Silic, Agar., Arsen., Pulsat. 

before the menses: Calc. carb., Pulsat., Sepia, Ver. alb. 

during the menses: Phosphor., Hyosc, Graphit,, Lycop. 

after the menses: Nux vom., Phosphor., G? r aphit. 

Amelioration by motion: Rhus tox., Pulsat., Capsic, Cyclam., Lycop. 

by rest: Nux vom., Natr. mur., Bellad., Colchic 

Revolving vertigo: Phosphor., Nux vom., Bryon., A?mica. 

Stupefying vertigo: Calc carb., Silic, Bellad., Hyosc 

Staggering vertigo: Aeon., Rhus tox., Nux vom., Platina. 

Vertigo with trembling and uneasiness: Phosphor., Calc. carb., Ignat., 

Arsen. 

with fainting: Phosphor., Nux vom., Natr. mur., Arsen., China. 

with vomiting: Nux vom., Ipec, Ver. alb., Arsen., Pulsat. 



86 SLEEP, STUPOR, INSOMNIA. 

Vertigo with inclination of falling forward: Phosph. ac, Graphit, Cicut. vir., 

Spigel. 
with inclination of falling backward: Rhus fox., Nux vom., Bryon., 

China. 
with inclination of falling sideways: Silic, Sulphur, Ipee. 



Seasickness. — Even here we have to study the peculiarities of the single 

case. 

Apo morphia. — Nausea without any apparent signs of gastricism. Dr. 
Skinner gave it with success. 

Borax. Perhaps never given, should be tried on account of its symp- 
toms of aggravation on downward motion. 

Calc. card, may be indicated by its aggravation on upward motion. 

Coccul. is perhaps the oldest remedy recommended in seasickness. 
Nausea with tendency to faint. 

Colchic. Excessive sensitiveness of smell against cooking. 

Nux vom. Headache; gastric symptoms; constipation. 

Opium. Great sleepiness; constipation. 

Sepia. Headache; desire for sour and refreshing things. 

Petrol, has proved beneficial very often. 

Pulsat. Drowsy, thirstless; dizzy, especially on getting up from a seat; 
feels better on deck. 

Some persons are greatly benefited by applying a piece of blotting paper, 
soaked in rum or brandy, upon the pit of the stomach. 

In all cases it will be well to exert the will-power in order to gain com- 
mand over the body against the motions of the vessel and to harmonize its 
motions with that of the ship. 

SLEEP, STUPOR, INSOMNIA. 

The fluids and tissues of the body are constantly undergoing change by 
the ceaseless activity of its various parts as an organized entity. Every 
voluntary or involuntary motion of the muscles, the action of the different 
glands, the working of the entire nervous system is attended with a continu- 
ous retrograde metamorphosis of constituent elements. All this must, at cer- 
tain periods, inevitably result in exhaustion. The consequent' necessity for 
reparation of the lost elements manifests itself in active assimilation of new 
material from what has been prepared by digestion; in other words, the con- 
scious activity of the cerebro-spinal system gives way to the unconscious ac- 
tivity of the sympathetic system — we fall asleep. Sleep, therefore, in its real 
nature, consists in the predominant activity of the sympathetic system over 
that of the cerebro-spinal. For this reason, we find during sleep, as Durham 
in his Physiology of Sleep observes, "a notable increase of blood in the 
stomach and other abdominal viscera," which is drawn there by the increased 
action of the assimilating system; for wherever there is greater activity there 
is a greater afflux of blood. But this heightened action of the assimilating 



SU3EP, STUPOR, INSOMNIA. 87 

system has also another effect; it subdues all other activities. Mentally we 
become unconscious, partly from actual want of exciting elements which have 
been consumed during waking life, and partly from the withdrawal of ex- 
citing elements b} T the increased action of the assimilating organs; we find, 
therefore, physiologicalry corresponding, less blood in the brain, as has been 
demonstrated by Durham, Hammond, and others. Bodily our voluntary 
muscles subside into inactivity, and the amount of work done by the excre- 
tory organs is equally lessened; we find physiologically corresponding respi- 
ration as well as circulation decidedly slower than during waking life. 

All this is the necessary consequence of the increased action of the 
assimilating system. For it is impossible that all our activities could be ex- 
cited at the same time in an equal degree. We see this clearly portrayed in 
the action of our mental life. Even during our waking periods conscious ex- 
citement belongs only to a very small portion of what we mentally possess; 
the bulk of our possessions lies dormant. Consciousness shifts from one men- 
tal modification to another, sometimes swiftly, even tumultuously, or only 
slowly or evenly, but always involving only parts and portions of our entire 
mental acquisitions. The same holds good when we consider man mentally 
and physically as one whole. During the predominant activity of his cere- 
brospinal system, the sympathetic system is in comparative rest, while the 
latter subdues the former, when the primary forces have been consumed and 
a new supply has to be prepared by it action. How great the force is with 
which the assimilating process assumes its ruling, we all have repeatedly ex- 
perienced; the eyelids droop, the sounds grow indistinct and irresistibly we 
fall asleep. The restitution of vital forces must be done, and during that 
process all other activities must partially or totally cease. It is erroneous, 
therefore, to say that "the state of comparative repose which attends upon 
this condition (sleep) allows the balance to be restored " (Hammond), since 
in fact this restitution, or more definitely expressed, the assimilating process 
does not allow the accustomed action of the mind, brain and other organs. 
Unconsciousness, partial or total, is a necessary concomitant of sleep, not its 
essential nature, just as the comparative repose of the voluntary muscle and 
excretory organs is the natural consequence of the heightened activity of the 
assimilating system. As long as either reigns, the other must be silent. And 
as an increased activity always causes an increased circulation, and vice versa, 
it is erroneous to say that the loss of consciousness, total or partial, during 
sleep be due to the lessened circulation of blood within the brain, since in 
fact the comparative inability of the mind (unconsciousness) and the conse- 
quent inactivity of the brain as its condition, is the cause of this lessened cir- 
culation. Being not needed in the brain and all other organs which are 
under the control of the cerebro-spinal system, the circulation slackens here 
and increases where a heightened activity calls for it, i. <?., in the assimilat- 
ing system. 

Playfair thinks that sleep is due to " a diminished supply of oxygen to 
the brain" {Northern Journal of Medicine, No. 1, 1844, p. 34; see Hammond 



SLEEP, STUPOR, INSOMNIA. 

on Sleep, p. 30); and Preyer holds the opinion "that the oxygen during 
sleep is used up in a different manner than in the waking state. During 
exercise of the brain as well as of the muscles, a kind of peculiar material, 
so-called ' material from weariness ' forms, which accumulates in quantities 
corresponding to the intensity of the activity, is very oxidable, and which 
lays hold of the oxygen during sleep, and thus becomes oxidized ' ' ( Wiener 
Freie Press, Sept., 1876; North Am. Journal, Feb., 1877, p. 349). These 
views are just as valuable and correct as the idea of a diminished circulation 
of blood in the brain during sleep. For oxygen is certainly a necessary con- 
stituent to healthy blood and of the consequent activity of any kind. But 
when, according to Pettenkofer's experiments, the system accumulates dur- 
ing sleep much more oxygen than during its waking state, one cannot clearly 
see why an increasing acquisition of oxygen should just induce sleep, which, 
is supposed to be due to a diminished supply of ox3'gen. Here as elsewhere 
again a condition is taken for the cause. The cause lies in the heightened 
action of the assimilating system, which again replenishes what during the 
activity of the cerebro-spinal is needed and consumed. 

It will not do to oppose this truth by reminding of the fact that an arti- 
ficial interruption or suppression of the circulation within the cranium by 
compressing the carotids will cause unconsciousness; for we have never 
stated that healthful circulation of the blood be not required for the func- 
tional activity of the brain, nor that a healthy brain be not a necessary con- 
dition for the legitimate exercise of the mind. A certain amount of healthy 
blood within the brain is a necessary condition for its successful operation, 
but is a condition the cause? Still, if it might be allowed to say that a cer- 
tain amount oi Opium, Chloral, Carbonic oxide, etc., causes stupor (uncon- 
sciousness) , why should we not likewise consider the lessened circulation of 
blood during sleep as the cause of its attending unconsciousness? Because 
thereby we would not at all explain the lessened afflux of blood to the brain, 
and the question would still remain: What lessens the circulation in the 
brain during sleep? And we have stated the cause: it is the reduced activity 
of the brain in consequence of the heightened activity of the assimilating sys- 
tem. Wave-like do these activities interchange, like ebb and flood, and 
where the one is in the ascendency, the other must go down. The necessit}- 
of each regulates their periodicity. In the new-born child the vegetative 
sphere is yet so predominant, that in the first six weeks, if well, the child 
sleeps all the time with but short interruptions. Gradually, however, as its 
mentality widens, sleep becomes shorter, until it is reduced to a certain space 
of time necessary for the assimilation of new forces required for action of the 
cerebro-spinal system. Worriment of mind, great passions, etc., ma}* banish 
sleep for a considerable length of time, that is, may subdue fry its strength 
the activity of the vegetative system, but not without an adequate cost to the 
whole organism, and yet finally even the strongest passion will have to yield 
to the still greater power of recuperating necessity. 

Stupor, coma, or whatever a state of unconsciousness, resembling deep 



THERAPEUTIC HINTS TO SEEEP, STUPOR, INSOMNIA. 89 

sleep, may be called, is no sleep. It is caused by a violent interference with 
the conditions necessary for a normal action of the brain. Such Causes 
are various remedial agents, like Opium, Chloral, Carbonic oxide, Alcohol and 
others, which vitiate the blood; or different blood-poisoning diseases, like 
typhus, scarlatina, uraemia and others; or haemorrhage within the brain 
(apoplexy), which compresses the organ so as to make it unfit for a success- 
ful operation of the mind. Sleep and stupor differ, therefore, in this that 
the first is the natural consequence of the predominating activity of the 
assimilating S3'Stem, while the latter is induced by a direct violence to the 
brain; there health, here disease is represented. 

The approach of sleep is favored by everything which either depresses 
mental life (cuts off the supply of exciting elements, especially fatiguing 
mental toil, and also listless reverie, want of external excitement), or which 
gives increased impetus to the bodily act of assimilation, such as super- 
abundance of food, hot drinks, great bodily exhaustion, loss of blood, etc. 
Excessive cold does not produce sleep, but stupor, like excessive heat. In 
both cases the effect is congestion towards the brain, which renders this 
organ unfit for the successful exercise of mental action. 

If on the contrary by excessive mental strain, as we find it not unfre- 
quently with business men, too eager students, or after great trials, sorrow, 
anxiety, night- watching, etc. — the assimilating process has been unduly 
restricted for a greater length of time — Sleeplessness (Insomnia) is the 
natural result. Mental and consequently cerebral activity so overbalances 
the process of appropriation, that the assimilating system at last becomes 
weakened, and losing its connative force, leaves the work undone which it is 
destined to do. This necessarily must prove destructive to the entire organ- 
ism, and cause bodily an overwrought condition of the brain (relaxed and 
enlarged blood-vessels), while the mental activities gradually confine them- 
selves to fixed ideas or uncontrollable combinations, until at last but an 
insane wreck of a formerly well-balanced constitution is left. 

But there are also a number of Bodiey Causes which induce sleepless- 
ness; they all may be summed up under the one head: Whatever interferes 
with the process of assimilation. The number of such disorders is large, and 
their pathologial specification will appear in the course of this work. In 
general most fevers have this effect, and among the daily used beverages, 
coffee and tea are the most prominent, as they retard, according to physio- 
logical experiments, the process of waste and repair in the tissues. 

Therapeutic Hints. 

It is one of the most favorable signs when soon after the administration 
of a remedy, a natural sleep ensues. On no acount should such sleep be 
interrupted. While it lasts, nature replenishes and rebuilds what has been 
spent. It does more good than a repetition of medicine, \yy which indeed 
the first beneficial effect might be destroyed; the remedy which induces it 
will quietly work on for the benefit of the patient; it is tire remedy. This 



90 THERAPEUTIC HINTS TO SLEEP, STUPOR, INSOMNIA. 

rule applies only to natural sleep. In case of Drowsiness, Stupor, etc., medi- 
cine must be repeated just because of this state, and it may be one of the 
leading symptoms for the selection of the remedy. 

Apis. Sopor with piercing shrieks; meningitis. 

Bellad. Heavy sleep with frequent starting or snoring, screaming or 
singing; with eyes half open; always attended with fever; skin may be dry, 
but is mostly perspiring; face may be flushed but is often pale. Many 
febrile diseases. Dentition. 

Bryon. Drowsy sleep with starting and crying; with chewing and 
swallowing. Head hot; children cry when taken up or being moved. 
Meningeal irritation. 

Chamom. Starting, moaning, screaming, talking, weeping during 
sleep; mouth open; face occasionally distorted by convulsive motions; head 
perspires a great deal. Dentition. 

Laches. Great drowsiness attending many complaints; feels bad or 
worse after sleep; starts when at the point of falling asleep and moans dur- 
ing sleep. 

Lycop. Very sleepy during the day with unsuccessful yawning; start- 
ing and jerking of the limbs during sleep; sudden loud screams during sleep; 
waking with a peevish mood, scolding, screaming, ugly demeanor, nervous 
irritation. Fevers. 

Nux mosch. Unconquerable drowsiness; falls asleep whenever sitting 
down to rest. Long spells of somnolence. Tongue often dry without any 
thirst. In company with many complaints. 

Opium. Stupor; snoring; eyes half closed; mouth open. 

Plwsph. ac. Being roused, answers correctly but goes to sleep again at 
once; typhoid. 

Pulsat. Very sleepy, with various symptoms of head, stomach and 
bowels. 

Rhus tox. Drowsy sleep, with murmuring and talking; t3~phoid. 

INSOMNIA. 

Aeon. Fever-heat, dry skin; tossing about; lamenting; great pain with 
inflammatory processes in teeth, chest, bowels, during menstrual period; 
after fright, fever. 

Bellad. Drowsy and yet unable to sleep; anguish; visions; large pupils; 
congestion towards the head; after morphium. 

China. Ideas crowd upon the mind; after loss of blood and weakening 
diseases. 

Coffca. Nervous excitement; wide awake; not the slighest inclination 
to sleep; after great mental strain, joy, night-watching, acute diseases; den- 
tal irritation. 

Hyosc. Drowsy or sleepless; wild expression; delirious; after chloro- 
form . 

Ignat. After grief and depressing emotions; after overstraining the 
mind by racking business. 



MENINGITIS. 91 

Moschus. Hysterical sleeplessness; after chloral. 

Nux vom. After mental strain till late at night; abuse of coffee, wine, 
liquor, opium, tobacco. 

Opium. Excessive wakefulness, or drowsiness with inability to go to 
sleep. 

Pulsat. Indigestion; after quinine, ferrum and strychnine, tea, chloral. 

Sulphur. Very important with many and different symptoms; sleepy 
in daj'time; sleepless at night. 

These are the main remedies of which one or the other may be indicated 
when drowsiness or sleeplessness is one of the leading symptoms of the case. 
However, there are a number of cases where these symptoms, although promi- 
nent and distressing, may entirely lose their rank as guiding symptoms, and 
none of them, indeed, would prove satisfactory. Then we have to choose 
our remedy irrespectively of these symptoms, which will disappear as soon as 
the mam string is touched. For such cases, of course, special therapeutic 
hints cannot be given a priori. 



MENINGITIS TUBERCULOSA, HYDROCEPHALUS ACUTUS, 
BASILAR MENINGITIS, 

Is in its nature an inflammatory affection of the pia mater, dependent upon 
the development of milary tubercles. In this it differs from all other menin- 
geal affections. 

The miliary granulations are always found in the immediate neighbor- 
hood of vessels, especially of those at the base; frequently at the arteries 
given off from the circle of Willis; they may be spread over large surfaces, or 
they may be confined to only particular portions of the pia. Their number 
likewise varies as their distribution, and so do their stages of development; 
they grow in crops. The pia shows frequently, especially at the base, yel- 
lowish cloudy patches along the vessels and swelling of its tissues; the 
ventricles are dilated and contain hydrocephalic effusion. The quantity of 
this effusion, however, varies greatly, and in many cases is entirely absent. 
The brain in some cases shows white softening, either of only a portion of 
the fornix and corpus callosum, or of larger portions of its tissue lying up- 
wards and contiguous to these parts. In other cases this softening is entirely 
wanting. The cortex and neighboring white substance is in many cases 
anaemic and of dry condition, most probably a result from the pressure 
of the hydrocephalic effusion within the ventricles. It seems that scrofulosis 
as the main spring of tuberculosis, is also the main predisposing cause of this 
disease. It is a secondary disease following local tubercular lesions in some 
other organs, as the lungs, bones and joints or lymphatic glands (scrofulosis); 
and occasionally occurs a sequelar to pertussis, scarlet fever, pneumonia and 
measles. 

The sex attacked most frequently is that of the male; the age that be- 



92 MENINGITIS. 

tween one and six years; from seven to ten years we find it less often, still 
less from ten to sixteen, and rarely afterwards. 

The Symptoms may develop slowly or rapidly. It seems that a crop of 
tubercles may be endured without causing marked disturbances; it is only 
when by some exciting cause an irritation is set up that the disease develops. 
The commencement may manifest itself in a mere indisposition, a change of 
mood, with frequent short naps full of dreams and starting; loss of appetite; 
irregularities of the bowels; febrile conditions towards evening, headache and 
giddiness. This undefined state may last a week and longer. Where there 
is already a developed pulmonary tuberculosis the superadded meningitis 
may not be suspected until suddenly facial paralysis, loss of consciousness 
and vomiting set in. 

As the inflammation progresses we find headache; vertigo; great sensi- 
tiveness to light and noise; vomiting of anything taken, or especially when 
being moved; coming at intervals and disappearing after some time; consti- 
pation usually, but diarrhoea sometimes to the end. If partial or general 
convulsions set in we have: tremor of the eyeballs; squinting; distortions of 
the fa^e; stiffness of the muscles of the nape of the neck and back; retraction 
of the abdominal muscles, so that the belly looks like a tray or boat. There 
may also be paralysis of the face; paralysis of the eyelids; one pupil may be 
larger than the other. The fever rises with evening exacerbations up to 
102.2 or 103 F. The skin is in some cases easily reddened by slight press- 
ure or scratching. And as the internal pressure in consequence of exudation 
increases the mind becomes clouded ; the patient is drowsy, even comatose. 
We occasionally hear a peculiar piercing shriek which, if heard once, is 
scarcely ever forgotten. Convulsive movements become more frequent, such 
as distortions of the face; squinting; chewing; winking the lids; grinding of 
the teeth. Paralysis of the one or the other extremity also sets in, while the 
other may still keep up convulsive motions; there may be paraplegia; there 
may be paralysis of the tongue and deglutory muscles. The pulse at this 
stage falls down to sixty and lower, but is easily excited to a hundred and 
over by any exertion; the temperature remains the same or sinks to about 
ioo° F., although the pulse may have risen from any exertion to 120 or 140. 
Now the fontanelle in children commences to bulge; the coma increases; con- 
vulsions and paralysis continue; the pulse rises again to 120 or 140; the 
respiration is irregular; sometimes the breathing seems to cease altogether, 
followed by a deep, long, sighing respiration. The face frequently changes 
color, now pale, and again red, and sometimes one side is pale and the other 
red. Or red spots appear on the face, coming and going. The blood-vessels 
of the eyes become injected, especially those of the inner canthi. This condi- 
tion of things may last several days. When, however, the skin gets dripping 
with perspiration; when the abdomen becomes bloated; when stool and urine 
pass off involuntarily; when the anterior fontanelle suddenly sinks in and we 
hear the ominous rattling in the chest, then the scene will be closed within a 
few hours. 



MENINGITIS. 93 

The Prognosis is bad. Is the disease always fatal ? Because there are 
no infallible means to distinguish during life between it and simple menin- 
gitis, those eases which have recovered and were claimed to be tubercular 
meningitis are simply set down as errors in the diagnosis; the real proof — 
post-mortem — is wanting, and therefore, as, in all cases which came under 
the hands of these physicians, the post-mortem proved their diagnosis correct, 
they concluded that all the other cases must likewise be fatal. Against this 
conclusion I allow myself modestly to protest. Might not a different treat- 
ment prevent post-mortem examinations ? And are all tubercular affections 
necessarily fatal ? I have lost cases of tubercular meningitis, to be sure, but 
I do believe that I also as well as others have cured some of them. The 
prognosis is bad, that is true. I shall defer therapeutic hints until I have 
spoken of other forms of meningitis. 

LEPTOMENINGITIS INFANTUM ; HYDROCEPHALUS AOUTUS 

SINE TUBERCULIS. 

Like tubercular meningitis this affection is considered an inflammatory 
process of the pia. The cortex and white substance are compressed, dry and 
firm; the ventricles are usually dilated symmetrically from hydrocephalic 
effusion; the softening of the surrounding brain-tissue is less extensive than 
in tubercular meningitis. The plexus chorioidei shows signs of greater 
hyperemia than the superficial portions of the pia. 

As exciting causes the following are mentioned: dentition; eruptive 
fevers; acute pulmonary affections; concussions of the brain. The disease 
belongs decidedly to the age of childhood, from one to five years. 

Its Symptoms correspond so closely to those of tubercular meningitis 
that there is none to enable us to distinguish positively between the two, 
unless we take the general outspoken tendency to scrofula, if it is outspoken, 
or the hereditary disposition in that direction as a basis for our judgment. 
In many cases, of course, the symptoms vary, but the general type remains 
the same. Usually there are less premonitory warnings; sometimes the 
inability to swallow sets in at an early stage; the skin of the body is dry, 
while the head often perspires profusely; facial paralysis and paralysis of the 
extremities are less frequent than in tubercular meningitis, yet they do occur. 
For further particulars compare the foregoing. 

The Prognosis is less fatal than that of tubercular meningitis. 

SIMPLE MENINGITIS, MENINGITIS OF THE CONVEXITY, 
LEPTOMENINGITIS. 

Meningitis is in the great majority of cases a secondary disease, compli- 
cating such diseases as scarlet fever, typhoid fever, diphtheria, measles, 
pneumonia, endocarditis, otitis media, erysipelas, rheumatism and nephritis; 
it may also follow sunstroke and fractures of the skull. 

The cortical portion of the pia is mostly affected; there is hyperemia 
and inflammatory exudation of a serous or fibro-purulent character, covering 



94 THERAPEUTIC HINTS TO MENINGITIS. 

the convolutions and sulci like a veil. In severe cases the brain cortex itself 
may become infiltrated and softened. 

The Symptoms are chilliness, intense headache and photophobia, spasms 
of groups of muscles, vomiting, high fever, 102 to 105 Fahr., contracted 
pupils, active or passive delirium, coma. 

The Prognosis is unfavorable; insanity may develop in cases that 
recover. 

Therapeutic Hints. 

Aeon. In the first stage of irritation and in the traumatic form, espe- 
cially where there is fever- heat, dryness of the skin, restlessness and im- 
patience. The pulse is full and bounding or thready; the breath is short. 

Apis. Convulsions; eyes, ears and skin lose their sensitiveness; when 
water is put into the mouth, there is no effort at swallowing; sopor, inter- 
rupted by piercing shrieks; bending back and rolling of the head; muscles 
of neck tense; profuse, sticky sweat on the head, of a musk-like odor; in- 
ability to hold up the head; eyes sunken, half shut; on opening eyelids no 
reaction; squinting; dilated pupils; hearing gone; occasional red streaks or 
crimson spots on the face or different parts of the body; face pale, of a milky 
blue; grating of teeth; scanty, but frequent emissions of a dark and some- 
times of a milky urine, or suppression of urine; no stool, or thin, scanty 
stool, passed but seldom and unconsciously, trembling of the limbs; twitch- 
ing or moving of the limbs of one side and paralysis of the other; irregular, 
slow pulse, or very quick and weak. 

Apoc. cann. Sutures opened; forehead projecting; sight of one e}'e 
totally lost, the other slightly sensible; stupor; constant involuntary motion 
of one leg and arm; urine suppressed. 

Arg. nitr. According tcGrauvogl in the last stage. He gives it in the 
6th dilution every two hours, and at the same time Calc. phosph., 2d trit., 
night and morning. 

Arnica. After a fall causing either concussion, a bruise or a perforating 
wound; also where there is suppuration in consequence. There are cases 
where the meningeal irritation does not show until several weeks after the 
injury. For such cases Arnica is specific. 

Art. vulg. Convulsions of right and paralysis of left side; body cold 
all over; sopor, and yet drinking and swallowing water eagerly; face pale 
and oldish looking; involuntary stools, greenish and thin, 

Bell ad. Vertigo on sitting up, with nausea or vomiting; redness and 
heat of the face, or alternate redness and paleness; sparkling, shining eyes, 
with dilated pupils; rolling and squinting of the eyes; blindness; throbbing 
of the carotid arteries; drowsiness, yet inability to sleep; or drowsy, restless 
sleep with frequent startings; trembling hastiness in taking hold of things 
and sitting up; spasms affecting eyes and face, or spasms of one side and 
paralysis of the other; involuntary discharge of urine. During dentition; 
after taking cold by exposure to a cold north wind. 



THERAPEUTIC HINTS TO MENINGITIS. 95 

Bryon. Leaning head against something; putting hand to the head; 
uncertain, tottering gait; tired; sudden change of disposition; dizziness; 
fall often and strike against things; sudden change of color in face; loss of 
appetite; restless sleep — as premonito^ signs. Later: head bent backwards; 
very dark red face, "crimson red;" dry lips; dry, brownish tongue; hasty, 
impetuous drinking and swallowing; constipation; suppressed or painful 
urination with much straining; dry heat all over and especially of the head; 
drowsy sleep; chewing and swallowing during sleep; cries when being taken 
up or moved. 

Canthar. May be a rival to Apis. Is important in inflammations of 
serous membranes, why not in meningitis ? There are a number of symp- 
toms which hint to it. Compare Condensed Materia Medica. 

Cina. Either real or simulating meningitis with so-called worm symp- 
toms. 

Cicuta. Rolling of the head from side to side, or boring of the occiput 
into the cushions; head hot; eyes closed; on lifting the lids, eyes stare up- 
wards; great agitation; child grasps at one's clothing in a frightened man- 
ner; jerking of limbs; convulsions with screaming afterwards. 

Cuprum. Hot head; deep sopor with twitching and» jerking of the 
limbs; coldness of the hands and a bluish appearance of the fingers. " Dur- 
ing scarlet fever without eruption; afraid of and shrinking away from every 
one who approaches him; afraid of falling; clinging tightly to the nurse; 
won't stay in bed but in the lap; conscious, knows people." Tongue dart- 
ing forth and back with great rapidity, like a snake's. After catarrhal or 
exanthematic fevers; during difficult dentition. 

Digit. Sopor; unconsciousness; pupils dilated, insensible to light; 
blindness; one-half of face convulsed; pulse very slow, often hard, with a 
corresponding powerful stroke of the heart, sometimes intermittent and 
small; breathing heavy, slow and deep; sleep with frequent startings and 
dreams of falling; general convulsions. 

Gelsem. The child wants to be let alone, wants to lie still; head hot, 
hands and feet cool; face red; eyes dull; tongue coated yellowish- white; no 
thirst j breath hot, sometimes offensive; sleepy and drowsy, sometimes coma- 
tose; during sleep, convulsive motions; creeps and flushes run up the back; 
more or less moisture of the .skin, especially on palms of hands and in the 
axillae; pulse depressed at first, later frequent and soft. During summer or 
warm weather with southerly and southeasterly wind. 

Glonoin. Headache; every pulse is felt, as if the head should burst; 
stupefaction; sunken eyes; under the eyes a bluish pallor; red eyes with 
photophobia; optical illusions; lightning black spots before the eyes; blind- 
ness; in the ears pain, fulness, pulsation, ringing, deafness; face is pale in 
spite of high fever, or red and hot; temporal arteries pulsate violently; heart 
beats strong and laborious; pulse mostly accelerated, often changing sud- 
denly to slow and back again; nausea, vomiting with the headache; sudden 
spasms. 



96 THERAPEUTIC HINTS TO MENINGITIS. 

G ratio la. Has been given as extract with good result in a case where 
there was low respiration; occasional sighing; gnashing of teeth; eyes shut; 
pupils enlarged; slow pulse; unconscous discharge of feces and urine. 

Helleb. Great irritability, getting angry easily; vertigo as if drunk; 
eyes staring or rolled, lids half closed; squinting; forehead drawn in folds 
and covered with cold perspiration; face pale and puffy; frequent rubbing of 
the nose; nostrils dry and dirty; chewing motions with the mouth; greedily 
swallows cold water; wants food occasionally, but rejects it when offered; rolls 
the tongue from side to side; lower jaw sinks; vomits green mucus; passes 
dark urine with a sediment like coffee-grounds. Breathing sometimes quick, 
sometimes slow and deep; sighing; boring back of the head; sporous sleep 
with screaming and starting; automatic motions of one arm and one leg; 
convulsive movements of muscles and jerking; exudation. 

Kali hydr. Is the remedy of Kafka, for scrofulous and tuberculous 
subjects. The disease develops gradually, and this remedy ought to be given 
at an early stage, although even later with symptoms of exudation it has 
been found to act favorably. 

Laches. Is often indicated after Lycop. , especially when there is dif- 
ficulty of swallowing; gagging with throwing up of wind; hot abdomen. 

Lycop. Is one of the most important remedies in tubercular meningitis. 
Generally speaking, it corresponds to scrofulosis and tuberculosis, cheesy de- 
generation and dropsical effusion. Special indications: drowsiness, loud 
screams during sleep; sleep with half open eyes, throwing the head from side 
to side with moaning; bad humor after sleep; comatose state; great emacia- 
tion; pale face; flushes of heat in the face; spasmodic twitching of the face; 
stiffness of the neck; constipation. Also in complications with eruptive 
fevers and pneumonia. 

Merc. sol. Drowsy, sleepiness with restless throwing about and oc- 
casional waking with a shrill cry, which is followed again by- dozing off. 
The sensitiveness of the eyes to light is diminished; squinting. Mercury is 
considered as being capable of exciting the process of absorption. 

Opium. Soporous condition with half open e3~es; snoring; iris insensi- 
ble to light; congested face; suppressed urine. 

Spongia. According to Hering, of great importance on account of its 
relationship to scrofulosis and tuberculosis. Guiding sj-mptoms: congestion 
of blood to the head with pressing, knocking and pulsating in the forehead; 
redness of face with anxious mem; better when lying in a horizontal position; 
heat in the head; bending the head backwards with tension in the neck. 
Eyes staring, lids wide open; double sight; face pale and cold with the heat; 
alternately red and pale. Twitching of the muscles with the fever; frequent 
waking with a start; tossing about; stupid slumber. 

Stramon. Head is thrust forward instead of back; conjunctiva injected; 
pupils contracted; desire for light, or bright light and glistening things cause 
spasms; calls for his parents who are present but does not know them; 
violent delirium; stammering; great dryness of the mouth; dysphagia; urine 



DIGEST TO MENINGEAL INFLAMMATIONS. 



97 



suppressed; trembling and convulsive movements of the limbs; striking with 
hands and feet; frequent torsions of the trunk; screaming; suppressed 
miliars- eruptions. 

Sulphur. Heaviness of the head; it sinks backwards; sweat on head of 
musk-like smell; frequent change of color in the face; pale, distorted feat- 
ures; sour smell from the mouth; turbid urine with red sediment ; suppressed 
eruption on head, behind the ears or elsewhere. Often indicated after 
Bryon. or Helleb. See above. 

Zincum. Cross and crabby in the afternoon and morning; pain in fore- 
head, better when lying; sensitive to light; dry nose; pale, waxy face; re- 
laxed features; gagging and vomiting and yet a voracious appetite; stool 
retarded, omitting for days; scanty, turbid urine, as if mixed with clay; 
cannot keep the feet still. Heat and fever morning, evening and part of 
night; restless sleep before midnight, after midnight more quiet, and in the 
morning awakes brightly. Complication with scarlatina. 

Digest to Meningeal Inflammations. 



FORJKS, STAGES AND SUCCES- 
SION OF SOME REMEDIES. 

Ileal or simulating, with so-called worm 
symptoms: Cina. 

Traumatic: Aeon. 

After a fall, causing either concussion, a 
bruise or a perforating wound; also 
where there is suppuration in conse- 
quence: Arnica. 

After exposure to a cold north wind: 
Bellad. 

During" summer or warm weather, with 
southerl}' or southeasterly wind: Gel- 
sem. 

During dentition : Bellad., Cuprum. 

scarlatina : Zincum. 

without eruption: Cuprum. 

With eruptive fevers and pneumonia: 
Lycop. 

After catarrhal or exanthematic fevers: 
Cuprum. 

suppressed eruption on head, be- 
hind the ears or elsewhere: Sulphur. 

miliary eruption: Str anion. 

For scrofulous and tuberculous subjects: 
Kali hydr., Lycop., Spongia. 

Children who do not grow, but pine 
away, with swelling of glandular struct- 
ures: Bar. carb. 

Eat babies with large heads, wide open 
fontanelles, which are often covered 
with dirty or scurfy skin; fair complex- 
ion: Calc. carb. 

Rather thin than fat children: Thuja. 

7 



Flabby, shrunken, emaciated children; 

great emaciation: Calc. phosph., Lycop. 
Rickety children: Silic. 
Children of sycotic and syphilitic taint: 

Thuja. 
Parents, one or both, have a greasy skin, 

and warts and moles: Thuja. 
Crave salt, and the little one will by and 

by show these hereditary symptoms: 

Thuja. 
Prone to eruptions which, on healing, 

leave purple spots: Thuja. 
Pimples, boils and other eruptions on 

head, face or other localities: Sulphur. 
Premonitory signs: Bryon. 
Premonitory loss of appetite; restless 

sleep: Bryon. 
In the state of irritation: Aeon. 
The disease develops gradually, and this 

remedy ought to be given at an early 

stage, although even later with s}-mp- 

toms of exudation it has been found to 

act favorably: Ixali hydr. 
During exudation: Helleb. 
Excites the process of absorption: 

Mercur. 
In the last stage: Arg. uilr., Calc. 

phosph. 
May be a rival to Apis: Canthar. 
Is often indicated after Lycop. : Laches. 
Often after Bryon or Helleb. : Sulphur. 

CONCOMITANT SYMPTOMS. 

Conscious, knows people: Cuprum. 
Unconscious: Digit. 



9 8 



DIGEST TO MENINGEAL INFLAMMATIONS. 



Stupefaction: Glonoin. 
Lively, precocious: Calc. carb. 
Violent delirium: Stramon. 

Calls lor his parents, who are present, but 

does not know them: Stramon. 
Trembling hastiness in taking hold of 

things and sitting up: Bell ad. 
Screaming: Stramon. 
Cries when being taken up or moved: 

Bryon. 
Striking with hands and feet: Stramon. 
Clinging tightly to the nurse; won't stay 

in bed but in the lap: Cuprum. 
Children do not like to be washed: 

Sulphur. 
Wants to be let alone, wants to lie still: 

Gelsem. 
Afraid of falling: Cuprum. 
Afraid of and shrinking away from every 

one who approaches him: Cuprum. 
Grasps at one's clothing in a frightened 

manner: Cicuta. 
Sudden change of disposition : Bryon. 
Great irritability, getting angry easily: 

Hcllch. 
Cross and crabby in the afternoon and 

morning: Zincum. 
Bad humor after sleep: Lycop. 
Restlessness and impatience: Aeon. 
Great agitation: Cicuta. 
Dizziness: Bryon. 

as if drunk: Hcllcb. 

on sitting up, with nausea or vomit- 
ing: Bellad. 
Headache : Glonoin. 

, nausea, vomiting: Glonoin. 

Pain in forehead, better when lying: 

Zincum. 
Every pulse is felt, as if the head should 

burst: Glonoin. 
Congestion of blood to the head with 

pressing, knocking and pulsating in the 

forehead; Spongia. 
Head hot: Cicuta, Cuprum, Gelsem. , 

Spongia. 
Forehead projecting; sutures opened: 

Apoc. cann. 
Skull thin and soft, with fontanelles wide 

open: Calc. p/iospli. 
Inability to hold up the head: Apis. 
Leaning head against something: Bryon. 
Heaviness of the head, it sinks back- 
wards: Sulphur. 
Boring back of the head: Hcllch. 



Head bent backwards; very dark red 
face, " crimson red:" Bryon. 

Bending the head backwards, with ten- 
sion in the neck: Spongia. 

Bending back and rolling head: Arsen. 

Rolling of the head from side to side, or 
boring of the occiput into the cushions: 
Cicuta. 

Head is thrust forward instead of back: 
Stramon. 

Putting hand to the head: Bryon. 



Red eyes with photophobia: Glonoin. 

Conjunctiva injected: Stramon. 

Eyes shut: Cicuta, Gratiola. 

sunken: Gelsem. 

and half shut: Apis. 

dull: Gelsem. 

sparkling, shining, with dilated pu- 
pils: Bellad. 

staring, lids wide open: Spongia. 

staring or rolled up, lids half closed: 

Helled. 

rolling and squinting: Bellad. 

squinting: Apis, Helleb., Mercur. 

On lifting the lids, eyes stare upwards: 
Cicuta. 

Pupils contracted: St rat) wn. 

dilated: Apis, Bellad,, Digit., Gra- 
tiola. 

Desire for light: Stramon. 

Sensitive to light: Zincum. 

Sensitiveness diminished: Apis, Mercur. 

On opening eyelids no reaction: Apis. 

Insensible to light: Digit., Opium. 

Blindness: Bellad., Digit., Glonoin. 

Sight of one eye totally lost, the other 
slightly sensible: Apoc. cann. 

Double sight: Spongia. 

Lightning or black spots before eyes: 
Glonoin. 

Optical illusions: Lycop. 



In the ears pain, fullness, pulsation, 

ringing, deafness: Glonoin. 
Offensive discharge from the ears: Thuja. 
Hearing gone: Apis. 



Dry nose: Zincum. 
Nostrils dry and dirty: Helleb. 
Pick at nose: Cina., Sulphur. 
Frequent rubbing of the nose: Helleb. 



Flushes of heat in the face: Lycop. 



DIGEST TO MENINGEAL INFLAMMATIONS. 



99 



Redness and heat of the face: Bel lad. 
Red and hot face: Glonoin. 
Congested face: Opium. 
Face red: Gelsem. 

with anxious mien: Spongia. 

crimson red: Bryon. 

Under the eyes a bluish pallor: Glonoin. 
Face pale: Lycop. 

in spite of high fever: Glonoin. 

and cold with heat: Spongia. 

, with distorted features: Sulphur. 

of a milky blue: Apis. 

and oldish looking: Art. vulg. 

and puffy:* Helleb. 

, waxy; relaxed features: Zincum. 

Sudden change of color in face: Bryon., 

Sulphur. 
Alternately red and pale face: Bellad., 

Spongia. 
Occasional red streaks or crimson spots 

on the face or different parts of the 

body: Apis. 
Forehead drawn in folds and covered 

with cold perspiration : Helleb. 
Spasmodic twitching of the face: Lycop. 
Salivary glands swell: Thuja. 
Dry lips: Bryon. 
Red lips: Bellad., Sulphur. 



Great dryness of the mouth: Stramon. 

Sour smell from the mouth: Sulphur. 

Chewing motions with the mouth: 
Helleb. 

Lower jaw sinks: Helleb. 

Dry, brownish tongue: Bryon. 

Sometimes thrush or ranula: Thuja. 

Tongue coated yellowish-white:- Gelsem. 

darting forth and back with great ra- 
pidity, like a snake's: Cuprum, Lycop. 

Rolls the tongue from side to side : Helleb. 

Stammering : Stramon. 

Gnashing of teeth: Gratiola. 

Grating of teeth: Apis. 

Retarded dentition, with cold tumors: 
Calc. phosph. 

Dentition slow and troublesome: Calc. 
carb. 

Claw their mouth during dentition: Silic. 

Teeth soon turn black and decay at the 
gums: Thuja. 



Drinknig and swallowing water eagerly 
during sopor: Art. vulg. 



Hasty, impetuous drinking and swallow- 
ing: Bryon. 
Greedily swallows cold water: Helleb. 
Wants to nurse all the time: Calc. 

phosph . 
Difficulty of swallowing: Laches. 
Dysphagia: Stramon. 
When water is put into the mouth, there 

is no effort at swallowing: Apis. 
Crave sour things: Sulphur. 
Great desire for salt meats and potatoes: 

Calc. phosph. 
Wants food occasionally, but rejects it 

when offered: Helleb. 
Gagging, with throwing up of wind: 

Laches. 
and vomiting, and yet a voracious 

appetite: Zincum. 
Vomits green mucus: Helleb. 
Feels faint in the forenoon: Sulphur. 
After eating and drinking, bellyache: 

Calc. phosph. 
Stomach and bowels are large, sensitive 

to pressure: Calc. carb. 
Pain in the left iliac region: Thuja. 
Hot abdomen : Laches. 
Constipation: Bryon., Lycop. 
Stool retarded, omitting for days: Zincum. 
Bowels inclined to be loose: Calc. carb. 
Diarrhoea early in the morning: Sulphur, 

Thuja. 
Loose, green and at times slimy stools: 

Calc. phosph, 
I voluntary stools, greenish and thin: 

Art. vulg. 
No stool, or thin, scanty stool, passed but 

seldom and unconsciously: Apis. 
Unconscious discharge of feces and 

urine: Gratiola. 



Painful urination, with much straining: 
Bryon. 

Suppression of urine: Apis, Apoc. cauu., 
Bryon., Helleb., Opium, Stramon. 

Turbid urine, with red sediment: Sul- 
phur. 

Dark urine, with a sediment like coffee- 
grounds: Helleb., Laches. 

Scanty, turbid urine, as if mixed with 
clay: Zincum. 

, but frequent emissions of a dark and 

sometimes of a milky urine: Apis. 

Ivollllltary discharge: Tel lad. 



:oo 



DIGEST TO MENINGEAL INFLAMMATIONS. 



Soreness of vulva: Mercur. 

of penis or vulva and buttocks: 

Thuja. 



accelerated, often changing 
to slow and back again: 



Breath hot, sometimes offensive: Gclsem. 

short: . Icon. 

Breathing", sometimes quick, sometimes 

slow and dee]>: Helleb. 

heavy, slow and deep: Digit. 

Low respiration : Gratiola. 
Occasional sighing: Gratioa, Helleb. 
Heart beats strong and laborious: 

Glonoin. 
Pnlse full and bounding or thready: 

Aeon. 

mostly 

suddenly 
Glonoin. 

Pulse depressed at first, later frequent 

and soft: Gelsetn. 

very quick and weak: Apis. 

sometimes intermittent and small: 

Digit. 

slow and irregular: Apis, Gratiola. 

very slow, often hard, with a corre- 
sponding powerful stroke of the heart: 

Digit. 
Temporal arteries pulsate violently, 

throbbing of the carotid arteries: Bel lad. 
Neck, stiffness of : Lyeop. 

, muscles tense: Apis. 

Coldness of the hands, and a bluish 

appearance of the fingers: Cuprum. 
Hands and feet cool: Gelsetn. 
Feet are cold in the morning and hot in 

the evening: Sulphur. 
One foot cold, the other hot: Lyeop. 
Feet damp and cool: Cale. earl). 

, fetid sweat: Si lie. 

Run about, but do not like to stand: 

Sulphur. 
Will not stand any more, and do not 

learn to walk: Cale. phosph. 
Sit hunched and walk stooping: Sulphur. 
Uncertain, tottering gait, fall often and 

strike against things: Bryon. 
Tired: Bryon. 
Trembling of the limbs: Apis. 

and convulsive movements of the 

limbs: Stramon. 

Eyes, ears and skin lose their sensitive- 
ness: . I pis. 

Twitching of the muscles with the fever: 
Spongia. 



Jerking of limbs: Cieuta. 

Convulsive movements of muscles and 

jerking: Helleb. 
Frequent torsions of the trunk: Stramon. 
Sudden spasms: Glonoin. 
Convulsions: Apis, Digit. 

with screaming afterwards: Cieuta. 

Bright light and glistening things cause 

spasms: Stramon. 
Spasms affecting eyes and face: Bellad. 
One-half of face convulsed: Digit. 
Twitching or moving of the limbs of 

one side and paralysis of the other: 

Apis. 
Convulsions of right and paralysis of left 

side: Art. vulg. 
Spasms of one side and paralysis of the 

other: Bellad. 
Constant involuntary motion of one leg 

and arm: Apoc. eanu., Helled. 



Stupid slumber: Spongia. 

Sopor: Digit. 

, interrupted by piercing shrieks: 

Apis. 

, with half open eyes: Opium. 

, and yet drinking and swallowing 

water eagerly: Art. vulg. 

, with screaming and starting: Helleb. 

, with twitching and jerking of limbs: 

Cuprum. 

Comato.e state: Lyeop. 

Stupor: Apoc. eann. 

Drowsy sleep: Bryon. 

, restless sleep, with frequent start- 

ings: Bellad. 

, sleepiness with restless throwing 

about and occasional waking with a 
shrill cry, which is followed again by 
dozing off: JLerc. sol. 

Drowsiness: Lyeop. 

, yet inability to sleep: Bellad. 

Sleepy and drowsy, sometimes comatose: 
Gelsem. 

Sleep restless: Sulphur. 

Restless sleep before midnight, after 
midnight more quiet, and in the morn- 
ing awakes brightly: Zincum. 

Starts when falling asleep: Sulphur. 

During sleep loud screams: Lyeop. 

Children sleep apparently soundly, but 
scream out suddenly in sleep, stare 
about and cannot easily be pacified: 
Lyeop. 



HYDROCEPHALUS . 



IOI 



Cry out, or murmur, moan and whine: 

Sulphur. 
Snoring: Opium, Sulphur. 
Frequent startings: Digit., Spongia. 

and dreams of falling: Digit. 

Head sweats profusely, especially on the 

occiput: Calc. card. 
Half open eyes, throwing the head from 

side to side with moaning: Lycop. 
Chewing" and swallowing: Bryon. 
Convulsive motions: Gelsem. 



Cold all over: Art. vulg. 

Creeps and flushes run up the back: 

Gelsem. 
Fever-heat and dryness of skin: Aeon. 
Dry heat all over and especially the head: 

Bryon. 



Heat and fever morning, evening and 
part of night: Zincum. 

Profuse, sticky sweat on the head, of a 
musk-like odor: Apis, Sulphur. 

Sweat much about the head, especially 
forehead and face: Silic. 

Uncovered parts sweat, while the covered 
parts are dry and hot: Thuja. 

Fetid foot-sweats: Silic, Thuja. 

More or less moisture of the skin, espe- 
cially on palms of hands and in the 
axillae: Gelsem. 



Better when lying in a horizontal posi- 
tion: Spongia. 
Tossing* about: Spongia. 
Cannot keep the feet still: Zincum. 



Glandular swellings and abscesses : Silic. 



HYDROCEPHALUS ACQUISITUS 

Develops itself secondary to acute attacks of the different forms of men- 
ingitis, external injuries, the abuse of intoxicating drinks, or too great 
mental exertion. In children, even if it originates after birth, it is never- 
theless similar to the affection called 



HYDROCEPHALUS CONGENITUS, 

that form with which children are born. It is probably the consequence of 
an inflammatory process of the lining of the ventricles during foetal life; 
perhaps it is a deficiency in the proper assimilation of calcareous substances 
which form the bones. Why this is we do not know in either case. Some 
women have given birth to hydrocephalitic children several times in succes- 
sion, without any apparent cause. 

As the water collects in the ventricles while the sutures of the bones have 
not yet united, its constantly increasing bulk drives the bones asunder and 
enlarges the head to an enormous size. Or, if we take the other view, which 
is perhaps the more plausible of the two, we might explain it in this manner: 
The insufficiently developed bones are not capable of restricting the growing 
brain within its proper limits; they give way here and there, and the brain 
gains entirely too much space within the skull. As, however, a vacuum can 
never exist, it is at once filled up with the general equalizing medium, water 
or serum. In this way the inner pressure becomes still stronger, and the still 
deficient bony structure becomes still less capable of restraining the increased 
internal pressure; it gives way again and again; and for the same reason 
the effusion of water must increase still more, until at length the whole 
cranium attains to an enormous size. 



102 THERAPEUTIC HINTS TO HYDROCEPHALUS. 

The disease can be recognized at once, although it may not have come 
to its full development. There is a disproportion between the size of the 
skull and that of the face; the fontanelles are much wider than usual, and 
the frontal opening may be traced down into the frontal bone; and laterally, 
down between the parietal and frontal bones. The bones themselves feel 
thin under pressure of the fingers; and externally the veins appear greatly 
enlarged, shining through the skin. 

All these external changes appear only when the collection of w T ater is 
very considerable. There have been found from six to ten pounds of serum 
within the ventricles, which then appear enormously distended and thickened, 
while the substance of the brain in the neighborhood is wasting away. A 
small amount of serum does, of course, not change the external form of the 
cranium, neither is it changed should the effusion take place at a later period, 
when the sutures of the skull bones have closed; to this there are a very few 
recorded exceptions. 

Children born with hydrocephalus fully developed, die frequently dur- 
ing birth or soon afterwards. Others show no signs of this malady in the 
first weeks; even during the whole of the first year it may be overlooked, 
until the inability of the child to hold up its head calls attention to it. But 
even then there may be no enlargement of the head visible, yet the child is 
slow in all its mental developments; it does not make any attempt to talk or 
walk; it remains uncleanly, and its actions look strangely; when in joy or 
fear it makes antics and straggles with its extremities. Its eyes do not look 
knowingly at any object; it shows no interest for things; it appears imbecile 
and foolish. Saliva is constantly oozing out of the half opened mouth; it 
eats greedily, and often is seized with spasms. 

The progress of the disease is either a steady one, going on from bad to 
worse, until at last general paralysis ends the scene; or it is interrupted by 
stationary periods, or it remains for years seemingly unaltered. It is rare, 
however, for such patients to live beyond the age of puberty; a few only 
have been observed to live to the age of twenty. 

Therapeutic Hints. 

As a general rule the pregnant woman ought to be under the watchful 
eye of her physician during that whole period. She may be relieved just 
during that time of many chronic troubles, better than at any other time and 
her offspring saved of as many serious afflictions. But where a mother has 
lost already one or more children from hydrocephalus, Grauvogl's advice to 
administer to such a mother during her next pregnancy Sulphur and Calc. 
phosph. at suitable intervals, ought never to be forgotten. Even after the 
birth of a child with suspicious hereditary proclivities, we may be able to 
ward off an acute "outbreak of meningeal inflammation by one or the other of 
the following remedies: 

Bar. curb. Children who do not grow, but pine away, with swelling of 
glandular structures. 



HYDROCEPHALUS SENILIS. 103 

Calc. card. Fat babies with large heads, wide open fontanelles, which 
are often covered with dirty or scurfy skin; fair complexion; they are lively, 
precocious; their head sweats profusely during sleep, especially on the occi- 
put; stomach and bowels are large, sensitive to pressure; bowels inclined to 
be loose; feet damp and cool; dentition slow and troublesome. 

Calr. phosph. Flabby, shrunken, emaciated children; skull thin and 
soft, with fontanelles wide open; will not stand any more; do not learn to 
walk; want to nurse all the time; great desire for salt meats and potatoes; 
after eating and drinking, bellyache; retarded dentition with cold tumors, 
emaciation and loose green, at times slimy stools. 

Lycop. Children sleep apparently soundly, but scream out suddenly in 
sleep, stare about and cannot easily be pacified. 

Silk. Rickety children; sweat much about the head, especially fore- 
head and face; claw their mouth during dentition; are prone to abscesses, 
glandular swellings and a fetid sweat of the feet. 

Sulphur. Children who do not like to be washed; have pimples, boils 
and other eruptions on head, face and everywhere; pick at nose; have red 
lips; crave sour things; feel faint in the forenoon; may have diarrhoea early 
in the morning; sleep restless; start when falling asleep; cry out during 
sleep; or murmur, moan and whine, or snore; their feet are cold in the morn- 
ing and hot in the evening; they run about, but do not like to stand; sit 
hunched and walk stooping. 

Thuja. Children of sycotic and syphilitic taint; they are rather thin 
than fat, are prone to eruptions which, on healing, leave purple spots; their 
teeth soon turn black and decay at the gums; the salivary glands swell; 
there is sometimes thrush or ranula; offensive discharge from the ears; sore- 
ness of penis or vulva and about the buttocks; frequently recurring morning 
diarrhoea; pain in the left iliac region ; fetid foot-sweats; often the uncovered 
parts sweat, while the covered parts are dry and hot. Their parents, one or 
both, have a greasy skin, and warts and moles, and crave salt, and the little 
one will by and by show these hereditary symptoms. — (T. B. Scales). 

HYDROCEPHALUS SENILIS 

Is that form of hydrocephalus which is found in old age, the second child- 
hood of man. It seems to be developed from the following condition of 
things: The brain in old age is apt to shrink, which necessarily would cause 
an empty space within the skull. As no vacuum can exist, the would-be 
empty space is at once filled up with serum. The same takes place when, 
from some cause or other, only a portion of the brain becomes atrophied. 
The space which hereby is vacated is at once taken up hy an exudation of 
fluid. Hence this sort of hydrocephalus is termed Hydrocephalus ex vacuo. 
It sometimes happens that the exudation of serum takes place so suddenly 
and so profusely as to cause all the symptoms of an apoplectic stroke, when 
it is called Apoplexia serosa. 

In most cases it is impossible to make a differential diagnosis between it 



104 PACHYMENINGITIS. 

and Apoplexia sanguinea ; neither have we any distinct signs by which to 
diagnose Hydrocephalus senilis. 

PACHYMENINGITIS, INFLAMMATION OF THE DURA MATER. 

The dura consisting of a periosteal (external) and an inner lamella, 
pathology recognizes: 

r. Pachymeningitis externa, which may be caused by external injuries, 
separating the membrane from the inner surface of the skull, or bruising and 
tearing it; or by transmission of inflammation from neighboring tissues 
(otitis media). It always is confined to circumscribed spots, and seldom 
recognizable as a separate affection, because of the ease with which the 
inflammatory process may spread to the inner lamella and pia. Pachymen- 
ingitis of old age is frequently detected post-mortem, without any marked 
symptoms during life. 

2. Pachymeningitis interna may be a mere continuation of inflammatory 
and suppurative processes of the outer layer. As such it is as little recog- 
nizable during life as the former. It may occur secondarily to the acute 
infectious diseases. 

3. Pachymeningitis interna Haemorrhagica or Haematoma durae matris 
is in fact not an inflammation, but an extravasation of blood, which under- 
goes the usual changes of a coagulum, and developing from itself a new 
formation. It is found either on the surface of both hemispheres or only on 
one, and principally attacks persons after thirty years of age and upwards, 
although cases under that age are likewise recorded. 

The Symptoms must naturally vary according to the quantity of extrava- 
sation, its location on one or both hemispheres or its spreading from one to 
the other, and its repetition. A sudden and increasing compression is indi- 
cated by headache, drowsiness, loss of consciousness, fever, slow, sometimes 
irregular, and towards the end mostly very frequent pulse. The contraction 
of the pupils, the absence of strabismus and ptosis indicate that the convexity 
is the seat of the lesion; the simple rigidity, paresis or actual paralysis 
of the muscles, the disturbances of sensation, numbness, formication, when 
present on one side only or on both, or progressing from one side to the 
other, indicate its location on the opposite hemisphere or over both, or its 
spreading from one to the other. Coma, disturbances of respiration, slow- 
ness of pulse, inability to swallow, cessation of reflex movements of the 
pupils, indicate a compression of the whole brain, while convulsions of one 
side and then on the other, afterwards paresis of one side with paresis of the 
facial or hypoglossus of the same side, then paresis of the other side show 
irritation of the motor centres of the surface of the brain. The intervals 
between different attacks of extravasation are characterized by headache, 
diminution of intelligence, loss of memory, drowsiness, partial paralysis, dis- 
turbance of speech, sudden mental excitement without cause and frequently 
mixed symptoms of dementia paralytica. 

Its predisposing influences are old age, atrophy of the brain from alco- 



ENCEPHALITIS. . 105 

holism, atheroma, affections of the lungs, heart and kidneys, chronic psy- 
choses, anaemia perniciosa, haemophilia, scorbutus. 

Its duration ma}^ extend from one day to one year and longer. 

For therapeutic hints see under meningitis and apoplexy. 

ENCEPHALITIS; ABSCESS OF THE BRAIN; RED AND 
YELLOW SOFTENING OF THE BRAIN. 

It is a true inflammatory lesion of the cerebral substance, a red softening 
and consequent abscess of the brain. The yellow softening is the consequence 
of a hsemorrhagic infraction, through the plugging up of a cerebral vessel, 
which may lead, however, by irritation, to a true encephalitis, and so may, 
vice versa, after its inflammatory stage has passed away, the true encepha- 
litis assume the appearance of yellow softening and even be accompanied on 
the surrounding cerebral tissue by a partial necrosis, so that indeed we may 
find spots of softening in the brain, of which we cannot ascertain the nature 
of the preceding process. True encephalitis is found always only in small 
spots (foci). These foci are red from extravasated blood and swollen; its 
boundaries imperfectly defined. By and by, if they are not absorbed almost 
completely, which small ones of a traumatic nature certainly do in many 
cases, they undergo the well-known destructive and reabsorbing changes; we 
see before us a focus of yellow softening, which gradually becomes more 
colorless, is transformed into a cavity with a thin, emulsive fluid, and may, 
at last, lead to the formation of firm sclerotic cicatrices; or the transformation 
results in a collection of pus — an abscess. Recent abscesses have usually no 
enveloping capsule, while old ones have. As they grow they increase the 
intercranial pressure and retard the circulation in the brain, or compress the 
neighboring vessels in such a degree as to cause yellow softening of the sur- 
rounding brain-tissue to a large extent. The abscess may perforate the 
surface of the brain into the ventricles, or open upon the base and give rise 
to diffuse acute meningitis of the base. 

It causes widespread acute oedema and also anaemia of the brain, and 
when located in the cerebellum in such a poistion that it lessens the cavity of 
the fourth ventricle, or of the aquaeductus Sylvii, hydrocephalus internus 
chronicus. 

It ma} 7 discharge through the skull into the subcutaneous tissue, or into 
the frontal sinuses and nasal fossae, or through the temporal bone in the 
neighborhood of the processus zygomaticus, under the temporal muscle, or 
into the cavity of the tympanum. 

Abscess of the brain is either single or multiple and varies in size. 

The most frequent Cause of acute inflammation and recent abscess is 
traumatic injury ; but there are also mentioned: Affections of the skull bones, 
tumors in the brain, acute diseases, such as typhoid, scarlatina, affections of 
the heart, suppurating and sloughing processes in different portions of the 
body. These same causes apply to the capsulated and chronic abscess. 



106 IXSOLATIO. 

Its Symptoms are not at all well defined. An acute encephalitis, say 
from a non-perforating- injury of the head, may run its course without our 
having a suspicion of its existence. Still, symptoms like the following should 
not be unheeded: Dizziness; headache; vomiting; loss of consciousness; 
sopor; pupils wide and fixed; pulse slow; rolling of the eyeballs; transitory 
divergence; paralysis of the face or even hemiparesis or hemiplegia ; twitching 
of both hands and feet; convulsions of the extremities. Its extent cannot 
be determined. If not cured, it may result in calcification of ganglion-cells, 
situated under the injured part; in chronic irritable melancholy; in chronic 
headache, dizziness, anxiety and hallucinations; in inability to think, with 
intercurrent periods of excitement and illusions of the senses; in complete im- 
becility, in a state resembling dementia paralytica; in epilepsy and tumors. 

The Diagnosis must principally be based on the knowledge of its 
etiology. 

Therapeutic Hints may be looked after under the preceding chapters on 
the different forms of meningitis. 

INSOLATIO, SUNSTROKE, THERMIC FEVER. 

Whether it be, according to von Grauvogl, a want of water in the blood; 
or according to H. C. Wood, a paralysis of the vasomotor nerves or some 
controlling centre in the brain, which influences the production of heat in 
the body; or according to Hill in Braithzcaitc s Retrospect, 1867, an imperfect 
decarbonization of the blood; or according to Huguen, a hyperaemia of the 
pia and brain; or according to Arndt, a diffuse encephalitis; or according 
to Xothnagel, a venous hyperaemia, dependent upon a diminished power 
of activity of the heart — we shall leave undecided; all physicians, however, 
agree that it is caused by the influence of excessive heat, and not merely by 
an exposure to the direct rays of the sun. The results of post-mortems are 
meagre; the most important may be gleaned from Dr. H. C. Wood's Thermic 
J 7 ci'ci\ 1S72, in which he states: " Right heart and pulmonary arteries, with 
their branches, gorged with dark fluid blood; venous congestion of the lungs 
and entire body. The heart, especially left ventricle, rigidly contracted in 
every case, caused by a coagulation of the myosin, is pathognomic of sun- 
stroke. It most cases, however, it is a post-mortem rather than an ante- 
mortem phenomenon. The muscles after death from each stroke soon become 
rigid, sometimes instantaneously so." As Predisposing Causes are enu- 
merated: "Want of acclimatization, lengthened exertions, deprivation of 
water, the free and habitual use of vile drinks, debility, a febrile state, 
fatigue, bad ventilation, improper head covering and clothing, depressing 
influences. 

Symptoms. — The final " stroke " does not at all set in without warnings. 
At first the wonted work becomes a burden; the muscles lose their elasticity; 
there is great debility, loss of appetite, but great thirst. The head grows 
dizzy, achy; the chest feels oppressed, with frequent and short breathing 



THERAPEUTIC HINTS TO INSOLATIO. 107 

and sighing; the throat gets dry, and swallowing painful; the voice becomes 
weak and hoarse; there is a general anxiety and irritableness of the mind; 
numb feeling in the extremities; restless sleep, or great drowsiness; increased 
vertigo, perhaps nosebleed, redness of the conjunctiva, pale face, tottering 
gait, or giving away of the knees. Many complain of a dreadful goneness at 
the pit of the stomach, nausea, vomiting; pain in the bowels, perhaps sudden 
diarrhoea, with profuse cold perspiration. Oftener the bowels remain consti- 
pated. The mind becomes clouded, he answers confusedly. If for such and 
similar indications nothing is done in the vain hope that it be a mere tran- 
sient indisposition, the "stroke" will surely and speedily follow, unless a 
change in the temperature should head it off by a still more rapid turn. 
This last link of a whole chain of more or less pronounced symptoms is very 
appropriate^ called ' ' stroke. " As if felled down by a blow, the patient sinks 
suddenly to the ground, with entire loss of consciousness, and complete insen- 
sibility of longer or shorter duration; subsultus tendinum; partial spasms, 
or violent general convulsions; or paralysis of the spinal cord, so that he 
cannot move a limb. The face at first is very pale, gradually growing 
flushed, suffused, often deeply cyanosed, and finally assuming a leaden hue. 
The breathing is slow and sighing, or rapid; or deep and labored, often ster- 
torous, with rattling in the trachea. The pulse grows feeble and exceedingly 
rapid; later irregular, intermittent and thready. 

Such a " stroke " might be mistaken for apoplexy, if it were not for the 
heat of the season and the premonitory symptoms. Apoplexy ma3^ occur at 
any season and is often preceded by apparent good health. 

In some cases the temperature rises to 106 to no° Fahr., this form is 
called Thermic Fever. 

Sunstroke is not necessarily fatal and least under homoeopathic treat- 
ment; however, it occasionally leaves very unpleasant after-effects, which 
" consist principally in symptoms of deranged innervation, inability to endure 
heat and sunshine, insomnia, vertigo and weakness, headache which returns 
after exposing oneself to the rays of the sun, or comes at regular times and 
in various parts of the v head; chronic encephalitis; insanity; constipation; 
dyspepsia and derangement of the liver. ' ' 

Therapeutic Hints. 

Man will never be satisfied. Cold water he improves by ice. Now-a-da3 T s 
it would be very old-fashioned not to keep ice- water summer and winter, and 
to gulp it down during, after and between meals. So dictates fashion, and it 
is good for the doctors and ice-companies. So in the treatment of sunstroke. 
Plain water, as river or well provide it, is entirely out of date. Being a 
"stroke," it must be dealt with "strikingly." Ice-water and ice-bags are 
the order of the day. Do we cure a frozen limb by boiling it ? Will you 
cure a man, nearly boiling, by freezing him ? Where is the sense ? But 
fashion has none. When you are called to treat a man struck down by the 
sweltering heat, take water as river or well present it, and bathe his face. 



IOS THERAPEUTIC HINTS TO IXSOLATIO. 

head, chest and spine, arms and limbs well with it. If you can have it luke- 
warm, it is better, because it is nearer to his temperature, and by evaporation 
will withdraw sufficient heat to cool the body down to a natural temperature 
in a very short time, without shock or malice. This alone may restore con- 
sciousness in a short time. But we have also remedial agents which may 
prevent the stroke or shorten its attacks and prevent bad consequences. 

Among the remedies of prevention 

Gelsem. is the most important. It covers all the symptoms of a man 
who feels "play'd out," as Lilienthal so characteristically designates it. It 
is especially indicated in hot, damp, stifling weather, the exact meteorological 
condition of sunstroke and it has, at least in my practice, proved itself ade- 
quate to the occasion. 

Aeon, and Arsen. are characterized by great thirst, hot and dry skin. 

Ant. crud. by a white tongue, loss of appetite. 

Bryon. by great thirst, gastric derangements and aversion to motion. 

Carb.veg. Vertigo; heaviness of head ; pulsative pain above eyes; gen- 
eral debility; obtuseness of sensibility. 

Laches, by great dryness of throat, hoarseness; tightness and oppression 
of chest, and drowsiness. 

Ver. vir. by prostration, febrile motion and accelerated pulse. 

Among the remedies during the attack 

Glonoin is the most important. Violent headache; vertigo; does not 
know the street nor his own house; losing senses and sinking down uncon- 
scious. Conjunctiva reddened; mist, black spots or visions of light before the 
eyes; pale and agitated countenance. White tongue as if painted. Thirst, 
pain and throbbing in the pit of stomach with a sense of sinking. Oppressed 
breathing, sighing, constriction and anxiety. Laborious and violent action 
of the heart. Numbness of limbs; muscular tremor; great prostration; 
sopor; convulsions. 

Amy! nitr. Anxiety; longing for fresh air; dull confusion of head; 
giddy, intoxicated feeling; head feels full to bursting; eyes protruded, star- 
ing; conjunctiva bloodshot; intense surging of blood to the face; crampy, 
epigastric pain; burning and pressure in stomach; dyspnoea and constriction 
of chest and heart; tumultuous beating of heart; tremulousness of hands and 
tired feeling in legs; tottering gait; weak, relaxed feeling. 

Bellad. Similar to Glonoin. Drowsiness; dulness of mind; congestions 
towards head; loss of consciousness; headache; vertigo; anguish; flashes 
before the eyes; whizzing in ears; constriction of chest; worse in summer heat. 

Campoora. Sinking of the forces; oppression of breathing; embarrassed 
action of the heart; coldness of body, tremors and cramps. 

Opium. Unconsciousness; deep coma; eyes glass}' and half closed. 

SEQUELS may be met with by 

. igar. Vertigo from sunlight. 

A)iac. Loss of memory. 

Bar. carl?., Laches., Natr. card., Stramon. Headache from being ex- 
posed to the sun. 



APOPLEXIA SANGUINE A. IO9 



APOPLEXIA SANGUINEA. 



It consists of an intracerebral haemorrhage, forming clots of various 
dimensions, usually from the size of a hazel-nut to that of a small apple, but 
they may be much larger or much smaller; their shape is either round or 
they are spread out in layers to a greater or less extent; they may occur 
singly, which is the rule, or in numbers of two, four or more. Their favorite 
seats are the corpus striatum and the nucleus lenticularis, with the neighbor- 
ing parts of the hemisphere, and the thalami optici; in other parts they occur 
only exceptionally, and in the cornu Ammonis, the corpus callosum or the 
fornix scarcely ever. 

Unless fatal after a few hours, these clots and the surrounding tissue 
soon undergo structural changes. By absorptions of the fluid parts the whole 
mass thickens, turns at first dark red and later yellowish, and the surrounding 
tissue becomes soft partly from the inhibition of serum and partly from fatty 
degeneration, or inflames to a greater or less extent. If the patient survives 
the attack for some time, the clot forms into a cyst which may persist without 
change; or is converted into so-called apoplectic cicatricial tissue. 

Capillary haemorrhages, showing blood-points of the size of a pin's head 
and smaller, are met with in places of softening, or in the cortex cerebri in 
consequence of thrombosis of the venous sinuses; they are secondary processes 
and should not be considered under this head. 

The Cause of these intracerebral haemorrhages is now in general at- 
tributed to a diseased condition of the cerebral vessels, especially the arteries, 
which consists, according to Charcot and Bouchard, in the formation of 
numerous miliary aneurisms, in consequence of chronic periarteritis. They 
may burst spontaneously under an ordinary amount of blood-pressure within 
the cranium, as in cases where the apoplectic attack occurs during sleep or 
in perfect rest, or they may be ruptured by an increased amount of blood- 
pressure during spells of hard coughing, vomiting, laughing, straining at 
stool, or during parturition; in consequence of mental excitement, or bodily 
exertions; after a full meal and the use of alcohol and coffee, and other car- 
diac stimulants. The most frequent occurrence of apoplectic attacks is after 
forty years of age, although childhood is not exempt. 

Symptoms. — In some cases, not in all, the first attack is preceded by 
premonitions for weeks, months, even }^ears. These are: frequentty recurring 
dizziness, headache, ringing in the ears, muscae volitantes, alterations in the 
disposition, sudden but transient loss of power to speak without paralysis of 
the tongue; sudden transient paresis in one arm, or leg, or both; or a sense 
of stiffness, a feeling of " pins and needles," numb feelings, or sensation of 
heat and cold, or of pain of an indescribable character in the extremities; 
disturbances of vision, diplopia and even amaurosis; sometimes nosebleed. 

The attack itself is ushered in by a sudden loss of consciousness, in 
many but not in all cases. It may develop itself gradually with symptoms 
above described, and unconsciousness following only after a lapse of several 



II,, APOPLEXIA SANGUINEA. 

hours or days, especially after venesection; or it may commence with pa- 
ralysis of one side: or with chronic or tonic spasms of certain muscles which 
later become paralyzed, when hours afterwards sopor follows; or conscious- 
ness may not be lost for a moment, although the symptoms which precede 
the attack and those which usually follow and remain permanently after the 
return of consciousness in the usual cases, leave no doubt of an actual intra- 
cranial haemorrhage. In case of complete sopor and relaxation of all the 
muscles in a degree that hemiplegia cannot be recognized in order to distin- 
guish the attack from opium poison, asphyxia, etc., we shall find the eyeballs 
turned toward the non-paralyzed side of the body; this symptom usually 
lasts a few days. The color of the face is not uniformly the same in all 
cases; sometimes it is deep *ed, even cyanotic; sometimes natural, or again 
quite pale; the pupils may be dilated, of normal size or contracted; one 
pupil larger than the other points to a unilateral affection of the brain ; the 
pulse varies likewise in different cases; in most cases it is slow and some- 
times irregular; in others very rapid and regular; the respiration may be 
quiet and regular as in healthy sleep; it may be labored, stertorous; it may, 
during deep sopor, be a kind of blowing, drawing the cheeks in during in- 
spiration and puffing them out during expiration — the so-called tobacco- 
smoker's respiration; towards the end respiration becomes intermittent and 
irregular. The temperature is at first usuahV lowered to 96. 3 F., and re- 
mains so in the fulminating form until death. If life endures for from ten to 
twenty-four hours the temperature rises rapidly. If life is prolonged to a 
still longer period the temperature rises only to 99. 8° or 100. 4 F., where it 
remains; another sudden rise is a very unfavorable symptom, as it usually 
precedes death. Urine and feces pass off involuntary during sopor. Ful- 
minating cases terminate in from five minutes (rare cases) to three or four 
days. Recovery rarely takes place after the coma has lasted forty-eight 
hours. But even if the coma ceases health is by far not restored; now in- 
flammatory reaction sets in; the temperature rises from a few tenths of a 
degree to two degrees; there is occasional cloudiness of mind, even delirium; 
loss of appetite; convulsive movements, even tonic contractions with pain in 
these parts. This may last for several days and then subside for a time, 
when the same symptoms, although in a milder form, reappear again at in- 
tervals of two, four or eight days. But there remain permanent symptoms 
for a long time, often through life, which depend on the extent and seat of 
the destruction caused by the haemorrhage. These are, with a few excep- 
tions, hemiplegia of that side of the body which is opposite to that in which 
the lesion of the brain occurred; paraplegia if the haemorrhage occurred 
simultaneously in both hemispheres; partial paralysis, for example, of the 
facial nerve, in connection with extravasation in the optic thalmus, and in 
the corpus striatum; contracture (in the later stages) of the paralyzed limbs; 
anaesthesia of the affected parts, which may or may not diminish or com- 
pletely disappear; hyperalgesia, by which a light touch is felt as pain, and 



THERAPEUTIC HINTS TO APOPLEXIA SANGUINEA. Ill 

which may alternate with anaesthesia or even exist side by side with it for 
years; spontaneous attacks of pain in the partially or totally paralyzed limbs. 

There are also disburbances of the trophic and vasomotor nerves. The 
affected limbs are often hotter and redder for some time than those of the 
unaffected side; they are swollen, oedematous; they sweat profusely; after 
some time, however, they become cold; or the skin is tending to be dry and 
scaly from the first; the pulse is diminished in its amplitude; bedsores ap- 
pear; the nails become yellowish, ridgy, brittle and curved in both direc- 
tions; the hair grows thicker and longer and the skin becomes hypertophied 
— all on the paralyzed side. 

Of the special senses taste is limited to the forepart of the tongue on one 
side in consequence of an affection of the chorda tympani; this symptom 
usually disappears soon, but may last for a long time. Hearing is sometimes 
slightly affected, and sight in the form of hemiopia frequently. 

Among the mental disturbances deficiency of memory is the most promi- 
nent, especially in regard to recent impressions, while old ones can be re- 
called with unimpaired distinctness. The power of judging may gradually 
weaken until the patient is reduced to childishness or dementia; the disposi- 
tion often changes to peevishness and irritableness. 

The Prognosis is grave; even if recovery from the shock takes place 
the consequences of the reactive inflammation are always to be dreaded, and 
there is no safety for a renewed attack at any time thereafter. 

Therapeutic Hints. 

Remedies to prevent the attack ought to be studied under hyperemia, to 
which may be added: 

Sepia. After previous attacks; in men who have been addicted to 
drinking and sexual excesses, with a disposition to gout and haemorrhoids. 
Forerunners: dizziness in walking, with staggering; things fall out of their 
hands; forgetfulness; use wrong words when writing; cold feet; intermitting 
pulse. 

Remedies during the attack and its inflammatory stage : 

Aeon. Head hot; carotids throbbing; skin hot; pulse full and hard, but 
not intermittent; after fright or vexation, or suppressed habitual bleedings. 

Arnica. Head hot and rest of body cool; paralysis of left side; pulse 
intermittent and irregular. 

Bellad. Red face; dilated pupils; loss of sight, smell and speech; pul- 
sation of carotids; spasms in the face; thick tongue, protruding; difficult 
deglutition; involuntary emission of urine; reaching with the hands to the 
genitals; moaning; paratysis of limbs, right or left; coma, sopor. 

Cocad. Face red and hot; eyes closed, with the balls constantly roll- 
ing about; pupils dilated; breathing without noise; stupor; left or right ex- 
tremities paralyzed; after night- watching and exhaustion. 

Conium. " Eighty years of age; one side completely paralyzed: sweat 
as soon as he falls asleep and even with the closing of the eyes.' 1 (Nash.) 

Gelsem. and Glonoin. See under Hyperaeniia. 



112 THERAPEUTIC HINTS TO APOPLEXIA SANGUINEA. 

Hyosc. Sudden falling down with a shriek; soporous condition; face 
red; inability to swallow; involuntary discharge of feces; blood-vessels 
swollen; pulse quick and full; numbness of hands after consciousness returns. 

Laches. Left side mostly affected; blowing expiration; cannot bear 
anything to touch his neck; when conscious talks and jumps abruptly from 
one idea to another; after the use of liquors or mental emotions. 

Lauroc. Vertigo; bloated face; jerking of the facial muscles; speech- 
less by full consciousness; palpitation of the heart; scarcely perceptible 
pulse; cold, moist skin, 

Xux vom. Snoring; paralysis of lower jaw and (mostly) of the lower 
extremities, which are cold and without sensation; after a heart}' dinner, or 
abuse of liquor or coffee. 

Opium. Open eyes; dilated pupils; red face; jerking of the muscles of 
the face; sinking of the lower jaw; foam before the mouth; slow, irregular 
or stertorous breathing; convulsive motions of the extremities, or tetanic 
stiffness of the whole body; cold, paralyzed limbs; hot sweat on the head. 
After consciousness is restored, the patient cannot retain what he reads and 
forgets the connection of consecutive thoughts. Old drunkards; is followed 
well by Xux vom. 

Remedies for subsequent chronic changes : 

^iiiac. Loss of memory; general paralysis. 

Caustic. Inability to select proper words; paralysis of face or extremi- 
ties, which latter is complicated with muscular contractions. 

Cuprum. Paralysis of tongue, stuttering, deficient speech; the para- 
lyzed limbs grow thinner, but preserve sensation; frequently complicated 
with unyielding contractions or chorea-like paroxysms. 

Plumbum. Consciousness blunted; mem or}' deficient; speech impeded, 
single syllables are omitted or the syllables cannot be combined into words; 
mimic spasms of face when speaking; trembling of tongue when it is put out; 
semi-paralysis of the buccinator muscles and of the velum palatinum, which 
manifests itself by violent snoring; sleeplessness, fear of death; the organs of 
the senses are torpid and insensible, the eyes are principally affected; the 
eyelids droop as if paralyzed; the pupils most constantly dilated; all objects 
seem smaller and further removed from the focus of vision, they may be seen 
as through a gauze; diplopia; pulse always slow, 50 to 60 in the minute; 
sometimes hard and tense like a wire; all the muscles may be paralyzed, 
especially of left side; the paralysis affects equally the motor and sentient 
nerves, is often attended with violent pains in the paralyzed parts, and con- 
siderable contractions, especially of the extensor muscles, which feel as hard 
as wood; in other cases the spasms are tonic, which, if they reach their full 
development, run into complete epileptic convulsions; the muscles of the 
affected parts become atrophied. If the paralysis is not complete, the 
patient's gait is unsteady, with particular tendency to fall forward. The 
paralyzed respirator}- muscles often occasion a high degree of dyspnoea. The' 
sphincters are scarcely ever paralyzed. (Baehr. ) 

Ziucum. Senses remain disturbed after the attack. 

Besides, compare what has been said under Meningitis. 



OCCLUSION OF THE CEREBRAL ARTERIES. 113 



OCCLUSION OF THE CEREBRAL ARTERIES; EMBOLISM 
AND THROMBOSIS ; SOFTENING OF THE BRAIN. 

An occlusion of the cerebral arteries takes place either by embolism, 
when the occluding mass is carried by the stream of blood from some other 
parts of the vascular system to a place where, on account of the smallness of 
the vessel, it cannot go any further; or by thrombosis, when the occluding 
mass is produced on the very spot of the occlusion. 

The emboli consist either of blood clots, masses of fibrine, connective 
tissue growths, or chalky concretions, the principal source of which is endo- 
carditis ; and next aneurism of the aorta; seldom thrombotic masses from 
within the lungs. 

Thrombosis takes its origin through structural changes in the vascular 
walls, such as fatty degeneration, or inflammation of the coats of the arteries, 
leading to sclerosis, ossification, or calcification, by which a gradual slack- 
ening in the speed of the blood current takes place, until an entire stoppage 
ensues. 

The emboli are carried much oftener into the left carotid than into the 
right, and they only exceptionally become lodged below the circle of Willis, 
but are swept into the arteria fossae Sylvii, which is the chief direct prolonga- 
tion of the carotid. Sometimes several arteries become the seat of occlusion 
at the same time. If the seat of occlusion is below or on the cardiac side of 
the circle of Willis, or if the embolus is swept onward into the arterial system 
of the cortex, no anatomical changes follow in the cerebral substance, because 
the circulatory disturbances are readily compensated for by collateral circu- 
lation. When, however, the embolus is lodged in a terminal artery of the 
basal system, or is carried beyond the circle of Willis, it causes first " red 
softening" of the neighboring brain-tissue, that is, the brain substance 
appears swollen and discolored in different shades of red and is dispersed 
with numerous dots of blood ( ' ' capillary apoplexies " ) . By and by the red 
color fades into yellow, partly from the absorption of the coloring matter of 
the blood, and partly from the ensuing fatty degeneration of the nerve 
elements; this state of things is called "yellow softening." After a lapse of 
several months, if the patient lives that long, the affected tissue is converted 
into a semi-fluid milky substance, which is termed "white softening." At 
length even this may partially be absorbed, leaving a sort of cyst filled with 
quite thin fluid. 

The Predisposing Cause of embolism is preeminently acute rheuma- 
tism, and it is therefore found oftener in relative^ youthful persons, while 
thrombosis has its predisposing cause in a morbid change of the vascular 
system, and is therefore oftenest met with in advanced years. 

Symptoms. — Embolism always sets in suddenly, and very often with a 
condition, which] resembles precisely that of an apoplectic stroke, without 
any premonitory symptoms. In some cases, however, there is no loss of con- 



114 THERAPEUTIC HINTS TO OCCLUSION OF THE CEREBRI, ARTERIES. 

sciousness or coma; there ma}' be delirium, aphasia, vomiting, paralysis — all 
disappearing in a few hours. 

Thrombosis comes on slowly with headache, dizziness and a sense of 
general confusion, loss of memory, numbness, coldness, and creepings either 
in only one extremity, or throughout the distribution of one nerve, or in one 
entire half of the body; paretic and paralytic symptoms, perhaps w r ith pre- 
ceding slight convulsive movements, likewise confined to certain regions of 
the body and determined by the size and importance of the occlued vessel. 
Finally the total occlusion ma}- manifest itself with all the symptoms of an 
apoplectic fit, or may occur without any loss of consciousness. 

In the further course of development embolism or thrombosis may be 
described conjointly. Either of them may terminate in death or in com- 
plete recovery, or be followed by a repetition, or by a chronic development 
of symptoms as consequences of the structural changes within the brain 
above described. Only these latter symptoms concern us here. The tem- 
perature begins to rise on the second or third day and may quickly reach 
104 F. , when after two or three days it rapidly sinks again and finally 
becomes stationary. Indeed the complex of symptoms now developing may 
be regarded as identical with that of cerebral haemorrhage, and need not, 
therefore, be repeated. Aphasia is of very frequent occurrence in this affec- 
tion, because the left Sylvian artery is the most common seat for embolic 
occlusion, inducing functional disturbances in that district of the cortex 
cerebri with which disorders of speech are regularly associated. 

The Diagnosis between embolism and haemorrhage is very difficult, 
unless we can take the predisposing causes (valvular diseases of heart and 
affection of the lungs) as a starting point. A distinction between throm- 
bosis and haemorrhage is not possible, only that the first occurs much less 
frequently than the latter. 

Therapeutic Hints. 

Compare Apoplexy and the various forms of meningeal affections spoken 
of before, to which I add the following remarks of Dr. H. R. Stiles: "When 
the disease shows evidence of inflammatory action, or is recent, Bellad., 
Nux vom., Mercur.; where it is evidently due to atheromatous conditions of 
arteries, Phosphor., Phosph. ac, Anac, Zincum; for hemiplegia, Nux vom., 
Coccul., Bar. carb., Arnica; for vertigo, Iodine (congestive), Sulphur, Digit., 
(cardiac); for sleeplessness, Coffea, Hyosc, or Nux vom., and Chamom., if 
the patient has been addicted to the use of coffee; China, if he has been a 
great tea drinker; for paralysis (general), Phosphor., Conium, Coccul. (local), 
Caustic, Aeon., Ignat., Bellad.; for convulsions (simulating epilyeps), 
Bellad.. Cole, carb., Cuprum, Strychnine; for emotional disturbances, Ignat. ; 
headache (active), Aeon., Bellad., Bryon., A T ux vom., Glonoin. (passive), 
Gelsem.j Opium,- for imbecility, Arnica, Ambra, Selen., Sepia; or sensation 
of formication, Secale. ' ' 

Compare nlso therapeutic hints under dementia paralytica. 



APHASIA. 115 



APHASIA. 



Under this term clinical observers have arranged a variety of deficien- 
cies of speech. 

When there is an incapacity for the motor co-ordination, so that the pa- 
tient, although he understands all that is said to him, and is able to express 
his wishes by writing, is yet unable to express them by words, although his 
organs of speech — tongue, etc. — are in perfect order, it is called ataxic 
aphasia. Here the connection between the idea and the organs of speech 
is interrupted. In some of these cases this does not amount to entire speech- 
lessness, some words of one syllable may possibly be in his reach, and he uses 
them as best he can, making up by writing and gestures what he cannot con- 
vey bywords; others utter only a few senseless syllables and words; but none 
can repeat words even if dictated to them. At times ataxic aphasia is com- 
plicated with agraphia, an inability to write either a single letter or a com- 
bination of letters into intelligible words and sentences, although otherwise 
the hands are fit to perform all sorts of other mechanical uses. The speech 
of gestures is seldom implicated in this affection. 

When there is an incapacity for the recollection of words, although the 
idea is present and the articulation is at the service of the word, it is called 
amnesic aphasia. Here the association between the idea and the word (its 
verbal expression) is interrupted. This occurs even during health. Some- 
times, with our best endeavors, we cannot recollect a name; in the diseased 
state especially nouns, which cannot be roused into consciousness; therefore 
the patient tries to describe what he means by other words, for instance, call- 
ing a pair of scissors ' ' that which cuts. " Or it is only the initial letters 
which are wanting, and he omits them in speaking and writing; or in more 
profound derangements, although the patient may be able, by paying strict 
attention, to repeat what another speaks aloud before him several times, of 
his own accord he cannot utter it at all, or only badly articulated, mutilated 
and distorted. So also the letter-signs are either totally forgotten, or ap- 
plied in unintelligible connections, while on the other hand the reading of 
written or printed matter may not meet any obstacles. 

When there is an inability to understand the words wnich they hear, or to 
read the words which they see, although sight or hearing and the ability to 
express their thoughs by speech and writing are unimpaired, it is called 
word deafness and word-blindness (Kussmaul). Here the association be- 
tween the word (spoken or written) and the idea is impeded, or in other 
words the external stimulus does not reach the idea, while in the amnesic 
form of aphasia the idea is not capable of exciting its corresponding verbal 
expression. This affection, however, is generally combined with amnesic 
aphasia or agraphia, and patients of this kind have been taken for deaf and 
demented, because their answers did not correspond to the sense of the ques- 
tions and they used distorted or wrong words. 

When there is an inability to connect the ideas with their appropriate 



Il6 THERAPEUTIC HINTS TO APHASIA. 

word-expressions, so that instead of the appropriate term another word of a 
different meaning or altogether strange and unintelligible expressions are 
used, it is called paraphasia. Here the connection between the ideas and 
their proper expressions is loosened, in a way that other words or names of 
ideas similar perhaps in meaning or sound interpose themselves and repress 
the proper ones. This disorder occurs at times without any pronounced 
morbid condition of the brain, when for instance from want of proper atten- 
tion we use a word which belongs perhaps to another train of thoughts, but 
which at that time preoccupies the mind; or in the hurry of excitement, dis- 
place the consonants of certain words and form strange, irregular combina- 
tions, say, for instance, " mood goring " instead of " good morning," or in- 
stead of "Liebig and Mitscherlich," as an absent-minded professor did, 
'' Mitschich and Liederlich." But in marked states of the brain this para- 
phasic confusion may amount to such total perversion and corruption of 
words and sentences that it is completely impossible for the hearer to under- 
stand what the patient means. And the same is true of paragraphia. 
"Royal naval medical office, etc.," one wrote in the following manner: 
11 Roydudendd navendendd oforendendd, etc." 

By numerous post-mortems it is proved that lesions of the left frontal 
lobe, and especially its third frontal convolution, are the most frequent 
Causes of aphasia ; the island with the neighboring frontal, parietal and 
temporal districts comes next in frequency. Aphasias, from lesions in other 
regions, are exceptions to the rule, as for instance the lesions of the right 
frontal lobe. These latter cause aphasia only in left-handed people, for the 
reason that such persons have exercised for speech and action the right 
frontal lobe; a lesion of the left frontal lobe does not affect their speech, 
since that of the right, which alone has been exercised, remains intact. 
Left-handed people, therefore, become aphasic only when the lesions include 
the right hemisphere; while lesions of the left lobe always cause aphasia in 
right-handed persons. 

These lesions for the most part consist of necrotic softenings from 
embolism and thrombosis of the artery of the fissure of Sylvius; then follow 
in frequency in the order named haemorrhages, abscesses and tumors of this 
region. Aphasia is, therefore, merely a symptom of pathological conditions, 
most of which we have already described separately. Its Prognosis 
depends entirely on the severity of these conditions, and they ought to be 
studied thoroughly in any case of aphasia. 

Therapeutic Hints. 

Here we must naturally refer to those already given under the corre- 
sponding chapters. Cases reported have been cured by: 

Bellad. Compare symptoms under apoplexy. ' ' After excessive fatigue, 
bad nourishment, loss of sleep, prostrated and enfeebled, that he cannot 
answer the simplest question. ' ' (Gallavardin. ) 



THROMBOSIS OF THE CEREBRAL SINUSES. 117 

Conium. Parenchymatous nephritis after scarlet fever. 
Glonoin. Loss of memory for words and of the power to articulate. 
Kali brom., 3d trit. Without symptoms mentioned. 
Lycop. Confusion of thoughts; forgetful; mixed up letters and sylla- 
bles of words in writing, or left out part of them. 

Stramon. In several cases used empirically with success. 

For additional hints compare the following collection of symptoms: 
Senseless after waking from a sleep at noon: Conium. 
Forgetful and absent-minded, with headache: Amm. carb. 
Cannot remember things which he wants to remember: Hyosc. ?iig. 
Forgets names: Anac, Oleand., Sulphur. 

Remembers having seen a person, but cannot remember her name. Crocus. 
All things appear new to him, after waking, even his friends: Stramon. 
Makes mistakes about time and objects, although they are quite clear and 

visible: Crocus. 
Unable to express himself properly while talking: Conium. 
Cannot talk connectedly: Canthar. 

nor express himself properly, with rush of blood to the head: Arg. nitr. 

Distracted, does not know what to say: Natr. mur. 

Slow remembrance, talks slow, hunts for the words when talking: Thuja. 

Absent-minded and forgetful: Alum., Bellad., Bovista, Coccul., Phosph. ac, 

Platin. 

with awkwardness in talking: Amm. carb., Natr. mur., Sepia, Sulph. ac. 

and awkwardness in writing: Bovista. 

Inability to find the right words: Anac, Arg. nitr., Mercur., Pulsat. 

with stammering: Chamom., Opium. 

with making mistakes in writing: Chamom., China, Graphit., Hepar, 

Ignat., Nux vom. 
With headache uses wrong words: Caustic, Nux mosch., or 

has difficulty in talking: Thuja. 

Absent-minded, says what she does not intend: Natr. mur., and 

makes mistakes in writing: Natr. mur. 

Leaves words out when writing: Rhodod. 

When he wants to write something down, he loses the ideas: Crocus. 
Forgetful, so that he cannot recall what he was about to write: Natr. mur. 
He can express himself on abstract subjects very well; when talking about 

common things, he gets confused: Lycop. 
He cannot read what he wrote himself: Lycop. 
Difficulty in understanding what he is reading: Conium. 

THROMBOSIS OF THE CEREBRAL SINUSES. 

The sinuses being ot a rigid nature and incapable of collapsing, they being 
also traversed by bands of connective tissue, and having no muscular walls 
to promote the flow of blood, it is easily comprehensible that in them a 



I i S THROMBOSIS OF THE CEREBRAL SINUSES. 

coagulation of blood may readily occur, if either the propelling power of the 
heart, the vis a tergo, should become weakened, or there should form obstacles 
to the flow of blood in the sinuses themselves by inflammation of their walls 
I phlebitis). The first usually occurs under conditions as are known by the 
name of marasmus, particularly common among children during their 
first year of life, when they are prone to sudden collapse induced by severe 
diarrhoeas; also in adults through the influence of various conditions which 
induce enfeeblement of the propelling force of the heart, such as profuse sup- 
puration, cancer, marasmus, senilis, etc. This form of thrombosis is especially 
found in the longitudinal sinus and in the transverse sinuses, and is called 
marantic thrombosis. 

The second or phlebitic form originates most commonly from disease 
of the cranial bones, especially of the petrous portion of the temporal bones 
which accompanies otitis media; then its seat is in the neighboring sinuses 
— the sinus transversus and petrosus; if phlebitis arises from caries of other 
cranial bones, or large furuncles in the face, especially on the upper lip, or 
erysipelas of the head and face, its seat is determined by the location of these 
lesions. 

The Symptoms of marantic thrombosis when accompanying conditions 
of marasmus in children, resemble greatly those of hydrencephaloid, both 
giving rise to cerebral anaemia; collapse, followed by somnolence and coma, 
is common to both. As a general rule of distinction between the two, the 
following may be laid down: If diarrhoeas, occurring in children a few months 
old, are followed by cerebral disorders of the active motor kind, such as 
rigidity of the muscles of the neck and sometimes of the back, and even of 
the limbs, sometimes nystagmus, the probability speaks for thrombosis of the 
superior longitudinal sinus; whereas the clinical history of hydrencephaloid 
usually closes with collapse, somnolence and coma, terminating either in 
death or recovery; convulsions or paralysis are only exceptionally met with. 

Marantic thrombosis in adults is in its manifestations still more indefinite. 
It may show nothing but a slight degree of apathy and general depression, a 
varying complex of symptoms of diffused, undefined cerebral diseases, such 
as headache, delirium, loss of consciousness, disturbance of the motor func- 
tions either of the spasmodic or paralytic kind. In some cases, however, 
symptoms occur in children as well as in adults, which are diagnostic, namely: 
swelling of those veins outside of the skull, which communicate with the af- 
fected sinuses; epistaxis ; tensely filled vessels, running from the anterior 
fontanelle to the neighborhood of the temples and ears on both sides; cyanosis 
of the face, all this in case of thrombosis of the superior longitudinal sinus. 

When the transverse sinuses are affected, there may be oedema limited 
to the parts behind the ears; or the internal jugular vein may be found less 
filled on the side of the lesion, than on the other side, but this symptom is 
not often so prominent that it could be turned to account. 

When the sinus cavernosus is the seat of the disease, there usually exists 
hyperaemia of the fundus oculi, oedema of the eyelids and. conjunctiva, and 



HYPERTROPHY OF THE BRAIN. 1 19 

prominence of the eyeball ; sometimes on account of the pressure upon the 
first division of the trigeminus, the trochlearis, the abducens, and the oculo- 
motorius, paratysis of the motor nerves, or neuralgia or trophic disturbance 
of the eye may arise. 

Sometimes particles from the thrombi are carried off by the blood-cur- 
rent and become lodged in the lungs. If such pulmonary embolism are found 
under conditions above described, it would be another sign in favor of the 
conclusion, that thrombosis of the cerebral sinuses actually exists. 

The Prognosis of this affection is decidedly unfavorable, and in regard 
to therapeutic hints, I must refer to hydrencephaloid, anaemia, summer-com- 
plaint, inflammation of the inner ear and other affections which are more or 
less related to this affection. 

HYPERTROPHY OF THE BRAIN 

Means an overgrowth of the brain. However, we ought to know, that it is 
not the cerebral substance itself, which develops more largely than naturally, 
but that "it consists of an undue growth of the interstitial tissue which binds 
the nervous elements together. It is confined mostly to the cerebrum; yet 
there are a few cases in which the cerebellum has also been said to be affected. 
Partial hypertrophy is still more rare, and in part, of very doubtful nature. 

On post-mortem examination the brain is observed to swell out from 
under the removed bone above the skull bones. The adjustment of the re- 
moved bones to their original position is quite difficult. The membranes are 
thin and bloodless, and between the arachnoidal spaces there is no cerebro- 
spinal fluid. The convolutions on the surface of the cerebral hemispheres 
are flattened and compressed, and the sulci between them scarcely noticeable. 
The ventricles are narrow and the substance of the brain itself is anaemic, 
but its consistence and elasticity is greater than in a normal brain. 

This abnormal growth is either congenital (and then is frequently com- 
bined with an imperfect growth of the body), or it develops itself after birth, 
mostly during early childhood, rarely afterwards. In the latter case we find 
it frequently associated with rhachitis and enlarged lymphatic glands. Its 
Causks are unknown. Its external Symptoms are: a considerable enlarge- 
ment of the head, if it takes place before the sutures of the skull are perfectly 
closed; a condition entirely similar to that in the enlargement of the head in 
consequence of hydrocephalus. When it takes place after the closure of the 
sutures, such extension is impossible, but the skull bones grow thinner and 
their inner layer becomes roughened by absorption. In the first place it can 
be distinguished from hydrocephalus by this fact: that children having this 
affection are rather forward in their mental development, while in hydro- 
cephalus the reverse always obtains. A hypertrophy after the closure of the 
sutures is never recognizable with certaint}'. One of its most important 
symptoms, however, are frequent attacks of fits, which resemble epilepsy. 



120 atrophy of the brain. 

Therapeutic Hints 

Cannot be given a priori. Each individual case must be studied by itself. 
Compare Hyperemia. 

ATROPHY OF THE BRAIN 

Is the opposite of hypertrophy, a shrinking, wasting away of the brain. 

Deficiencies of growth have been found congenital, being confined 
either — i, to both hemispheres of the cerebrum; or 2, to both hemispheres 
of the cerebellum ; or 3 , to certain parts of the brain which are not developed 
at all. In such cases the children are idiots. In some other cases the defi- 
ciency has been found confined; 4, to one-half of the cerebrum and to the 
opposite half of the cerebellum (the usual condition), or to the corresponding 
half of the cerebellum; then the children are not idiots, but mostly affected 
with hemiplegia of the opposite side and in a great many cases with epileptic 
fits. This deficiency, in the proper development of the brain, the causes of 
which we do not know, is called agenesia. 

Ileal atrophy is a shrinking — wasting away — of the cerebral substance. 
It occurs, occasionlly, in old age, in consequence of marasmus senilis, where 
a want of general nutrition causes a waste of the brain; the lost substance 
being at once replaced by an exudation of serum, constituting hydrocephalus 
senilis. It also occurs as a result of exhausting diseases and chonic alco- 
holism, almost always leading to general paralysis and imbecility of mind. 

But it may develop itself in portions of the brain only — partial atrophy 
— when in consequence of apoplexy, inflammation or exudation, as we have, 
already seen, by destruction or pressure upon the capillaries or arteries, such 
portions become deprived of the necessary nutrition. Its consequences are, 
in almost all cases, aberrations of the intellect, imbecility of mind, and para- 
lytic affections. 

Therapeutic Hints. 

A deficient development of a portion of the brain can not be remedied; 
congenital deficiencies are therefore clearly out of the reach of any medicine. 
Where we suspect an atrophy in consequence of exhausting disease, we must 
select our remedies according to these circumstances. Destroyed portions 
will ever remain destroyed in spite of medicine. 

TUMORS OF THE BRAIN AND ITS MEMBRANES 

Consist of morbid growths in the connective and epithelial tissues of the 
blood-vessels and their sheaths, which either retain the character of the 
affected tissue, or become altered by modification of the newly-formed ele- 
ments and by changes in their relations to the connective tissue and vascular 
distribution. 

Their Causes seem to be a hereditary predisposition, abuses of spiritu- 
ous drinks, blows and falls of all kinds, syphilis and tuberculosis. They 
occur much more frequently in men than in women. 



TUMORS OF THE BRAIN AND ITS MEMBRANES. 121 

Tumors which retain the character of the affected tissue, are: 

Glioma, formed by proliferation of the neuroglia, greatly resembles 
normal brain tissue, and is therefore not easily distinguishable; when it 
assumes a more mucous character, it is soft and closely resembles myxoma ; 
when its structure is harder, it resembles and is allied to sarcoma. It grows 
slowly, may finally undergo fatty degeneration, and is found usually in the 
white substance of the cerebral hemispheres and especially their posterior 
lobes. 

Hyperplasia of the pineal gland presents a solid, grayish-red, slightly 
lobulated or else smooth, round tumor, which may grow as large as a walnut 
or even larger; its histological elements are somewhat larger and firmer than 
in the normal. 

Psammona or sand tumor is an inflammatory proliferation of the cellular 
tissue in which a calcareous deposit takes place; it usually grows from the 
dura mater commonly at the base of the skull, is a hard, hemispherical 
tumor, white and smooth and of the size of a cherry-stone. 

Melanoma takes its origin in the pigment cells of the pia, is small in 
size, but may be multiple; is of rare occurrence. 

Neuroma, a genuine hyperplasia of the gray substance, occurs in sizes 
from a millet-seed to that of a pea and is found on the ventricular surface, in 
the white substance, or on the outer surface of the brain. 

Hyperplasia of the anterior half of the pituitary gland. 

Cysts may be the result from apoplectic effusions, abscesses and softening. 

Aneurisms are of frequent occurrence, especially upon the large vessels 
at the base of the brain, and usually in consequence of atheroma; when 
bursting they cause fatal apoplexy. 

Cholesteatomata consist partly of hardened epithelial cells and partly of 
epithelial cells which have undergone fatty degeneration; they unite, as 
Rindfleish says, ' ' the structure of an epithelial carcinoma with the harmless- 
ness of a wart or weal. ' ' They are generally found in some hollow at the 
base of the skull or in some recess of the brain. 

Tumors by which the affected tissue is changed in its character, are: 

Tubercles, gray, yellow, or yellowish- white, hard tumors, which fre- 
quently grow larger than a hazel-nut; their favorite position is the gray sub- 
stance, especially of the cerebellum; they occur most frequently in child- 
hood. Miliary tubercles are a frequent concomitant or source of meningeal 
inflammation. 

Carcinoma appears usually as primary fungus hsematodes on the outer 
or inner surface of the dura. When starting from the outer surface it rapidly 
softens and pierces the skull bones and then spreads on the external surface 
of the skull (fungus durse matris); when originating on the inner surface its 
growth is entirely directed towards the brain; it never penetrates the dura, 
except at the natural openings for the nerves, such as the olfactory, optic, 
etc. , hence the growing in and out of cancers in the orbits on the perforated 
plate of the ethmoid bone, in the spheno-maxillary fossa and so on. 



122 THERAPEUTIC HINTS TO TUMORS OF THE BRAIX. 

Sarcoma is either a hard, dense, homogeneous mass, which can easily be 
detached from the surrounding tissue, or is of a soft, medullary consistence, 
which constitutes a transition to a myxoma or glioma. 

Myxoma forms a very soft gelatinous mass, which frequently breaks 
down into cysts containing a mucous fluid; they may attain the size of a 
man's fist, and are met with only occasionally in the cerebral hemispheres. 

Syphilitic tumors are not common; they generally resemble the gum- 
mata of other parts, being composed chief!)* of grayish, semi-translucent 
matter, which is liable to become opaque and crumbling on undergoing a 
caseous transformation. 

Symptoms. — One should suppose that the pressure of any of these 
tumors should manifest itself more or less by various outward symptoms. 
But this is not always the case. Large tumors have been found post- 
mortem, and not a single symptom did betray them during life. It is 
remarkable how the system, even the brain, ma}* become accustomed to an 
abnormal growth, when it is invaded slowly. Yet there are symptoms in 
many cases which should rouse our suspicion in this direction. They are: 
Depression of spirits, melancholy, rarely maniacal attacks, mental derange- 
ment, aphasia, sleepiness; amblyopia and amaurosis, with the appearance of 
choked disk and neuroretinitis; inequality of the pupils; strabismus; violent 
headache, often accurately localized; monolateral anaesthesia, usually in the 
form of anaesthesia dolorosa; neuralgia; monolateral paralysis of varying 
degree, gradually increasing; jerking; quivering; cramps of the affected 
groups of muscles, developing sometimes into epileptoid attacks." Further 
on: "imbecility; total want of energy; sopor; comatose condition; wide- 
spread anaesthesia; very hesitating speech; paraplegia; incontinentia urinae 
et alvi, or else retention; increased temperature of the body; symptoms of 
meningitis: apoplexy." 

Glioma is to be thought of when there is: "preceding considerable 
injur}* of the skull; slow progress of the symptoms and hence relatively long 
duration of the illness; intercurrent apoplexies; good state of nutrition." 

Tubercular tumors, when there is " a hereditary predisposition to tuber- 
culosis; occurrence in childhood; tuberculosis of other organs; commence- 
ment of the symptoms after acute febrile diseases, for instance measles; 
complication with meningitis. ' ' 

Carcinoma, when there is " a rapid progress of the symptoms; perfora- 
tion of the bones of the skull; carcinoma in other organs." 

Notwithstanding all this, the Diagnosis of brain tumors will in many 
cases remain problematic and is often impossible. 

Therapeutic Hints. 

Little can be said. In all cases we must be governed by the totality of 
the symptoms, even if we should suspect a tumor. 

When a considerable injury of the skull has preceded, we will have to 
choose a remedy accordingly. 



DISEASES OF THE CRANIUM AND ITS INTEGUMENTS. 1 23 

When tubercles are suspected, compare what has been given under 
meningitis tuberculosa. 

In case of carcinoma, compare: Calc. carb. or phosph., Arsen., Carb. 
an., Bellad., Laches., Phosphor., Silic, and many others. 



DISEASES OF THE CRANIUM AND ITS INTEGUMENTS. 



a. ABNORMAL LARGENESS OF THE HEAD 

May be caused \yy hydrocephalus, hypertrophy of the brain and by pseudo- 
formations within the cavity of the skull, when they perforate the skull. To 
this are to be added morbid conditions of a more external nature. 

Dropsy of the Scalp. 

This is a collection of serum either in the cellular tissue (cellular dropsy) 
or between the aponeurosis and the pericranium (aponeurotic dropsy). When 
the watery fluid collects in the cellular tissue, it is apt to spread down to 
the face, and on pressure with the finger it leaves a pit, as is seen on all 
parts of the body, where dropsical effusions exist within its cellular tissue. 
When it is underneath the aponeurosis or the galea capitis, the swelling is 
tight, elastic, fluctuating, and leaves no pit on pressure, and never spreads 
over the ears or eyelids, and this for obvious anatomical reasons. 

Both forms exist without cerebral symptoms, and may be the conse- 
quence of either a general dropsical condition, or of erysipelas, external in- 
juries, stings of insects, eruptions, and so on. 

Hypertrophy of the Skull. 

This may either involve a part only of the cranium, in which case it 
forms exostosis or bony protuberances ; or the whole skull, whereby the bony 
walls may attain a thickness of one inch and a half. Both forms cause an 
enlargement of the head, and are mostly found as a concomitant to rhachitis 
or syphilis. When they grow from the inner plate of the skull, the}' do not 
cause an external enlargement of it, and are therefore not recognizable with 
any degree of certainty. 

The Bruised Head of a Child after Birth, 

Caused by the pressure during birth, is either an extravasation of lymph or 
blood into the cellular tissue, in which case it is called caput succedaneum ; 
or it is an extravasation of blood between the bones and the pericranium, 
causing the affection called thrombus neonatorum. 

The Caput succedaneum may extend over the fontanelles or sutures of 
the bones; it may even be formed on any part of the head sufficiently ex- 



124 AFFECTIONS OF THE SKULL WITHOUT ENLARGEMENT. 

posed to a great pressure of the pelvis, or the forceps, during labor. It has 
a soft, doughy feel, and the outer skin looks bruised. 

The Thrombus, however, is confined generally to the parietal bones, 
and never extends over the sutures of the bones, because there the peri- 
cranium adheres firmly to the skull. It feels elastic and fluctuates, and 
shows no discoloration of the external skin. 

Both forms are bruises in their nature, and ought to be treated, should 
treatment be necessary at all, like bruises. Aniica will usually do what is 
required; in some cases, however, Bar. mur. and Mercur. have been success- 
fully applied. 

b. ABNORMAL SMALLNESS 

Of the head is found in idiots. It may be partial or general, congenital, or 
caused after birth, before ossification is completed. Always, however, it will 
be found in connection with an imperfect development or derangement of the 
brain. 

c. AFFECTIONS OF THE SKULL WITHOUT ENLARGE- 
MENT. 

The cranium consists of two tables, which run parallel with each other, 
and are separated by an intermediate cellular structure, which is called 
diploe. The whole, however, consists of eight different bones, which are 
connected to each other by sutures. Before these sutures consolidate, there 
are, of course, on those places where different bones are to meet, larger or 
smaller openings, which are called fontanelles. At the time of birth, how- 
ever, as a general thing, only one of these fontanelles exist, and that is the 
anterior opening, whilst the posterior and parietal openings have already 
closed. 

The anterior fontanelle closes normally in the second year of life. If it 
stays open much longer than two } T ears, it shows a want of proper nutritive 
action in the system; if it grows larger, dividing the frontal bone and parting 
the parietal bones, it is a sign of chronic hydrocephalus, or of hypertrophy 
of the brain. If you lay your hand softly upon it, or watch it closely, you 
will observe a constant motion up and down, a kind of breathing of the brain. 
Screaming or coughing causes momentary distention and protrusion of the 
integument over it. If, however, as in cases of meningitis, this opening 
swells out permanently, it is a sign of exudation of serum in the brain. Its 
suddenly sinking in denotes a collapse of the brain, which is soon followed by 
death. In like manner, the posterior fontanelle, by a morbid process of ab- 
sorption of the already formed bony substances, ma}* reopen; or several holes 
may form near by — the bony structure withering away gradually, leaving 
only the integuments. This is called the Soft occiput or Craniotabes. It 
has been observed mostly towards the end of the first year, especially in 
children of rhachitic or scrofulous parents. It is doubtless a deep-seated, 
constitutional disorder, and can be successfully treated only by a careful 



DISEASES OF THE INTEGUMENTS. 1 25 

stud)' of all the symptoms. Nevertheless, Sulphur, Calc. carb., Calc. phosph. 
and Silic. might often be indicated. If not checked, it frequently becomes 
complicated with meningitis, or pneumonia, or tuberculosis and diarrhoea, 
which soon end the scene. 
To this I ma)' add — 

Atrophy of the Skull. 

This may be a consequence of internal pressure from carcinoma within 
the cavity of the skull, which may even perforate the cranium; or from hy- 
pertrophy of the brain; all of which have already been mentioned. 

We also meet with inflammation of the skull or ostitis, with all its 
sequelae — caries and necrosis — which is mostly of a syphilitic or tuberculous 
origin, or is caused by external wounds badly treated. 

Therapeutic Hints. 
Caries call for Asa/., Calc. carb., Calc. phosph., Fluor, ac, Pulsat., Silic, 
Sulphur, and other remedies. 

d. DISEASES OF THE INTEGUMENTS. 

The integuments of the cranium consist of the following five different 
layers: 

1 . The external skin or derma is covered thickly with hair, and contains 
innumerable sebaceous and sudoriparous glands, of which the former secrete 
an oily, fatty substance, and the latter are the organs of perspiration. 

2. The subcutaneous cellular tissue, in which the net- work of the larger 
blood-vessels and nerves lies imbedded, and which conjoins the derma to 

3. The aponeurosis; which is expanded tightly over the cranium. Under 
it is found — 

4. The second cellular tissue, which consists of loose meshes and con- 
nects the aponeurosis only loosely with 

5. The pericranium, which is the immediate covering of the bones, and 
which, although very thin, is nevertheless of great strength. It transmits 
numerous blood-vessels into the bones. 

In diseases of the scalp all or single of these different layers may be 
affected. 

Eczema Capitis, Humid Tetter or Scald. 

" A non-contagious affection, characterized by the eruption of minute 
vesicles of great numbers, and frequently confluent, upon a surface of ir- 
regular form and usually of considerable extent. The vesicles are so closely 
aggregated in some situations as to give rise to one continuous vesicle of 
great breadth . " ( Wilson . ) 

They dry and form thin scales, or else break and discharge a watery or 
milky fluid of different consistencies, which, by concreting, give rise to 



126 THERAPEUTIC HINTS TO DISEASES OF THE INTEGUMENTS. 

thinner or thicker crusts. It is acute and chronic in its nature, and may 
appear on any part of the body. According to its appearance, location, or 
severity and obstinacy, it has received a variety of names, which gives a 
nomenclature most remarkably confused and confounding. It is called 
ekthenia, porrigo, tinea with various adjectives, and, if chronic, psoriasis. 
In order to simplify the whole we will just remember that eczema exhibits 
the following characteristics: It is a vesicular eruption, in clusters, often con- 
fluent, discharging limpid or turbid and milky fluid, which forms crusts of 
different thicknesses, is acute or chronic, mild or severe, situated here or 
there. 

It may be confounded with 

Impetigo, 

Because its appearance so closely resembles this latter as to force upon the 
mind the impression that they are the same disease. And, indeed, impetigo, 
derived from ab impetu — a bursting forth with violence — is nothing but a pus- 
tular eczema; so that, in order to distinguish between the two, we must know 
what is a vesicle and what is a pustule. A vesicle is understood to be a very 
small blister, containing a transparent, limpid fluid; a pustule means a pimple 
containing pus. The difference between eczema and impetigo lies then in 
the pyogenetic (that is, pus-forming) character of the latter. If both are 
found together, covering large patches on the scalp, their distinction is quite 
difficult, unless w T e say: the hardened coverings of the excoriations of eczema 
are thin scabs, because growing out of a limpid, thin fluid — lymph; while 
those of impetigo are tense and thick, greenish-yellow, or brownish crusts, 
on account of their being formed from pus. 

Therapeutic Hints. 

Calcar., Lycop. When the eruption yields a thick and mild secretion. 

Arsen., Natr. mur., Rhus tox. When it looks angry, excoriated. 

Bar. card., Graphit., Natr. mur., Rhus tox. When it causes falling out 
ot the hair. 

Lycop., Psori)i. \\ nen it smells very badly and causes lice. 

Natr. mur. When situated on the boundaries of the hair on the nape 
of the neck. 

Clemat., Petrol. When on the neck and occiput. 

Hepar sulph. When the eruption itches worse in the morning, when 
rising, with burning and smarting after scratching — likewise after external 
application of salves. 

Clemat., Graphil., Hepar sulph., Lycop., Natr. vnir., Rhus tox., 
St aphis., Thuja. For moist eruptions. 

Arsen. > Calcar., Mcrcur., Sepia, Silic, Sulphur. For dry crusts. 

Mercur. When the lymphatic glands are inflamed. 

Bar. card. When the lymphatic glands are swollen and painless. 



THERAPEUTIC HINTS .OF DISEASES OF THE INTEGUMENTS. 1 27 

Arsen. Nightly burning and itching, relieved from external warmth. 
Bar. card. Falling off of the hair; glandular swelling on the neck and 
under the lower jaw. 

Bromium. Eruption covering the scalp like a cap; oozing profusely 
and smelling badly; cervical glands swollen. 

Calc. card. During teething; scrofulous habit, swollen glands of the 
neck; burning worse after washing; small wounds suppurate easily; sweat 
after eating or drinking anything warm; worse about new moon. 

Cicuta. Thick yellow crusts. 

Clem at. The eruption looks angry and inflamed during the increasing, 
and is dry during the decreasing moon. 

Crol. tig. Vesicles and erysipelatous inflammation around the crusts; 
itching, and burning after scratching. 

Graphit. Eruption with sticky secretion; causing falling out of the hair; 
commencing behind the ears and spreading over the scalp and face, especially 
on chin; chronic lachrymation ; fluor albus; worse after washing. 

Hepar. Especially back part of head; itching; worse in the morning; 
falling out of hair and leaving bald spots; crusts dry on some and moist on 
other places with inflamed surface and pus underneath; hard, knotty pimples 
like small furuncles in the face and other parts of the body; scrofulous 
ophthalmia; enlarged glands on nape of neck; frequent urging to stool and 
difficult discharge; sour smelling sweat at nights. 

Hydrast. Especially on margin of hair in front; oozing after washing; 
all secretions tenacious, ropy and profuse. 

Lycop. Crusts with lice between the crevices; underneath oozing of 
bloody or purulent fluid; badly smelling; sore and moist behind the ears; 
often eruptions on other parts of the body. Skin dry, raw, chapped and 
cracked; disturbed sleep with sudden loud screams; emaciation. 

Mercur. Stinging and burning; surroundings inflame after scratching; 
salivation and sore gums. 

Mezer. Eruption dry and scaly, extending over forehead, ears and 
neck, or thick leathery crusts with pus underneath, matting the hair, and 
breeding vermin; violent itching, worse in bed and from touch. 

Natr. mur. Raw surface; the discharge is corroding, eating away the 
hair, without forming thick crusts. Especially on the boundary of the hair 
on the nape of the neck. 

Petrol. Crusts on scalp; soreness behind the ears; tetter on nape of 
neck, breast and knees; chapped skin; hands and fingers full of bloody rha- 
gades during winter. 

Psorin. Badly smelling, yellowish, moist crust with lice; terrible itch- 
ing; sadness; don't want the head uncovered; the whole body has a filthy 
smell, even after bathing. 

Rhus tox. Often indicated; the crusts are thick with greenish, fetid 
pus underneath and fresh pimples on the surroundings; stiffness of neck and 
swollen glands on nape of neck and axillae; itching worse at night. 



128 DANDRUFF. 

Staph is. Crusts are moist, offensive, and itch violently; on scratching 
the itching is relieved, but appears immediately at some other place. 

Sulphur. Dry or moist crusts; eruptions, pimples on different places of 
the body; eyes inflamed with photophobia; face bloated, pale; cervical 
glands swollen; stool undigested, diarrhoea early in the morning; belly 
bloated; sleepless nights on account of itching; easily bleeding after 
scratching. 

Viol. trie. (Jacea). Thick crusts and oozing of profuse yellow fluid, 
matting the hair together; frequent involuntary urination; the urine smells 
like cat's urine. 

Dandruff 

Is an eczema with but scanty exudation, not sufficient to raise the epidermis 
into vesicles; it merely loosens it, when it dries and peels off in scales. The 
scalp underneath remains congested, and thus new scales are constantly 
reproduced. It may extend over the whole scalp even down to the eyebrows, 
the whiskers and the beard, or be confined to patches only of irregular form 
and variable dimensions. The most effective remedies against small, brany 
scales are according to Jahr: Bryon., Sulphur, Calc. carb., Kali card., 
Arsen., Alum. For the peeling off of large scales, the same author recom- 
mends: Phosphor., Lycop., Sulphur, Calc. carb., Nitr. ac. 

Seborrhoea Oapillittii. 

' ' The secretion of the sebaceous glands in the foetus is greater during 
intra- uterine life than subsequently, and we meet it at birth on the body 
generally, where it constitutes the vernix caseosa. This abundant secretion 
continues on the scalp during the first year of extra-uterine life, and if the 
sebum is allowed to collect there and gather dirt and dust from without, we 
may have finally crusts several lines in thickness, and the whole hairy scalp 
may be enveloped in a thick layer of sebum. When the crusts remain for a 
long time, the seborrhoea is generally complicated with eczema, for the col- 
lected mass of sebum decomposes, macerates and irritates the skin, and pro- 
duces redness and moisture on it. The same disease appears also as thick 
scales, which cause the hair to adhere to one another in little bundles (psori- 
asis amianthacea). In adults it forms one of the commonest varieties of 
scurf, or dry scales, which are formed in large quantities, and in old people 
it is seen in connection with senile decay. The scalp is for the most part 
devoid of hair, and covered with a dirty, 3 T ellow T ish-brown, easily removable 
crust. It may also be a part of syphilis. ' ' (Xilienthars Ski?i Diseases, p. 1 18. ) 

Therapeutic Hints. 

These crusts are best dissolved by the application of oil or grease, and 
afterwards removed by washing with castile soap. The internal use of Sul- 
phur ', a dose of a high potency occasionally, corrects the disposition for this 
abundant secretion. For adults Phosphor., Calc. carb., Natr. mur., Graphit., 
Vine, min., Mercur.. have been recommended. 



FAVOUS, HONEY-COMB RINGWORM, &C. I2Q 

Favus, Honey-comb Ringworm, Tinea Favosa or Maligna, 
Porrigo Favosa or Lupinosa, 

Is a vegetable parasite, the achorion Schoenleinii. "It used to be classed 
among the pustular eruptions, because it first appears as a small yellow spot, 
the sheath of the hair being filled with the fungous growth; but it has no 
tendency to suppurate. It grows with great rapidity, and forms large, hard, 
dry crusts, which have a peculiar mouse-like odor. It is most liable to be 
confounded with impetigo, but it requires only moderate care to determine 
whether the crust be hardened pus or an independent growth. The distinc- 
tion is based upon the presence or absence of secretion; be the crust of im- 
petigo ever so dry, some trace of purulent secretion is sure to be met with; 
and if removed by a poultice, the moist, exuding surface cannot be mistaken. 
Knowing this fact we have no need to particularize the rounded form, the 
cracked, broken-looking surface, and all the other characters resembling 
honey-comb, which the older writers were obliged to enumerate." (Bar- 
cley.) The scalp is its most usual place of development, but it is sometimes 
found upon the nape of the neck, or in front of the ear, and even upon the 
arms. 

1 ' The pathology of favus is best understood by considering it essentially 
to be a form of abnormal nutrition, with exudation of a matter analogous to, 
if not identical with, that of tubercle, which constitutes a soil for the germi- 
nation of cryptogamic plants, the presence of which is the pathognomic of 
the disease. Hence is explained the frequency of its occurrence in scrofulous 
persons, among cachectic or ill-fed children, and the impossibility of incubat- 
ing the disease in healthy tissues, or the necessity of there* being scaly, 
pustular and vesicular eruptions on the integuments previous to contagion. ' ' 
(Bennet, Lilienthal's Skin Diseases.^) This view is borne out by actual 
clinical experience. 

Jahr says: "Notwithstanding its parasitic nature it has been cured by 
the sole internal administration of Sulp/ncr, Calc. card., Rhus fox., and 
Arsen.," and Teste considers the treatment of this affection the triumph of 
Homoeopathy, recommending: 

Sulphur and Dulcam. for the humid form in children of blonde and 
fresh complexion. 

Viol, trie, in alternation with either of the above when the itching is 
very violent. 

Oleand. , when there is intense itching and an insupportable nocturnal 
burning after scratching; affection of the mesenteric glands with swelling, 
hardness and tension of the abdomen, and frequently loose and undigested 
stools. 

Hepar sulph., when extending to the nape of the neck or the face: 
ophthalmia with or without ulceration of the cornea, etc. 

Besides compare Arsen., Bar. carb., Bromine, Calc. carb. } Dulcam., 



130 TINEA, HERPES TONSURANS. 

Graphit., Hepar, Mercur., Jfczcr., Rhus fox., Petrol, Staphis., Sulphur, 
I 'iol. trie. , under Tinea capitis. 

Crysophanic acid has been recommended by C. E. Fisher. 

Lapp, maj., grayish-white crust over head, face and neck; swelling and 
suppuration of the axillary gland. 

Phosphor., the skin of the denuded scalp is clear, white and smooth. 
Vine, min., spots on head, oozing, matting the hair together; the hair 
falls out in single spots, while hair grows on it. 

Tinea, Herpes Tonsurans, or Ringworm of the Scalp. 

The hair falls out in a patch of a circular form, leaving the skin of the 
head perfectly smooth. It is a microscopic fungus, known as trichophytum 
tonsurans, that invests the roots of the hair and destroys them. 

Cases are reported as having been cured by Graphit., Phosphor., Arsen. y 
Tcllur., Sepia, and others. Alcohol is said to destroy the parasite. 

The Wen 

Is an encysted tumor of varying size; from that of a small pea to the size of 
a walnut, and even a small orange. 

' ' The sebaceous or fatty substance in these sacs or cysts is variously 
altered in its qualities and appearance. Sometimes it is a limpid fluid-like 
serum, and contains crystals of stearine; at other times it is soft and white, 
of a pappy consistency; again, it is 3-ellowish and resembles beeswax. Some- 
times it contains epidermal scales and hairs. Sometimes the contents of the 
cysts are exceedingly fetid ; and the fetor is increased when the tumor in- 
flames." (Wilson). Under the pressure of the finger they feel elastic and 
are movable under the skin. 

Therapeutic Hints. 

Thus far have been successfully applied: Bar. carb., Bellad., Calc. carb., 
Caustic., Clemat., Phytol., Sepia, Silic, Sidphur, Thuja. 

The Teleangiectasia, or Vascular Naevus, Mother's Mark, 

Is a dilatation of a portion of that fine net-work of capilllary vessels which 
everywhere pervade the derma and cellular tissue. Such dilatations may 
occur in either of them. They form red, easily compressible, flat tumors, of 
different sizes. They are sometimes stationary, but more frequently increase 
slowly in size; and we often find enlarged blood-vessels in their vicinity. 
They generally appear on the scalp and still oftener on forehead, but also on 
other parts of the body. 

Therapeutic Hints. 
Carbo veg., Condur., Fluor, ac, Strontian, Sulphur, Silic, Thuja. Phos- 
phor., when they bleed easily. Sepia in broad, flat, dark venous nsevi, par- 
ticular! v when on the face, head or nose. 



THE HAIR. 131 



The Hair. 



Alopecia — its falling off — may originate in various conditions. If it 
consists in a total atrophy of the hair- follicles the hair, of course, will never 
grow again; if it is only a partial atrophy, the hair grows thin. A transient 
deficiency in the nutrition of the hair-follicles, as it occurs in several ill- 
nesses, such as typhoid fever, pneumonia, puerperal fever, chronic head- 
aches, syphilis, does not hinder the hair from growing again as soon as these 
disturbances have passed away. 

The Alopecia circumscripta or Porrigo devalcans has its cause in a 
parasite, microsporon audonini, which attacks the hair in isolated patches, 
and the denuded spots are left clean and polished and of a marble whiteness; 
it is not considered as contagious. 

Alopecia in consequence of erysipelas, seborrhcea and different eruptions 
of the scalp, disappears after these disturbances are healed. 

Cosmetic means also may bring on alopecia. 

Baldness is more or less an attribute of old age; it is found oftener in 
men than in women ; it also is seen in younger individuals in consequence of 
hereditary disposition. 

Therapeutic Hints. 

Kali carb. , Natr. mur. , with great dryness of the hair. Carb. veg. after 
Kali carb. 

Hepar sulph., Phosphor., Sepia, Silic. After chronic headaches. 

Kali carb. , Nitr. ac. After nervous fevers. 

Phosph. ac. After great anxiety and grief. 

Besides these compare Ambra, Amm. carb., Bar. carb., Calc. carb., 
Conium, Fluor, ac, Graphit., Lycop., Natr. mur., Sulphur, Zincum. 

For bald patches: Aloes, Arsen., Phosphor., Vi?ica min. 

The cutting of the hair is often attended with great effect upon the 
general system. Colds in the head are a very frequent consequence, and in 
children even spasms may result therefrom. But there are also cases on 
record where it proved beneficial to patients, relieving them of headache, and 
in one case even from a sort of mania. 

The changing of color into gray and white is usually a process of age; 
but grief, sorrow and worriment may bring it on much before its time, and 
sometimes in a very short time. There are a number of cases related where 
this change took place during one night in consequence of terror, or other 
violent emotions of the mind, so that the poet says: " O nox ! quam longa 
es, quae facis una senem !" But of late these instances have been doubted, 
because they are not well authenticated. However that may be, so much is 
certain, that strong mental emotions have great effect upon the discoloration 
of the hair. 



132 



THERAPEUTIC HINTS. 



Therapeutic Hints. 

Bad consequences of cutting the hair are mostly removed by Bellad. or 
Dry on. 

The process of growing gray and white we best leave undisturbed, unless 
we choose remedies for its next causes. All of the so-called cosmetic means 
are hurtful, sometimes dangerous; and the vain will be punished for his 
vanity. 

The Plica polonica — matted hair — as is here and there found in Poland, 
is, according to Hebra, an eczema of the scalp, forming crusts and matting 
the hair together in a most hideous manner. 



EYES. 



Considering the eye as a whole, we find its general appearance frequently 
altered by disease. Without dwelling upon the language which the mental 
emotions — fright, terror, joy or sorrow, love or hatred — speak through them, 
we observe: 

An unnatural lustre of the eyes in fevers; and 

A brilliancy in consumptives. 

Glassy eyes are characteristic, in children, of inflammation of the mesen- 
teric glands; and, if accompanied with dark, dry lips and tongue, dry skin, 
and great restlessness, of an acute inflammation of the stomach. In fevers 
the}' indicate great danger, or critical changes. 

Dull eyes are frequently observed in febrile conditions of the system; 
during catamenia, in catarrhal and other affections. 

Sunken eyes are the consequence of an absorption of 'the fat cushions, 
whereupon the eyeballs rest and turn in their sockets. This takes place in 
all diseases which are accompanied with great loss of blood or other vital 
fluids. 

Exophthalmus or protruding eyes, when not congenital, is a characteristic 
sign of Basedow's disease. 

In treating the particular diseases of the eye, I shall condense in a small 
space what is important for the general practitioner in his daily practice; 
the specialist will necessarily have to consult special works on this subject. 

LIDS AND LACHRYMAL APPARATUS. 

Inflammation of the Eyelids. 

It may be of various character. A simple inflammation may be the con- 
sequence of a cold. It usually commences on the edge and thence spreads 
over the whole lid to the margo orbitalis, where it abruptly ceases. By this 
it is distinguished from erysipelas, which is apt to diffuse itself further and 
further. The lid is hard, swollen and red, sometimes covered with little 
blisters. 

A graver form is the Phlegmonous inflammation, or Abscess of lid. 
Commencing as a little, firm nodule, it often extends over the eyebrow and 
cheek, and the lid may attain the size of a pigeon's egg. If not checked in 
the onset, it terminates in the formation of an abscess which breaks either 
outside or, in rarer instances, perforates the conjunctiva. If this abscess 
forms at the inner angle of the eye, near the lachrymal sac, it has been 



134 THENAPBUTIC HINTS TO INFLAMMATION OF THE EYELIDS. 

termed Anchylops. The Causes are: injuries (wounds or blows upon the 
eve); severe conjunctivitis, or erysipelas; spontaneous development has also 
been observed. 

A third form is the Tinea tarsi, Ophthalmia tarsi, or Blepharitis margin- 
alis, etc., which consists of an inflammation of the edges of the eyelids. In 
its simplest form it shows merely a slight redness of the edges and some 
gluing together of the lids in the morning. This may increase, however, to 
ulceration, thickening and hardening of the whole margin of the lids, when 
it is termed Tylosis. The conjunctiva and the Meibomian glands usually 
participate more or less in this inflammation, and if the ulceration extends to 
the hair-follicles the lashes loosen and fall out. In places where the destruc- 
tion is not too extensive, the lashes grow again, but thinner, crooked and 
often inverted, which state is called Trichiasis; or there forms a double row 
of cilia either along the greater portion of the lid, or chiefly at one point; 
this is called Distichiasis. This faulty position of the cilia is generally ac- 
companied, or soon followed, by a certain degree of inversion of the eyelid, 
and perhaps by a shortening and incurvation of the tarsal cartilage, which 
state is termed Entropium, though in simple trichiasis or distichiasis it is 
not always present. ' ' Entropium may also result from spasmodic contrac- 
tion of the orbicularis muscle, especially in elderly persons, where the skin of 
the eyelids is abundant and lax." (G. S. Norton.) When, however, by 
extensive ulceration of the edges and consequent cicatrization the appertures 
of the Meibomian follicles become closed and obliterated, the lid's margin 
thickens, and shows a tendency to become everted. This grows the more 
apparent, when the conjunctiva also is involved in the inflammatory process. 
And, if to all this a certain degree of atrophy and relaxation of the orbicu- 
laris associates, the somewhat everted lid no longer covers the eyeball, but 
sinks away from it and the punctum lachrymale becomes exposed. This 
state of things is termed Ectropium. ''Ectropium ma}' also result from 
paralysis of the facial nerves, tumors, caries of the orbit, etc., but the most 
frequent cause is from cicatrices in the vicinity of the lids. " (G. S. Norton. ) 

Blepharitis marginalis occurs often as a consequence of hypermetropia 
or myopia, but very frequently it is associated either with, or caused by, 
conjunctivitis or corneitis, affections of the lachrymal canal, as stricture, 
blenorrhoea, etc. Its intensity is much aggravated by dirt and want, by 
exposure to wind, cold, bright glare, or an impure, smoky atmosphere. 

Therapeutic Hints. 

Simple inflammation of the lids is easily arrested by: 

A<-on. After exposure to cold winds. 

Apis. With cedematous swelling and stinging pain. 

Bellad. Bright, shining redness; right side; photophobia. 

Chamom. Red swelling after a cold. 

Pul sat. With catarrh in the head. 

Rhus tox. From left to right; dull redness; watery vesicles. 



THERAPEUTIC HINTS TO EYELIDS. 1 35 

Phlegmonous inflammation L "ires besides one or the other of the 
above : 

Hepar. Pricking and throbbing pa worse from cold and contact; 
anchylops. 

Laches. Purplish hue. 

Merc, sol. Pain worse at night. 

Pul sat. Anchylops. 

Silic. After Hepar, when suppuration has taken place, and the patient 
wants to have his head wrapped up. 

Blepharitis marginalis is often very obstinate and difficult to treat. 
When caused hy h}-permetropia or myopia, suitable eyeglasses are the 
remedy; when caused by dirt and want, their removal ought to be attended 
to; washing and cleaning the lids with lukewarm water is a daily require- 
ment. Remedial agents are quite as necessary. 

Alum. Dryness of lids, worse in the morning; absence of lachrymation. 

Arsen. Burning, acrid lachrymation, excoriating the lids and cheek. 

Calc. carb. and jod. Lids swollen and hard, indurated, also after styes; 
tonsils enlarged. 

Carb. ac. When caused by parasitic fungi, embedded around the hair 
follicles. 

Cinfiab. Discharge in the morning; dull pain from the inner canthus 
over the eye, or around it. 

Caustic. Better in the open air; warts on the eyebrows, upper lid or 
nose. 

Digit. Lid-margin slightly swollen and pale red; inside of lids yellowish- 
red; burning of the lid-margin; photophobia; lachrymation and mucous 
discharge. 

Euphras. Suppurating lid-margins; constant winking of lids; profuse, 
acrid, burning lachrymation, or very acrid, thick or yellow discharge, 
excoriating lid and cheek; fluent coryza, which is mild. 

Graphit. Dry crusts on the cilise, and scales on the margins; the outer 
canthi are often the most affected part; they crack and bleed easily; moist 
eczema on the head and behind the ears, cracking and bleeding. " It is the 
most frequently indicated remedy for chronic ciliary blepharitis, and a more 
rapid cure can usually be effected by its local application at the same time of 
its internal administration. I use it locally in some unguent, as cosmoline, 
about eight grains to the ounce." (G. S. Norton.) 

Hepar. Upper lid-margins unevenly rounded, swollen and red; tough 
mucus in lashes and canthi; scleral conjunctiva injected with red vessels 
running towards the cornea, where they form little vesicles with turbid secre- 
tion, lachrymation; pain in the evening, agglutination in the morning; right 
eye worse; small pimples or little furuncles on the face, or elsewhere, in com- 
plication with tinea. 

Kali carb. Swelling of lids; edges, canthi and caruncula red and swol- 
len; lachrymation and pain from bright light; pressing pain in front of head 



136 therapeutic hints to inflammation of the eyelids. 

and temples into the eyes, with heat in face and head; after eating, pressure 
in stomach, belching; nausea and emptiness in stomach; gagging and vomit- 
ing of slime; pressure and anxious feeling in chest; face pale, dirty gray. 

Magn. mur. When accompanied with pimply eruption on the face, 
which comes and goes, but is worse after supper, in a warm room, and before 
the menses. 

Merc. sol. Lids smart, are sore and red, especially upper lids; worse at 
night in bed, from warmth and cold, and from the glare of a fire. 

Merc. corr. Indurated lids; secretion thin and excoriating; nocturnal 
aggravation. 

Mezer. Accompanied by tinea capitis of thick, hard crusts, from which 
pus exudes upon pressure. 

Natr. mm. After the application of nitrate of silver; after measles; 
acrid lachrymation, excoriating the lids and cheeks and making the skin 
glossy and shining; eczema. 

Nux vom. After previous drugging and when worse in the morning. 

Petrol. Pain in the back of the head, rough skin; diarrhoea only dur- 
ing the day. 

Phosph. ac. Lid-margins swollen, red and rounded; lashes partially 
falling out; pus particles on lashes and in canthi; itching and burning; sen- 
sitiveness to candle-light; difficult opening of the eyes in the morning. 

Psorin. From right to left; worse mornings and during the day; old 
chronic cases; offensive discharges from the eyes; photophobia; strumous 
diathesis. 

Pidsat. Worse in the evening and in a warm room, better in the open 
air; lachrymal apparatus affected; styes and acne in the face. 

Rhus fox. Lids cedematously swollen; copious, acrid and serous dis- 
charge, corroding the adjacent parts of the cheeks. 

Sepia. " Small pustules, like acne, on the edge of the lids; tight feel- 
ing in lids; aggravation morn and eve." (G. S. Norton.) 

Silic. Objects appear as if seen through a fog, ameliorated by wiping 
the eyes; fluent coryza, corners of mouth cracked; offensive sweat of feet. 

Stop his. Lid-margins dry, with hard lumps and destruction of the 
ciliary roots; small tarsal tumors. 

Sulphur. Lid-margins thick, granulated and rounded; dry crusts in 
lashes; sharp, sticking pains, as if pins or a splinter of glass was sticking in 
the eye; morning agglutination; glandular swellings on the head and neck; 
eruption on the face; pale and puffed face; abdomen hard; disturbed diges- 
tion; worse in the evening and gaslight; cannot bear to have the eyes 
washed. 

Tellur. Eczema impetiginoides on the lids, with pustular conjunctivitis; 
much purulent discharge from the eyes; offensive otorrhcea. 

Thuja. Dry, branny eruption upon the lids, chiefly about the ciliae; 
lashes irregular and imperfectly grown; eyes weak and watery. 



HORDEOLEUM, STYE. 137 

Anchylops will best be met in the beginning by Apis, Bellad. , Hepar, 
Pulsate or Rhus tox. 

Trichiasis may require operative measures; but cases have been cured 
without them. 

Aeon. Has been successfully applied in a case of trichiasis and en- 
tropium. 

Borax. Has the symptom, but no verification to my knowledge. 

Graph it. May soften the scars. 

Natr. vuu . After abuse of nitrate of silver. 

Sepia. Eyelashes gone; edges raw and sore; eversion of puncta; eyes 
full of matter. 

Thuja. Dry, bramry eruption upon the lids, chiefly about the ciliae; 
lashes irregular and imperfectly grown; eyes weak and watery. 

Entropium is surety amenable to internal treatment, if recent. 

Aeon. Acute inflammation with dryness and burning. 

Calc. card. Has cured cases of senile entropium. 

Merc, corr., Rhus tox. and Sulphur are oftene'r indicated than Lycop. 

Natr. viur. After abuse of nitrate of silver. 

Sepia. Acute belpharitis. 

Ectr opium has been cured by: 

Apis. Stinging pains and great ©edematous swelling of lids and con- 
junctiva. 

Ai'g. nitr. Tear-points greatly inflamed and prominent. 

Hamam. During the course of a severe conjunctivitis — by external 
application of ' ' Pond's Extract. ' ' 

Merc, corr., Nitr. ac. and Sulphur have been successfully employed. 

Rhus tox. Sac-like swelling of the conjunctiva; oedematous swelling of 
the lids; cilise fall out; acrid lachrymation in the morning and in the open 
air. Lids are spasmodically closed; on opening them, protrusion of a thick 
red swelling and yellow, purulent discharge. 

Hordeoleum, Stye. 

It is in its nature a small furuncle, forming in the connective tissue 
near the edge of the lid, and has its name from its fancied resemblance to a 
grain of barley. It appears as a red, hard swelling, which rapidly increases 
until it suppurates and breaks, either outside or inside of the lid-margin. In 
some cases it is attended with considerable pain and swelling of the whole 
lid. Some persons are subject to repeated outbreaks of this furuncular 
inflammation. • We find it most frequently in youthful individuals of rather 
delicate health with a tendency to acne, or in persons addicted to free living 
or dissipation. If by frequent relapses it induces inflammatory changes in 
the Meibomian glands, and is followed by fatty or chalky degeneration of 
their contents, it is called Chalazion. 



I 28 TUMORS OF THE LID. 



Therapeutic Hints. 



Pulsat. Most frequently used and indicated; it often arrests its growth. 

Hepar. If Palsat. has not been sufficient to prevent suppuration. 

Staph is. Often found useful and especially when the stye does not sup- 
purate and break, but remains a hard nodule. 

Upper lid: Alum., Caustic, Ferrum, Mercur., Phosph. ac, Sulphur. 

Lower lid: Phosphor., Rhus tox., Senega, Staphis. 

Right side: Cale. card., Canthar., Natr. mur. 

Left side: Colehic., Lycop., Pulsat., Staphis. 

For removing the disposition : Amm. cark. , Cale. carb. , Ferrum. , GrapJiit. , 
Su iphur, Th uja . 

Chalazion : Cale. carb., Conium, Graph it., Pulsat., Sepia, Silic, Staphis., 
Th uja . 

Tumors of the Lid. 

Chalazion has been mentioned under styes. "It is mostly situated at 
some distance from the free margin of the lid and generally most manifest 
on its inner surface, lying close beneath the conjunctiva. In rarer cases the 
tumor points outwards and lies close beneath the skin, which is frequently 
somewhat reddened and thinned over and around it. It occurs far more 
frequently in the upper than in the lower lid." (Walton.) 

Sebaceous tumors occur most frequently at the outer and upper mar- 
gin of the orbit, close to the eyebrow. Their contents are suet-like and seba- 
ceous, consisting of broken-down epithelial cells, fat molecules and hairs; 
sometimes they are softer and more oily. The whole is encased in a cyst 
wall, the posterior portion of which is somewhat thickened and hyper- 
trophied. 

Warts occur occasionaly on the edges of eyelids. 

Fatty tumors (wens) are of rare occurrence. ' ' They may be recognized 
by their smooth, circumscribed, somewhat lobulated form, and are firm and 
elastic to the touch." 

Epithelioma ' ' is the most frequent in occurrence of all malignant tumors 
of the lids; arises as a small nodule near the edge of lid, and is painless, slow 
in its progress and at last ulcerates. The skin around the ulcer is not 
swollen and discolored as in lupus. The slowness of its growth and the his- 
tory of the case distinguish from syphilitic ulcer." (G. S. Norton.) 

Therapeutic Hints. 

Encysted tumors have been cured by: Cale. carb., Graphit., Silic,, 
Staphis., Thuja; warts by: Caustic, Thuja; wens by: Bar. carb., Graphit.; 
epithelioma by: Apis, Hydr. ac, Laches. (G. S. Norton.) 

Dacryocystitis 

Is an acute inflammation of the lachrymal sac, which frequently reaches its 
acme in a few days and is very painful. Its swelling may extend to the 



BLENNORRHEA OF TAE LACHRYMAL SAC. 139 

cheek, eyelids and even conjunctiva. In less severe cases, or after the acute 
inflammatory symptoms have passed away, pus may be squeezed out of the 
puncta ; but when the swelling and thickening of the lining membrane closes 
the passage, or the opening into the sac becomes somewhat displaced by it, 
the pus cannot escape, and if left alone, will finally force its way through the 
skin. After the discharge of pus, the inflammation subsides either entirely, 
and the opening heals, or there remains a chronic inflammation of the sac, 
with subsequent renewals of acute attacks, or the aperture in the skin does 
not firmly cicatrize, but merely scabs over, while fresh pus is collecting, 
which again forces its w T ay out at the same place, thus finally leaving a fistu- 
lous opening, through which a thin, muco-purulent discharge and the tears 
constantly ooze — Fistula lachrymalis. Or again the sac may undergo ulcera- 
tion at one point and the matter escape into the neighboring cellular tissue, 
thus giving rise to a secondary sac or pouch, which may break, whereby 
another more or less extensive fistulous opening is established, often very 
obstinate and intractable, especially if the bony structure is likewise diseased. 
Of chronic cases there are instances where several such pouches burrow 
beneath the skin in different directions. 

The Causes. — This inflammation is often merely an extension of con- 
junctivitis, especially the granular form, or of nasal catarrh; it may be pro- 
duced by periostitis and caries of the nasal bones in scrofulous or syphilitic 
persons, or may occur as a primary affection, being then generally due to 
exposure to cold and wet. " Its most frequent cause is a previous stricture 
of the nasal duct or blennorrhoea of the lachrymal sac." (G. S. Norton.) 

Therapeutic Hints. 

Instrumental aid may be required, but often bad cases have been cured 
by internal treatment alone. For dacryocystitis, at the beginning, Pulsat. , 
or Apis, when there is cedematous swelling and stinging pains, but Bellad. , 
Hepar and Silic. may also be indicated. We will, no doubt, have to consider 
its causes (conjunctivitis, nasal catarrh, etc.), and then compare the corre- 
sponding remedies. 

Fistula lachrymalis : Bellad., inflammation of the lachrymal duct; intol- 
erance of light; profuse lachrymation; lid edges inflamed and agglutinated; 
morning and evening a gritting sensation in the lids; aggravation in the 
evening. 

Bromine, Calc. carb., Caustic., Fluor, ac., Hepar, Laches., Natr. mur., 
Petrol., Pulsat., Sulphur, Silic, disorganization of the walls of the sac; denu- 
dation of the internal horny wall and closure of the nasal canal. 

Blennorrhoea of the Lachrymal Sac 

Is another consequence which may follow acute inflammation of the lach- 
rymal sac, in fact it is a chronic inflammation of that organ by which its 
w r alls become either thickened and hypertrophied, or thinned and greatly 
distended, secreting constantly a thin, glairy, viscid fluid, which flows down 



140 CONJUNCTIVA. 

the nasal duct, or oozes up through the puncta. When the sac gets filled 
with this secretion, we observe it as a swelling of varying size and hardness. 
On pressure its contents discharge through the puncta, and the finger sinks 
in as the sac is being emptied. During warm and dry weather the patient 
usually experiences very little inconvenience, while on exposure to cold and 
damp winds the trouble increases, inducing fresh inflammatory action. In 
this way it comes to pass that strictures are formed either in some part of 
the nasal duct, or of the canaliculus near its opening into the sac. 

Its Causes are like those of dacryocystitis — conjunctivitis, nasal catarrh, 
periostitis or caries of the nasal bones; also obstructions in the lachrymal 
passages either above or below the sac by a narrowing obliteration, or ever- 
sion of the puncta; or by contraction or stricture of the canaliculus or of the 
nasal duct; or by polypi or other growths which compress and obstruct the 
duct. 

Therapeutic Hints. 

Compare the previous article and also those which treat of its causes. 
Stannum. "Is one of the most important remedies, especially if the 
discharge is profuse, thick and of a yellow white color." (Geo. S. Norton.) 
Firm strictures require instrumental aid. 

CONJUNCTIVA. 
Catarrhal Ophthalmia 

Is an inflammation of the conj unctiva which may extend into the Meibomian 
ducts, the canaliculi, and the ducts of the lachrymal gland. In its mild form 
it shows merely a slight hyperaemia with a sensation of grit in the eye, itch- 
ing, stiffness and heaviness of the eyelids with or without sticking together 
in the morning; there is only exceptionally some mucus excreted and found 
collected at the inner canthus either fresh or dried into little yellowish or 
brownish crusts. It is aggravated by exposure to cold winds, when lachry- 
mation is produced. Usually of a chronic nature, it is found especially in 
persons of ill health, and is often difficult to cure. 

In its acute form the blood-vessels are much enlarged and appear as a 
vascular net-work of brick-dust, or of bluish or lilac hue, especially on the 
ocular portion of the conjunctiva, while on the palpebral portion it is less 
marked. Often it is accompanied by spots of extra vasated blood within the 
meshes of the membrane, which swells, and has, especially on its palpebral 
portion, a villous appearance, being due to the engorged state of the villi, an 
appearance which must not be confounded with granular conjunctivitis. At 
first there is an increased flow of tears which after a while is replaced by a 
secretion of mucus, which by degrees gets thicker and is either whitish or 
yellowish. If it assume a purulent character, the mere catarrhal ophthalmia 
passes into the purulent form. Chemosis is very rare; photophobia, pain 
and impairment of vision do not occur in the catarrhal form. In severe 



THERAPEUTIC HINTS TO CATARRHAL OPHTHALMIA. 141 

cases the eyelids participate in the inflammation; usually both ej^es are 
affected, not, however, always simultaneously; the second often becomes 
involved when the first is getting well; it always shows an evening aggrava- 
tion; and is apt to recur. Its Causes are: mechanical and chemical irrita- 
tion; getting cold and wet; excessive strain of the eyes by artificial light; 
extension from inflammatory processes of neighboring parts; measles, scarlet 
fever, small-pox; sometimes it appears epidemic. It is infectious. 

Therapeutic Hints. 

If caused by some foreign body this ought to be removed. 

Aeon. Reduces the inflammation caused by a piece of steel or cinder 
and facilitates its removal, if that could not be effected before the inflamma- 
tion had full}' developed. If there remains still some inflammation after 
Aeon., Sulphur will cure it. Aeon, is also indicated at the beginning of any 
ordinary catarrhal conjunctivitis, where there is great dryness, burning 
and heat in the eye and where it has been brought on by exposure to sharp, 
cold winds. 

Apis. CEdematous swelling of lids and skin over orbits with redness, 
heat and sensitiveness to external covering; stinging pains. 

Arg. nitr. Profuse discharge approaching a purulent character; feels 
better in the open air, worse in warm room. 

Arsen. Lids spasmodically closed; conjunctiva of a dark, violet color; 
secretion thin and acrid with burning pain, worse at night. 

Bellad. Right eye; throbbing pain, hot tears or dryness of the eyes; 
light is painful; nose sore from coryza; headache and similar Belladonna 
symptoms. 

Chamom. Often for infants after exposure to cold while bathing and 
washing. The children cry much; have colic and green stools; also during 
dentition. Extravasation of blood sometimes. 

Conium. Right eye bloodshot; aches on lying down to sleep; thirsty; 
sweat on head, face and neck. 

Crocus. Feeling in the eyes as after weeping with a corresponding 
appearance, extending from left to right eye; feeling of something alive and 
moving in the abdomen. 

Digit. Chronic; a yellowish redness of the palpebral conjunctiva. 

Eiphras. Acrid tears and profuse, acrid, thick and yellow discharge; 
blurring of vision relieved hy winking; coryza with burning and pain in the 
frontal sinuses; after exposure to cold and during the first stage of measles. 

Graphit. Chronic; thin, acrid discharge; external canthi crack and 
bleed easily; nose sore and excoriated, with crust on the nostrils. 

Merc. sol. Blenorrhcea, thin and acrid; great swelling of lids; sensitive 
to touch; worse in warm room or in the cold air, and in damp weather; also 
from evening till midnight; no relief from sweat; frequent relapses. 

Nux vom. The inner canthi are more inflamed than other parts: 
bloody exudation; smarting like salt; all worse in the morning. 



142 PURULENT OPHTHALMIA. 

Pulsat. Bland, moderately profuse, white discharge; worse in the warm 
room: in the evening; from reading; better in the open air. 

Rhus fox. (Edematous swelling of the lids; chemosis of conjunctiva; 
great restlessness; after getting wet. 

Sepia. Muco-purulent discharge in the morning and dryness in the 
evening; the conjunctiva is of a dull red color with some photophobia and 
swelling of the lids, especially in the morning. 

Sulphur. Acute and chronic; sharp, darting pains, like pins piercing 
the eye; severe pain darting through the eye back into the head, from i to 3 
a. m., waking the patient from sleep; feverish and restless at night. 

Zincum. The inner half of the eye is the most affected part, with much 
discharge; worse in the evening and in the cool air. 

Digest follows at the end of the ophthalmias. 

Purulent Ophthalmia. 

Commencing with mere congestion, itching and dryness, particularly at 
the inner corner, it gradually augments to intense inflammation of the whole 
conjunctiva with considerable mucous secretion, which soon is changed into 
a purulent discharge, dissolved in the tears. The lids swell and become 
slightly everted, the conjunctiva is dark red and the single blood-vessels are 
no longer to be seen. The parts affected feel hot and scalding with neuralgic 
pains which may extend to the temple and forehead. As the disease pro- 
gresses, Chemosis sets in, that is an infiltration of the conjunctival and 
subconjunctival tissue, and in addition we observe spots of extravasated blood. 
In this way the conjunctiva swells often to a degree that it overlaps the 
cornea, but shows itself most prominently at the lateral sides of the eyeball, 
where it receives the least pressure from the eyelids. The inflammation 
generally spreads to the areolar tissue of the orbits together with the tunica 
vaginalis oculi, causing a slight protrusion of the eyeball; the eyelids swell 
still more and the upper overlaps the lower, while the protruding conjunctiva 
always averts the lower and sometimes both. The protruding part of the 
conjunctiva is very marked in its villous appearance. If cured in this stage, 
the eye may escape serious injury. But if it goes on the palpebral papillae 
may undergo a change which is called granulation, of which later; the cornea 
may be rendered opaque by interstitial changes, or it may be destroyed by 
softening and ulceration; the iris ma}- inflame and adhere to the cornea; the 
vibrous body, the retina, and the choroid may be partially or quite spoiled; 
the sclerotica may become softened; the crystalline lens, when not discharged 
through the perforated cornea, becomes quite yellow; and all this destructive 
process may run its course in a space of time from a few days to three weeks. 

This dreadful disease is most common and severe in hot climates; in 
temperate latitudes it is found more especially in the army, navy, in work- 
houses, prisons, and among the poor; it is chief!}* endemic and spreads b}~ 
infection. 

Gonorrhoeal ophthalmia, which has been developed by infection from 



THERAPEUTIC HINTS TO PURULENT OPTHALMIA. 1 43 

urethral pus, cannot be distinguished from the purulent form, except by the 
history. It is one and the same kind of inflammation, only intensified, 
destroying the eye with great rapidity. 

Ophthalmia neonatorum ' ' is essentially the same disease as purulent 
ophthalmia in the adult, merely modified by the undeveloped tissues of the 
babe, and the activity of the growing processes, the infant organism, but it is 
generally more severe." (Walton.) Usually about three or four days after 
birth it commences with some slight redness of the lids and slight discharge; 
the e}-es are kept closed; light is distressing; then gradually the lids swell, 
and the purulent discharge becomes profuse, when the whole train of symp- 
toms, above described, may be considered as fairly set in motion. But for- 
tunately not all cases are of this virulent nature; simple catarrhal inflamma- 
tion, caused by chilling the child when bathing or washing it, or using 
strong soap, which irritates the eyes — may as well commence at that time; 
the purulent form originates from leucorrhceal or gonorrhoeal discharges of 
the mother transmitted to the eyes of the child during parturition. 

Therapeutic Hints. 

As in all three forms of purulent ophthalmia the discharge is poisonous, 
great care should be taken as to cleanliness in nursing such cases. 

Apis. CEdematous swelling of the lids and adjacent cellular tissue; con- 
junctiva congested, puffy, chemosed; lids everted, villous; cornea grayish, 
smoky, opaque; burning, stinging pain, photophobia and hot lachrymation. 

Arg. met. Purulent; infant; any effort to separate the lids caused a 
drawing-in of their edges. (After Sulphur and Calc. curb, had been without 
effect. ) 

Arg. nitr. Allen and Norton have witnessed the most intense chemo- 
sis with strangulated vessels, most profuse purulent discharge and commenc- 
ing haziness of cornea with a 'tendency to slough, subside rapidly under 
this remedy in its 30th potency internally, and at the same time a solution 
of five or ten grains to two drachms of water of the 1st, 3d or 30th dilution 
as an external application. The very absence of subjective symptoms, with 
the profuse purulent discharge and the bulging lids from a collection of pus 
underneath or from swelling of the subconjunctival tissues, and not from in- 
filtration of the connective tissue of the lids themselves (as in Rhus or Apis), 
indicate this drug. 

Arsen. Is characterized by a thin and corroding discharge with great 
burning pain and restlessness; after abuse of Nitrate of silver. 

Calc. carb. Profuse, yellowish-white discharge; ulceration of cornea; 
oedema of lids; later opacities of cornea; well-known Calcarea symptoms; 
after working in the water. 

Chamom. Ophth. neonatorum; lids much swollen; conjunctiva bleed- 
ing w T hen separating the lids; child cries much; wants to be carried about; 
has colicky pains and green discharges. 

Euphras. Compare catarrhal ophthalmia. 



144 GRANULAR OPHTHALMIA. 

Hepar. Purulent secretion in scrofulous subjects; lids swollen, spas- 
modically closed, bleeding easily on attempting to open them and sensitive to 
touch: intense photophobia; throbbing pain, better from external warmth, 
worse from any draught of cold air. Ulceration of cornea and hypopion; 
affection of Meibomian glands. 

Lycop. Ophth. neonatorum; copious discharge of pus; the lids are 
puffed out by pus beneath; the conjunctiva looks like a piece of raw flesh. 

Merc. sol. Ophth. neonatorum; thin, excoriating secretion from the 
eves; green, diarrhceic stools with straining; soreness of anus; jaundice; 
syphilitic and gonorrhoeal infection. The other mercurial preparations have 
also been successfully used. 

Natr. mur. Especially as an antidote to Nitrate of Silver, so frequently 
abused. 

Nitr. ac. Especially as an antidote to mercurial and syphilitic poison. 

Pulsat. Ophth. neonatorum; profuse and bland discharge; from gonor- 
rhoeal poison; all worse in the evening and better in the open air. Allen 
and Norton found it of great benefit as an intercurrent remedy when Arg. 
nitr. seemed to give out. 

Rhus tox. (Edematous swelling of lids, and of conjunctiva; great rest- 
iessness; after getting wet; commences on the left eye. The discharge is 
profuse, or tears are gushing out of the eye. 

Sulphur. Often in chronic cases with an outspoken psoric cachexia. 

The gonorrhoeal and syphilitic form may require besides the remedies 
mentioned: Cannab., Cin?iab., Card, veg., Kali biehr., Phytol., Tart. emet.> 
Thuja. 

Granular Ophthalmia. 

<l Under granular ophthalmia are classed two different forms of conjunc- 
tivitis, follicular and granular. The former is an accumulation of lymphoid 
elements. It never involves the deep structures of the lids or surrounding 
conjunctiva, and, therefore, disappears without leaving cicatricial changes. 
It is characterized by round or oval, pale red prominences, often arranged in 
rows in the oculo-palpebral folds, especially the lower, and is accompanied 
with some catarrhal symptoms of conjunctiva. 

" True granular conjunctivitis is a much deeper and more serious form of 
Inflammation. It involves deeply the stroma of the conjunctiva (palpebral), 
as is shown by the proliferation of papillae and development of so-called 
granulations. It always leaves scars behind, causes pannus, serious results 
to vision, entropion, trichiasis and other disorders, which is not the case in 
follicular conjunctivitis. It also especially involves the upper lid. It may be 
acute or chronic. The two diseases may be found together. ' ' (G. S. Norton. ) 

By the continual friction of the granules upon the cornea the latter may 
become hazy, rough or semi-opaque and vascular, a state which is known 
under the name of Pannus, though this opacity and vascularity of the cornea 
may also be produced by trichiasis, or any friction of the lid-edges. The 



THERAPEUTIC HINTS TO GRANUEAR OPHTHAEMIA. 145 

granular eyelid is usually attended with great sensitiveness to light, cold air, 
wind, dust and smoke; reading, writing and sewing cause pain in the eyes 
and an increase of redness; there is mistiness of sight; rainbow colors appear 
around luminous bodies and finally, when the cornea more and more degen- 
erates and even deeper portions of eyeball become involved in the inflamma- 
tory process, sight may be considerably damaged. 

Causes. — Being not a specific disease, it usually is the consequence of 
neglected conjunctivitis, which has become chronic. We find it, therefore, 
most frequently among the poor, and as in all ophthalmias the secretion is 
infectious, it too is propagated by infection, and consequently most prevalent 
where large masses of people are crowded together. ' ' But the commonest of 
all exciting causes is the use of Nitrate of Silver in substance for the primary 
inflammation, or in lotions or salves, of such strength as to be highly irri- 
tating." (Walton.) 

Therapeutic Hints. 

Aco7i. In acute aggravations by overheating or exposure to dry, cold 
winds. 

Alum. Upper lids are weak and hang down loosely. 

Arg. nitr. Being so often the cause of granular lids, it surely must do 
good where it has not been abused; compare the foregoing chapters. 

Arsen. See purulent ophthalmia; lids spasmodically closed; palpebral 
conjunctiva inflamed, raw and suppurating; cornea degenerated; on the face 
a fine eruption; under the eyes excoriated places by the acrid discharge, 
which are sometimes covered with crusts. 

Aurum. With pannus; great photophobia; hot, burning tears when 
attempting to open the eyes; excoriation on the cheeks and swollen glands 
on the neck; after the abuse of Mercury \ 

Bellad. Acute aggravations with great photophobia. 

Calc. carb. With pannus; caused by working in the water; deafness, 
or ear discharges; sweat on forehead; thick, red nose with acrid discharge, 
or nose stopped up; swollen upper lip; swollen glands on neck; large abdo- 
men; desire for boiled eggs. 

Euphras. With or without pannus; profuse lachrymation and thick 
discharge, excoriating lids and cheek. 

Kali bichr. With pannus; everything appears slightly red; eyes feel 
better when lying on the face. 

Merc. pr<zc. rub. With pannus; old chronic cases. 

Merc, protojod. With pannus, and superficial ulceration upon it. 

Merc, bijod. " Of great value in old cases of granular lids and pannus." 
(G. S. Norton.) 

Natr. mur. The most important remedy after cauterization, especiall}- 
with nitrate of silver. 

Nux vom. Often gives great relief after many other crude drugs have 
been employed. 
10 



146 PHLYCTENULAR OPHTHALMIA. 

Petrol. With pannus; occipital headache; roughness of skin; scrofu- 
lous habit. 

Puhat. Papillary trachoma without pannus in tearful females; with 
evening aggravation and amelioration in the open air. 

Rhus fox. With pannus and profuse lachrymation. 

Sulphur. When other remedies fail to act; often better indicated by 
other than eye-symptoms; the psoric tendency of the patient and his dislike 
to water and the like. 

Thuja. Granulations large, wart-like; pain worse at night, after mid- 
night. 

The following remedies are mentioned favorably: Alumen exsiccation, 
Caustic, Chin, mur., Chin, tan., Cinnab., Conium, Cupr. ac, Cupr. sulph., 
Hepar, Merc, sol., Natr. phosph., Sepia, Tart, eniet., Zinciun. 

Phlyctenular Ophthalmia. 

The phlyctenula commences as a little vascular patch, at the summit of 
which the epithelium is raised by serum into a vesicle; the conjunctiva 
swells, the vessels enlarge, profuse lachrymation ensues, and a catarrhal dis- 
charge is produced. By this time the vesicle bursts and a little ulcer is 
formed which secretes an opaque grayish substance, under which the ulcer 
may heal, if the inflammation does not extend, before the repair is effected. 
The phlyctenule appear most frequently at the corneo-scleral border, some- 
times also on the cornea, and exceptionally on the oculo-palpebral or pal- 
pebral conjunctiva. They appear either singly or there may be several 
scattered about or in groups, and sometimes disposed in a circular manner, 
partially surrounding the cornea. Ordinarily the redness is only on one side 
of the eyeball, where the eruption is located; sometimes the whole conjunc- 
tiva is inflamed. At its outbreak it is attended with stinging and itching; 
photophobia is not very great, but increases as the inflammation is nearer or 
at the cornea. 

Causes. — 111 health, debility; hereditary weakness, impure air, insuf- 
ficient diet and clothing, want of exercise; exposure to wet and cold. 

Therapeutic Hints 

Include those for pustular keratitis and so-called ophthalmia scrofulosa. 

Apis. Eyelids puffed; conjunctiva chemosed; cornea grayish, smoky, 
opaque; pain burning, stinging. 

Arsen. Lids spasmodically closed; conjunctiva and cornea pustulous 
and ulcerated; lachrymation and discharge excoriating the surrounding 
parts; burning pain; nose and upper lip excoriated by acrid discharges; 
great restlessness and thirst. 

Aur. vtct. Great photophobia; hot, burning tears; cutting pain 
through the eyes, sensitive to touch; swollen glands on neck; after mercurial 
poisoning. 

Bar. carb. and jod. Enlarged cervical glands. 



THERAPEUTIC HINTS TO PHLYCTENULAR OPHTHALMIA. 1 47 

Calc. carb. and jod. Scrofulous subjects; from exposure to wet, and 
worse during damp weather; complication with deafness; swollen glands, etc. 
See previous chapters 

Caustic. Pain relieved by external pressure; yellow face; warts on nose 
or eyebrows. 

Chamom. Compare under purulent ophthalmia. 

Cinnab. Pain from inner canthus across the eyebrows or around the 
eye. 

Conium. Great photophobia without much inflammation of the con- 
junctiva. 

Crot. tigl. With a corresponding eruption on face and lids. 

Eaphras. Compare previous chapters. 

Graphit. Often indicated in the chronic and acute form; the external 
canthi are cracked and bleed easily when opening the eyes; intense photo- 
phobia. 

Hepar. Ulcers on cornea; intense photophobia, lachrymation and great 
redness, even to chemosis; pain throbbing, better from external warmth 
scrofulous, cross children. Abuse of Mercury. Hypopion. 

Kali bichr. and hydr. Absence of pain, of photophobia and redness; 
secretion of a stringy character. 

Merc. sol. Ulcers, and chalk- white appearance of the cornea; lids 
swollen and spasmodically closed; intense photophobia; excoriating lachry- 
mation; pain worse at night; excoriation of nose; ulcers on tongue; eruption 
on face and head; aching in the bones; syphilitic subjects. These symptoms 
fit more or less to other mercurial preparations, of which there have been 
used with success — 

Merc. corr. When the acridity seems still more intense. 

Merc. nitr. Has been used with great success by Dr. Iyiebold in this 
Torm of inflammation, whether acute or chronic. 

Merc, prcsc. rub. Differs little from the others. 

Mere, protojod. When the tongue has a thick, yellow coating at the 

base. 

Natr. mur. Lachrymation and discharge acrid and corroding; after the 
abuse of Nitrate of Silver. 

Nux vom. After much drugging; morning aggravation. 

Psorin. Chronic cases with psoric taint. 

Puis at. Phlyctenule confined to the conjunctiva. Compare former 
chapters. 

Rhus tox. Pimples and vesicles on the cornea; great photophobia and 
intense inflammation; eruption on head and face; swelling of glands behind 
the ears. Compare previous chapters. 

Sepia. Complication with uterine affections; aggravation morning and 
evening. 

Silic Suppurating and perforating ulcers on the centre of the cornea, 
without blood-vessels running towards it; neuralgic pain in supraorbital 



14* 



DIGEST TQ THE DIFFERENT FORMS OF OPHTHALMIA. 



nerve; phlyctenules on the boundary of sclera and cornea, recurring often. 
After vaccination. 

Sulphur. Very often indicated by the general state of the patient, or 
when other remedies fail to relieve. The pain is sharp and piercing through 
eye into the head; worse at nights; eruptions on other parts of the body; 
swollen glands; diarrhoea early in the morning; w T ater and washing aggra- 
vate, and there is a general dislike to being washed. 

Tart. emet. Photophobia and herpetic eruptions. 

Tcllur. Complicated with offensive otorrhcea. 

Zincum. Persistent redness, especially at the inner angle and worse in 
the evening and in the open air, remaining after pustular keratitis. 

Still other remedies have been found useful: Arg. nitr., Bapt. tinct., 
China, Chloral, Cupr. etc., Ferrum, Ferr. jod., Hyos., Kreos., Laches., Lycop., 
Magn. card., Mezer., Nitr. ac., Petrol., Phosphor., Podoph., Sulph. jod., 
Thuja. 

Digest to the Different forms of Ophthalmia. 



FORMS. 

Acute or chronic: Graphit., Merc, nitr., 
Sulphur. 

aggravations by overheating or ex- 
posure to dry, cold winds: Aeon. 

great photophobia : Bellad. 

frequent relapses: Merc. sol. 

Chronic: Digit., Graphit., Merc, prcec. 
rub. 

psoric taint: Psorin., Sulphur. 

Ophthal. neonatorum : Chamom. , Lycop. , 
Merc. sol. , Pulsat. 

DISCHARGE. 

Acrid, excoriating, thin: Arsen. , Graph. , 

J here, com, Merc, sol., Natr. mur. 
with burning pain, restlessness and 

worse at night: Arsen. 
Acrid, thick and yellow, excoriating lids 

and cheeks: Euphras. 
Bland, profuse, whitish: Pulsat. 
Profuse, yellowish- white: Calc. carb. 

, or tears gush out of eyes: Rhus tox. 

, inner half of eye most affected: 

Zincum. 
Purulent : Arg. met., Arg. nitr.,Hepar, 

Lycop. 
Muco-purulent, dry in evening: Sepia. 
Stringy : Kali bichr. 

LACHRYMATION. 
Acrid, excoriating: Euphras. Merc, sol., 

Natr. mur. 
Hot and burning: Arg. met. 



, w T hen attempting to open the eyes* 

Aurum. 
Hot, or dryness of eyes: Bellad. 

and photophobia: Apis. 

Profuse: Euphras., Rhus tox. 

PHOTOPHOBIA. 

Great, intense: Aurum, Bellad., Graph., 
Hepar, Merc, sol., Tart. emet. 

, with intense inflammation: Rhus 

tox. 

, without much inflammation: Con- 

ium. 

, with hot lachrymation: Apis. 

PAIN. 

Aching on lying down to sleep. Conium. 

Burning, stinging. Apis. 

Cutting through the eyes and sensitive 
to touch: Aurum. 

Sensitive to touch: Merc. sol. 

Sharp, piercing, like pins through eye 
into the head, from I to 3 a. m., waking 
from sleep: Sulphur. 

Smarting, like salt: Nux vom. 

as after weeping with a correspond- 
ing appearance, from left to right eye: 
Crocus. 

Throbbing: Bellad. 

Pain from inner canthus across the eye- 
brows, or around the eyes: Cinnab. 

Absence of pain, photophobia and red- 
ness: Kali bichr. and Hydroj. 



DIGEST TO THE DIFFERENT FORMS OF OPHTHALMIA. 



I49 



SIGHT. 

Blurring of vision relieved by winking: 

Euphras. 
Everything appears slightly red: Kali 

bichr. 



SIDES. 
Right eye : Bellad. 
Commences in the left: 
tox. 



Crocus, Rhus 



LIDS. 

Bulging from pus beneath or from sub- 
conjunctival tissues, and not from in- 
filtration: Arg. nitr., Lycop. 

Puffed, swollen: Apis., Chamom., Hepar, 
Merc, sol., Septa. 

(Edema: Apis, Calc. card., Rhus tox. 

and of adjacent cellular tissue, with 

redness, heat and sensitiveness to ex- 
ternal covering: Apis. 

and of conjunctiva: Rhus tox. 

Affection of Meibomian glands, and lids 
sensitive to touch: Hepar. 

Drawing-in of edges when trying to 
separate them: Arg. met. 

Spasmodically closed: Arsen., Hepar, 
Merc. sol. 

Bleeding on attempting to open them: 
Chamom., Hepar. 

Everted, villous: Apis. 

Upper lids hang down loosely: Alum. 

External canthi crack and bleed: 
Graphit. 

Inner canthi more inflamed: Nux vom. 

CONJUNCTIVA. 

Inflamed with dryness, burning and heat 
in eyes: Aeon. 

Dark, violet color: Arsen. 

Dull, red color, with some photophobia 
and swelling of lids, worse in the morn- 
ing: Sepia. 

Persistent redness of inner angle after 
keratitis, worse evening and in open 
air: Zincum. 

Yellowish redness of palpebral conjunc- 
tiva: Digit. 

Bloodshot: Chamom., Conium., Nux 
vom. 

Chemosis: Apis, Arg. nitr., Hepar. 

Granulated, with pannus: Merc, bijod. 

, like warts: Thuja. 

, in tearful females: Pulsat. 

Phlyctenules : Pulsat. 



, on boundary of sclera and cornea, 

often recurring: Silic. 
Pustulous and ulcerated: Arsen. 
Raw and suppurating: Arsen. 
Like a piece of raw flesh: Lycop. 

CORNEA. 

Grayish, smoky: Apis. 

Hazy, with tendency to slough: Arg. 
nitr. 

Chalk- white : Merc. sol. 

Opaque : Apis, Calc. carb. 

Pannus: Aurum, Calc. carb., Euphras., 
Kali bichr., Merc, protojod., Petrol., 
Rhus tox. 

and superficial ulceration upon it: 

Merc, protojod. 

Ulcers: Calc. carb., Hepar, Merc. sol. 

s perforating on centre of cornea, with- 
out blood-vessels running towards it: 
Silic. 

and hypopion: Hepar. 

Degeneration: Arsen. 

SYSTEMIC SYMPTOMS. 

Child cries much and wants to be carried 

about: Cha?nom. 
■ don't want to be washed: Sulphur. 



Headache: Bellad. 

in occiput: Petrol. 

Eruption on head and face: Merc. sol. 

Rhus tox. 
Sweat on forehead: Calc. carb. 
on head, face and neck: Conium. 



Offensive otorrhcea: Tellur. 
Ear discharge : Calc. carb. 
Deafness : Calc. carb. and jod. 



Neuralgic pain in supraorbital nerve: 

Silic. 
Excoriation under eyes and surrounding 

parts: Arsen., Aurum, Natr. mur. 
Fine eruption on face: Arsen. 
Corresponding eruption 011 face and lids: 

Crot. tigl. 
Yellow face: Canst. 
Swollen upper face: Calc. carb. 



Coryza, with burning and pain in frontal 

sinuses: Euphras. 

, with sore nose: Bellad. 

Acrid discharge, with excoriation: 

Arsen., Calc. carb., Graphit, Merc. sol. 



150 



DIPHTHERITIC CONJUNCTIVITIS. 



Crust on the nostrils: Graphit. 

Upper lip excoriated: Arsen. 

Nose thick and red, stopped up: Calc. 

cart. 
Warts on nose and evebrows: Caustic. 



Glands swollen: Arsen., Aurum, Bar. 

card, and jod., Calc. card., jod. and 

phosph. 
behind the ears: Rhus tox. 



Thick, yellow coating on base of tongue : 

Mi re. protoj. 
Ulcers on tongue: Merc. sol. 
Thirsty: Arsen., Conium. 
Desire for boiled eggs: Calc. carb. 
Feeling" of something alive moving in 

abdomen: Crocus. 
Large abdomen: Calc. carb. 
Diarrhoea early in morning: Sulphur. 
Colic and green stools: Chamom. 
Green, diarrhceic stools with straining: 

Merc. sol. 
Uterine affections: Sepia. 



Bones aching: Merc. sol. 

Eruptions on different parts of body: 

Sulphur. 

, herpetic: Tart, evict. 

Roughness of skin: Petrol. 

Jaundice : Merc. sol. 

Scrofulous habit: Calc. carb. and jod., 

He par, Petrol. 
Psoric tendency: Sulphur. 
Feverish and restless at night: Sulphur. 
Sweat on head, face and neck: Conium. 

gives no relief: Merc. sol. 

Great restlessness: Arsen., 'Rhus tox. 
and thirst: Arsen. 

CAUSES. 

Pieces of steel or cinder, etc.: Aeon. 

If there remains still some inflammation 

after Aeon.; Sulphur. 
Getting 1 wet: Calc. carb. and jod., Rhus 

tox. 

Working in water: Calc. carb. 
Bathing and washing of infants: 
Chamom. 



Sharp, cold winds: Aeon., Hepar. 
Exposure to cold and during first stage 

of measles: Euphras. 
During dentition: Bel lad., Chamom., 

Calc. carb. 
After vaccination: Silic, Thuja. 
Gonorrheal poison : Pulsat. 

and syphilitic infection: Merc. sol. 

Mercurial and syphilitic poison : Hepar, 

Nitr. ac. 

AGGRAVATION. 

Morning : Nux vom., Sepia. 

Evening: Pulsat., Sepia, Zincum. 

From evening till midnight: Merc. sol. 

Night : Merc, sol., Sulphur. 

After midnight: Sulphur, Thuja. 

In warm room: Arg. nitr., Merc, sol., 

Pulsat. 
In cold air: Aeon., Merc, sol., Nux 

vom., Zincum. 
Throbbing pain from any draught of 

cold air: Hepar. 
During damp weather: Calc. carb. and 

jod. 
After working in w r ater: Calc. carb. 
Water and washing: Sulphur. 
From reading: Pulsat. 

AMELIORATION. 

Throbbing pain from external warmth: 

Hcpat, Silic. 
In open air: Arg. nitr., Pulsat. 
External pressure: Caustic. 
When lying on the face: Kali bichr. 

RELATION OF DIFFERENT 
REMEDIES. 

Arg. nitr. antidoted by: Arsen., Natr. 

mur. 

is followed well by: Pulsat. 

Mercurial preparations antidoted by: 

Aurum, Hepar, Nitr. ac. 
Nux vom. alter previous drugging. 
Sulphur, when other remedies fail. 
Arg. met., when Sulphur and Calc. carb. 

fail. 



Diphtheritic Conjunctivitis. 

Like diphtheritis of the pharynx, it is an inflammation of the entire 
conjunctiva, which becomes tumefied by a corpuscular infiltration of newly- 



CROUPOUS CONJUNCTIVITIS. 151 

formed cells into the subepithelial connective tissue, so abundant as to com- 
press the blood-vessels and arrest the circulation and nutrition, in conse- 
quence of which the conjunctiva degenerates into a necrotic mass, and is 
thrown off in pus-like secretion. On examining the eye, the conjunctiva 
appears as if covered with a felted nocculent membrane of a pale yellowish 
or grayish hue, especially on the palpebral conjunctiva and on the oculo- 
palpebral fold. The eyelids are swollen, hard, stiff and hot. Often the 
internal parts participate in the inflammatory process. After six to eight 
days the active inflammation subsides, the exudation dissolves and is thrown 
off as a pus-like discharge, when finally the injured parts heal and become 
cicatrized, involving sometimes the cartilage and deeper tissues of the lids, 
and causing entropion, symblepharon, secondary corneal affections, etc. It 
ought to be borne in mind that the diphtheritic conjunctivitis is the most 
destructive form of external inflammation of the eye and that its discharge is 
extremely contagious. 

Causes. — In Northern Germany it has appeared as an epidemic; in this 
country only sporadic cases have been seen. Some hold that purulent oph- 
thalmia may be converted into this form by the improper use of escharotics; 
it may be inoculated and it may be apparently idiopathic, or be complicated 
with diphtheria in the throat, with scarlet and puerperal fevers, and even 
with measles. It may attack young and old. 

s . 

Therapeutic Hints 

Must be more or less identical with those given under Diphtheria, which 
compare. 

Croupous Conjunctivitis 

Is much more common and should be distinguished from diphtheritic. The 
lids are swollen (usually cedematous), but not firm and hard, as in diph- 
theritic. The false membrane is present to a greater or lesser extent and 
more or less adherent, but it is on the surface of the conjunctiva (especially 
palpebral) and does not leave cicatrices behind, while in the diphtheritic 
from the exudation is in the stroma of the conjunctiva and cicatrization 
always results. Croupous conjunctivitis is therefore much less serious than 
diphtheritic, though the former may pass over into the latter. 

Therapeutic Hints. 

Acet. ac. is particularly the remedy when the membrane is 3'ellow, white 
and very dense, tough and adherent. 

Arg. nitr. After degeneration of the membrane has set in and the dis- 
charge is more purulent. 

Kali bichr. If the membrane is loosely attached and comes off in strings 
and threads. (Geo. S. Norton.) 



I52 CORXEITIS, KERATITIS. 

Pterygium. 

This is a triangular or wing-shaped adventitious growth on the ocular 
conjunctiva. Starting with its broad base at the corner of the eye, it reaches 
with its apex (seldom the middle, and still more seldom crossing the middle) 
of the cornea. It is loosely connected with the conjunctiva. It generally 
makes its appearance at the inner — rarely at the outer — corner of the eye. 
Very rarely it appears on the upper or lower part of the eyeball. These 
growths are of different consistency and color: some look red, inflamed and 
are full of blood-vessels; some are quite thin, almost transparent; and still 
others are thick and of a whitish or yellowish hue. 

Their origin is usually due to a chronic inflammation of the conjunctiva, 
and therefore always preceded by increased vascularity of the spot of the 
conjunctiva in which it appears. Tropical influence is considered as an 
excitant. It appears after the adult period; but there are also congenital 
cases. 

Therapeutic Hints. 

Arg. nitr. Pink color; discharge from the eye; inflammation better in 
the open air, unbearable in a warm room, with pain at the root of the nose. 

Arsen. Dryness and burning in the eye; or acrid lachrymation and dis- 
charge. 

Calc. carb. From exposure to wet and cold. 

Zincum, Thick and vascular; conjunctiva injected; lashes inclined to 
turn inward; external canthi sore and cracked; eyes feel sore in cold air, 
better in a warm room; itching and lachrymation at night; green halo around 
candle-light; rush of blood to the head over face, followed by perspiration 
over body; pressure across the root of the nose and supraorbital region. 
(Dunham. ) 

Still other remedies have proved useful: Chimaph., Laches., Nux 
mosc/i., Psorin., Ratan., Spigel., Sulphur. 

CORNEA. 

Oorneitis, Keratitis. 

Inflammation of the cornea is always attended by some degree of inflam- 
mation of the surrounding conjunctiva and sclerotica. Ordinarily its epithe- 
lial layer is first affected; it becomes visible by the molecular cloudiness of 
its cell contents and the proliferation of the cells themselves; this is followed 
by a subepithelial infiltration which may involve the true corneal elements. 
In this way the cornea swells; the epithelial layer becomes rough and loses 
its polish, and the anterior portion of the true cornea assumes a general dull- 
ness or grayish opacity of different degrees. The blood-vessels, in a fine 
net- work superficially arranged, follow the opacity from the circumference, 
being formed in the exuded material, whereby the cornea is reddened; they 



CORNKITIS, KERATITIS. 1 53 

communicate with the blood-vessels of the conjunctiva. This affection is 
always accompanied with photophobia, lachrymation, blepharospasm and 
pain; the amount of interference with vision depends on the amount of the 
opacity over the pupil. Its causes are either mechanical or chemical irrita- 
tions. 

When phlyctenule form on the cornea, the affection is usually called 
Strumous or Scrofulous ophthalmia; it is frequently associated with phlycten- 
ules or pustules on the conjunctiva, as described under "phlyctenular 
ophthalmia," which compare. 

When the inflammatory symptoms are more chronic in character and 
the destructive effects are deeper and greater, it is termed Diffuse or Parenchy- 
matous corneitis. 

1 ' The cornea has then lost its natural polish and resembles a piece of 
glass that has been breathed on. Or it may have a more stippled aspect, 
with greater roughness, whereby there is more haziness. With this there is 
a deep-seated, streaked or speckled whiteness or yellowishness, arising from 
interstitial deposits of materials in the true cornea. The true corneal tissue 
is not long pervaded by opacity in any form, before such opacity commences 
to be injected with blood-vessels, which may be few and isolated, or numer- 
ous and close, looking like a red patch." (Walton.) Pain, photophobia, 
and blepharospasm seldom exist, except in the beginning of the disease. Its 
spoiling effects may be changes in the curves of the cornea causing myopia 
or astigmatism; or limitation of vision; adhesion of the iris to the cornea; 
changes in the deeper parts of the eye; even atrophy of the eyeball from 
ophthalmia. 

Causes. — External injuries to the cornea and constitutional derange- 
ments, especially hereditary syphilis. 

When by long-continued mechanical irritation from cicatrices of the eye- 
lids, from the contact of the cilia in trichiasis and entropium, from granular 
conjunctivitis the cornea becomes inflamed, cloudy and vascular, or even 
vascular granulations appear, especially on the upper half of the cornea in 
consequence of the greater irritation of the upper lid — we have Pannus. As 
the vascularity increases, the cornea is ultimately surrounded by a thick 
tumefied net-work of varicose vessels, interspersed with numerous reddish- 
brown granulations. 

When in consequence of inflammation suppuration takes place between 
the layers of the corneal laminae, we have an Interstitial abscess of the cornea, 
which appears either as a yellowish spot with whitish circumference in any 
part of the cornea, or as a deposit of pus diffused throughout the cornea, so 
that the whole looks yellow. The pus may gravitate to the lower margin of 
the cornea, forming there a curved line which resembles the white mark at 
the root of the nail, hence it is called Onyx. 

When in consequence of inflammatory proliferation of epithelium of the 
posterior elastic membrane of the cornea, an exudation of mucus and pus cor- 
puscles takes place into the anterior chamber, we have Hypopion. The 



154 THERAPEUTIC HINTS TO CORNEITIS, KERATITIS. 

quantity of this exudation may be merely recognizable or may fill both 
chambers of the eye. Its color is usually creamy, but it may be streaked 
red with blood, or altogether red from the same. In changing the direction 
of the head from the perpendicular, the loosely lying mass shifts its position 
in the chamber and is therefore readily distinguished from onyx. 

When, however, in consequence of inflammation of the conjunctival 
layer of the cornea, its substance becomes rough and is cast off or exfoliated, 
and the breach constitutes an ulcer, we then have a surface abscess, or, as it 
is termed, Ulceration of the cornea. The ulcer may appear at any part of 
the cornea; it may be superficial or deep, even penetrating the cornea. The 
surrounding conjunctiva and sclerotica become vascular, and the more so as 
the ulcer is nearer the margin of the cornea. Deep ulceration excavates the 
cornea and the spot becomes covered with a pus-like material; it may per- 
forate the cornea, when the aqueous humor flows off; it may be associated 
with onyx or hypopion. The subjective symptoms are those of interstitial 
conjunctivitis, and its causes the same. Iritis is no uncommon complication. 
It may result in opacity of the cornea (Leucoma, Macula corneae), or in 
spherical or conical protrusion of the remaining posterior portion of the cor- 
neal tissue, and of the posterior elastic lamina, when it is called Ulcerative 
corneal staphyloma ; or the ulcerated surface may heal over and cicatrize, 
leaving, however, the cornea still protruding. This is called Cicatricial 
corneal staphyloma ; its most prominent part is the thinnest and the sur- 
rounding cornea is often curved in several directions and affected with super- 
ficial and interstitial opacity. The staphyloma may burst. When in case of 
perforation of the cornea the iris falls against or into the gap, it either pro- 
tudes through the opening, or in case of cicatrization of the opening, the 
cornea yields in consequence of the intraocular pressure and gradually bulges 
forward, giving rise to a Partial staphyloma of the cornea and iris ; a total 
destruction of the cornea by sloughing or ulceration causes Total staphyloma 
of the cornea and iris, in which process mostly the neighboring portion of 
the sclerotica, and in time, the whole anterior half of the globe becomes 
involved. 

Therapeutic Hints. 

Keratitis, when caused by mechanical irritation, requires: Aeon., and 
later Sulphur, Euphras., with a feeling as if a hair were hanging over the 
eye; Symphit., with a feeling as if the lid were moving over a ball. Besides 
may be indicated: Arnica, Calcnd., or Hamam. When caused by chemical 
irritation we will have to look for the corresponding antidotes of the different 
chemicals. Arnica is most important in preventing suppuration. 

Phlyctenular corneitis requires the same treatment as detailed under 
phlyctenular conj unctivitis. 

Diffuse or Parenchymatous corneitis. Merc. sol. and other mercurial 
preparations are the most important. Besides compare: Apis, stinging, 
burning pain and cedematous swelling; Arscn., burning pain and restless- 



THERAPEUTIC HINTS TO CORNEITIS, KERATITIS. 155 

ness; Aur. vntr., hereditary sj^philis; "I have found it more commonly 
indicated than any other remedy." (Geo. S. Norton.) Bar. jod., greatly 
enlarged cervical glands and bone pains at night; Calc. carb. and jod., 
strumous habit; Cann. sat., Hepar, promotes absorption; Sepia, uterine dis- 
turbances; Sulphur, promotes absorption. 

Pannus. Apis, Arg. nitr., Arsen., Aurum, Bellad., Cannab., Chin. 
mur., Euphras., Graphit., Hepar, Kali carb., Merc, sol., protoj. and prcec. 
rub., Natr. viur., Petrol., Pulsat., Rhus tox., Sulphu? . For particular indi- 
cations compare granular ophthalmia and the following: 

Ulceration of the cornea. ' ' Bandaging is of the very greatest importance 
in the treatment of ulcers of the cornea. See page 205 Allen and Norton's 
Ophthalmic Therapeutics." (Geo. S. Norton.) 

Act. rac. Sharp, neuralgic pains through the eye into the head. 

Apis. Stinging burning and cedematous swelling. 

Arg. nitr. Profuse discharge; halo around the light; darting pain 
through eye, morning and evening; better in open air; worse in warm room. 

Arsen. Burning, acrid, profuse lachrymation; photophobia; pain worse 
after midnight; with restlessness; better from warm applications. 

Asa/. Iris affected with pain in the direction from within outwards; 
better from rest and pressure. 

Aurum. With pannus; great photophobia and profuse, scalding lach- 
rymation; pains go from without inwards; cervical glands enlarged and 
inflamed. 

Calc. carb. and jod. For scrofulous children with large heads, open 
fontanelles, slow dentition; pot-belliedness; frequent catarrh of nose and 
bowels; pale face; enlarged tonsils and cervical glands. 

Cha7nom. Cross, peevish children who want to be carried about all the 
time, etc. 

Chin. mur. With pannus; severe intermittent pains; anaemic conditions 
of malarial origin. 

Cimic. See Act. rac. 

Cinnab. Pain above the eye, extending from the internal to the external 
canthus, or running around the eye. 

Conium. Superficial ulceration with intense photophobia and a gush of 
tears whenever the spasmodically closed lids were forced open; with all this 
but little redness of the conjunctiva. 

Crot. tigl. Pain in the supraciliary region at night and vesicular erup- 
tion on the face and lids. 

Euphras. Burning flow of corrosive tears and a feeling of a foreign 
substance in the eye, as of a hair; blurring of the eyes relieved by frequent 
winking; is followed well by Calc. carb. and later hy Silic. 

Graphit. Great photophobia; profuse lachrymation; superficial or deep 
ulcers; hypopion; lids red and sore, covered with scales; chronic eczema on 
head, behind ears, on face. The external canthi are prone to crack and bleed. 

Hepar. Torpid ulceration; hypopion; also profuse lachrymation or 



156 THERAPEUTIC HINTS TO CORXEITIS, KERATITIS. 

want of lachrymation; great redness of cornea and conjunctiva; throbbing 
pain, better by warmth, worse by cold, or uncovering the eye in the evening. 
Strumous, outrageously cross children; chilliness, desire to be covered; mer- 
curial poisoning. 

Kali bichr. Indolent ulceration without photophobia or redness; little 
pain; slight (if any) discharge of a stringy character. 

Kali cart. Ulcer in centre; no photophobia; pale, fat and flabby chil- 
dren. 

Merc. cyan. Trachoma with pannus; intense pain in eyeball, orbit and 
supraciliary region and head; worse on lying down; nocturnal pains in the 
joints; syphilitic origin. 

Merc, proioj. Serpiginous superficial ulceration of the cornea; much 
vascularity and photophobia; tongue yellow at base. (Geo. S. Norton.) 

Merc. sol. , and other mercurial preparations compare under phlyctenular 
conjunctivitis. 

Natr. mur. Acrid tears and discharge; sharp piercing above eye on 
looking down; after cauterization. 

Nitr. ac.j is often indicated after Calc. carb., or Pulsat. 

Nux vom. , Pulsat. Compare previous chapters. 

Rhus tox. After getting drenched; compare former chapters. 

Sccale. Worse from warm applications. 

Silic. Deep ulcers; sloughing ulcers; hypopion; the patient wants to 
have his head wrapped up; after vaccination. 

Sulphur. Acute and chronic form ; hypopion; otorrhcea; eczema; affec- 
tion of the bones. Cannot bear being washed. ' ' The pains of Sulphur are 
usually sharp and stitching, as if a needle or splinter were sticking in the 
eye. They do not extend into the head, with the exception of the shooting 
pain through the eye into the head from i to 3 A. m." (Geo. S. Norton.) 

Thuja. Syphilitic origin; hypopion; pain over the eyes as if a nail 
were being driven in. 

Vacci?i. With smallpox and after vaccination; also Variol. 

Opacities have been cured especially by Calc. carb.; but the following 
have also been successfully employed: Apis, Aurum, Cannab., Chelid., 
Crotal., Cupr. al., Euphras., Hepar, Kali bichr., A T atr. sulph., Nitr. ac, 
Phosphor., Pulsat., Rhus tox., Silic, Spongia and Sulphur. 

Staphyloma. — Notwithstanding several denials from persons who did not 
know anything about it, 

Apis did cure, or to say the least, did reduce under my own observation, 
a staphyloma, to a degree that the eye regained its former usefulness. Years 
after the same doubts were thrown upon Dunham's cure of a pterygium. 
Although such doubts do not alter the facts, yet they do injury by disheart- 
ening the young physician from even trying to do his best. It seems scarcely 
necessary to mention that Apis, in order to be successful, must correspond 
with the symptoms of the case. 

Schelling cured a staphylomatous protrusion by Euphras. and Eycop. 



SCLERITIS, SCLEROTITIS. 1 57 

{Allg. Horn. Ztg., 36, 148), and so did Stapf by the gradual administration, 
according to the symptoms, of Sulphur, Calc. carb., Nitr. ac, Pulsat., 
Euphras. , and Se?iega ; there remained at last a mere slight opacity of the 
cornea and some distortion of the iris; the protrusion of the cornea had been 
entirely removed {Arch. 18, 2, 45). 

Be Had., Hepar, Mercur. and other remedies may also be indicated, but 
if we give up before trying, how shall we find out ? 

Hypopion has been cured by: Hepar, Silic, Sulphur, Thuja. 

SCLEROTICA. 

Scleritis, Sclerotitis. 

Inflammation of the sclera takes place around the cornea and is usually 
circumscribed, especially between the insertion of the recti muscles; it is 
characterized by a bluish-red elevation, due to increased vascularity and 
lymphoid infiltration in the episcleral tissue, and by bright red vessels on the 
surface; it is usually painful to touch. Although at times complicated with 
choroiditis, it is not always a sign of hyperemia of the choroid, because there 
are severe cases of choroiditis without any scleral complication , and vice versa 
severe cases of scleritis without choroidal affection. When the uveal tract is 
involved it is usually the iris or ciliary body and not the choroid, as both 
(iris and ciliary body) are supplied by the anterior ciliary vessels in common 
with the sclera. (Norton.) 

Repeated attacks of scleritis tend in time to interfere with the nutrition 
of the sclera, in consequence of which the tunica becomes thin, blue and 
bulging, either in whole or in part, constituting an Anterior staphyloma of 
the sclera and choroid, which again may terminate in suppuration within the 
globe, spontaneous bursting and atrophy of the eyeball. 

Therapeutic Hints. 

(Allen and Norton's Ophthalmic Therapeutics.') 

Aeon. Acute stage; violent aching, dragging, tearing pains in the eye- 
balls; contracted pupils; photophobia. Eye sensitive to touch and feels hot 
and dry. After exposure to cold, dry air, or injuries. 

Kalmia. Sclera inflamed; vitreous filled with opacities; glimmering of 
light below one eye, especially on reading with the other. 

Mercur. The sclera is thinned and blue; aching in the eye all the time, 
but worse at night; some pain around the eye if the iris has become involved. 
Flabby tongue, offensive breath, night pains; syphilitic origin. 

Silic. Pains severe, extending from the eyes to the head, relieved by 
wrapping up the head; aching in the occiput corresponding to the eye 
affected. 

Thuja. Has often shown itself useful in all forms of this affection: the 
sclera becomes soft in consequence of extension of inflammation of the cornea 



158 IRITIS. 

and iris; tenderness of the globe; intolerance of light; general cachectic con- 
dition, either scrofulous or syphilitic; long deprivation of fresh air. 

Besides are recommended: Coccul., Pulsaf., Spigel. and Sulphur. 

If in spite of these remedies staphylomatous degeneration of the sclera 
ensues, iridectomy must be made, unless still other remedies are found to 
check this morbid process. 

IRIS. 

Iritis. 

Iritis is of frequent occurrence and is usually uncomplicated with inflam- 
mation of the neighboring tissues. It very rarely extends from the ciliary 
body and the choroid, but may extend to these structures. Tenderness of 
the eyeball to pressure is not marked in iritis, unless the ciliary body is 
involved. 

Simple Plastic iritis is characterized by ciliary neuralgia, almost always 
worse at night, photophobia, lachrymation, dimness of vision, ciliary injec- 
tion, chemosis, iris discolored, aqueous, hazy, sluggish, pupil contracted, 
and adhesion of iris to lens — posterior synochia. 

In Parenchymatous iritis the iris is more swollen and vascular with 
more exudation in pupil. 

In Suppurative iritis the lids are cedematous, there is more chemosis, 
and pus in the anterior chamber. 

In Syphilitic iritis we have secondary symptoms of syphilis and often 
gummata on the iris. 

Rheumatic iritis is like plastic, only the episcleral injection may be 
more marked. 

Traumatic iritis is like plastic. 

Serous iritis is characterized \>y a deposit of lymph on the posterior 
surface of the cornea, which takes a pyramidal shape with apex toward the 
centre of the cornea, cloudiness and hypersecretion of the aqueous humor, 
dilated pupil, deep anterior chamber and slight photophobia, lachrymation, 
ciliary injection. (Geo. S. Norton.) 

Therapeutic Hints. 

" In the treatment of iritis Atropine is, I believe, of the greatest impor- 
tance. The pupil must be kept dilated, or you are always certain, in the 
great majority of cases, to have serious results, as posterior S3mochia remain- 
ing after the inflammation has been subdued. Dry warmth and rest are also 
very important aids in the treatment." (Geo. S. Norton.) 

Aeon. Rheumatic form, after exposure to cold winds, with great dry- 
ness and heat in the eye; traumatic origin, even more important than 

Arnica. Rheumatic and traumatic form. 

Arsen. Burning pains worse after midnight, better from warm appli- 
cations. 



THERAPEUTIC HINTS TO IRITIS. 159 

Asa/. Syphilitic form and after overdosing with Mercury ; severe 
throbbing, or burning, or sticking pain from within outward, better from 
rest and pressure. 

Aurum. Syphilitic form and after the abuse of Mercury and Potash; 
pain in the orbital bones, pressing from above downwards, or from without 
inwards, worse on touch; great mental depression. 

Bellad. Rheumatic form, pressing pain around the eye, or stitching 
pain above or beside the eye, as if it were torn out or pressed in; pains come 
and go, with flashes of light or dark spots with light margins, or dark fog 
before the eyes; severe vertigo and headache even to loss of consciousness. 

Bryon. Rheumatic form; the pain is worse from moving the eyes and 
also in the evening and at night; there is shooting pain in the head, and 
pain as if the head should burst on stooping. 

Catena 1 . Traumatic iritis. 

Cedron. Supraorbital neuralgia, periodical. 

China. Periodical pains; after loss of vital fluids and of malarial in- 
fection. 

Cinnab. Syphilitic form; pain commences at inner canthus, extending 
across the brow, or passing around the eye; nocturnal aggravation; inter- 
mitting pain. 

Clemat. Pressing pain in the eyes, photophobia and lachrymation, 
worse in the open air; heat in the eyes. 

Coloc. Rheumatic form; around the cornea a bluish- white ring; photo- 
phobia; no lachrymation; tearing pain in eye and surroundings; worse in 
the evening and at night. 

Conium. Excessive photophobia without corresponding redness of eye. 

Euphras. Rheumatic form; aching and occasional darting pain in eye, 
worse at night; iris adhering. 

Gelsem. Serous form with choroidal exudation. 

Hamam. Traumatic form with haemorrhage into the anterior chamber. 

Hepar. With corneitis or hypopion. Characteristics see in former 
chapters. 

Kalijod. Syphilitic form. After abuse of Mercury. 

Mercur. and its various preparations, syphilitic and other forms; tearing, 
boring pains in the bones around the eyes; worse at night; sclerotitis; and 
conjunctivitis; sweat without relief; bad smell from mouth; frequent spitting 
of saliva; tenesmus. 

Merc. corr. , is commonly indicated by the symptoms of iritis more than 
any other drug. (Norton.) 

Natr. mur. Pupil contracted; iris discolored; violent stitches in the 
temples on looking into the light or when the light is changed; on reading 
or writing the letters run together; sight much impaired. 

Nitr. ac. Chronic syphilitic form with very little pain (Norton"); also 
after abuse of mercury; pain worse on any change of temperature, at night 
and on touching the parts. 



l6o CHOROIDITIS. 

Nux vom. Rheumatic and syphilitic form; after drugging; pain worse 
in the morning. 

Petrol. Syphilitic form with occipital headache. 

Pulsat. Rheumatic form; pain worse in the afternoon and evening; 
cries easily and is worse after crying. 

Rhus fox. Rheumatic and traumatic form; lids swollen and spasmodi- 
cally closed; lachrymation; conjunctiva chemosed; pain worse at night; after 
getting wet; rainy weather; after Bryon. 

Si lie. With hypopion and corneitis. 

Spigcl. Rheumatic form; excessive pain in and around the eye, espe- 
cially on moving; sometimes periodically from morning till noon, and then 
abruptly ceasing. 

Sulphur. Rheumatic and other forms; with hypopion; relapsing cases; 
psoric tendency; pain worse in the evening and at night; ears often affected. 

Tereb. Rheumatic form; after suppression of perspiration of the feet; 
urinary symptoms. 

Thuja. Syphilitic form; condylomata on the iris; wart-like excrescences 
on the iris; pain better by warmth. 

Besides have been successfully employed: A?g. nitr., Crot. tigl., JPyos., 
Iodum y Lyeop., Plumbum, Stilling., Zincuvi. 

CHOROIDEA. 

The choroid is a dark brown vascular coat, which lies within and in 
contact with the sclera, and between it and the retina; its proper structure 
terminates anteriorly where the ciliary body commences, which forms the 
connecting link between it and the iris. 

Choroiditis 

Is usually found uncomplicated with inflammation of other portions of the 
uveal tract. 

In Choroiditis disseminata the eyes feel weak and vision is blurred. 
The ophthalmoscope shows a yello wish- red nodule in the choroid in the first 
stage which soon atrophies, leaving a white spot surrounded by a rim of pro- 
liferated pigment. Other spots follow, and as they have a tendency to 
coalesce the}' form large atrophic plaques. The haziness of the vitreous is 
not marked unless the choroiditis is of the syphilitic variety, when the hazi- 
ness of the vitreous is a very prominent symptom, as is the non-tendeiKry of 
the spots to run together. 

Choroiditis suppurativa ( panophthalmitis) is usually the result of foreign 
bodies or injuries and its course is generally rapid, destroying the eye. 
Characteristic symptoms are: cedematous swelling of the lids, chemosis, pro- 
trusion of the eye, hypopion, synochia posteriora, white reflex from the 
fundus, tension increased, eye sensitive to touch, loss of vision, very severe 
pain, fever and vomiting. 



THERAPEUTIC HINTS TO CHOROIDITIS. l6l 

Sclerotico-choroiditis posteriora or Posterior staphlyoma is found in 
myopia, especially high degrees, and is characterized by a white crescent 
around the optic nerve entrance, especially outer side, which corresponds to 
the bulging of the sclera at that point. It may, however, be irregular and 
extend around the optic disc. When it is progressing the myopia increases, 
vision becomes more impaired, black, floating spots appear before the sight 
and the edges of the crescent are not as well defined. It is a congenital 
trouble and is increased by overuse of the eyes. 

Cyclitis usually passes over into irido-cyclitis or irido- choroiditis. A 
prominent symptom of irido-choroiditis is the increased tension in its early, 
and diminished tension in its late stage. (G. S. Norton.) 

Therapeutic Hints. 

Aurum. Serous exudation between the choroid and retina; haziness of 
the vitreous; sensitiveness to light and touch; pressive pain in eye from 
above downward or from without inward; pain in the bones around the eye. 
After abuse of Mercury or Potash. 

Bellad. Often indicated by congestion towards the head; eyes sensitive 
to light; halo around the light; various flashes of light, sparks, etc., before 
the eyes. 

Bryon. Serous exudation; following rheumatic iritis; eyeball sore to 
touch and motion; darting pains through the eye into the head. 

Gelsem. Serous choroiditis; iritic complications; vision varies from day 
to day or from hour to hour; sometimes fever, with thirstlessness. 

Kalihydroj. Syphilitic origin; disseminate variety. 

Meir. corr. or sol. disseminate form; iritic complications; syphilitic 
dyscrasia; tendency to adhesion; nocturnal aggravation of the pains, both in 
and around the eye. 

Nux vom. After use of stimulants; aggravation in the morning. 

Phosphor. Luminous appearance before the eyes, especially red; after 
sexual excesses; bright light, natural or artificial, hurts the eyes; they feel 
better in the twilight. 

Prun. spin. With or without iritic or retinal complication; severe pain 
in the eyeball, as if it were being pressed asunder, or else shooting and cut- 
ting pain through the eye and corresponding side of head, or crushing pain. 

Palsat. When corresponding to the general disposition of the patient. 

Sulphur. Chronic state; sharp, darting pains; after suppression of 
eruptions; psoric taint. 

Besides, the following remedies have been useful: Aeon., Arsen., Coloc, 
Hepar, Ipec., Psorin., Pufa, Silic, Sol. nig. 

In Sclerotico-choroiditis posteriora has been found useful: 

Bellad. Flushed face and throbbing congested headaches; photophobia. 

Crocus. Pain from the e}^e to the top of the head; also pain from left 
eye darting to the right; sensation of cold wind blowing across the eyes. 

Mercur. Usual indication. 
ii 



1 62 GLAUCOMA. 

Phosphor. Muscae volitantes, flashes of light before the eyes. 

Prun. spin. Pains in eye as if pressed asunder, or sharp and darting in 
and around the eye. 

Spigel, Sharp, stabbing pains through the eye and around it, often 
commencing at one point and then seeming to radiate in every direction. 

Thuja. Often called for in strumous and sycotic persons. 

Besides compare: Carb. veg., Kali jod., Lycop., Physost., Rata and 
Sulphur. 

In Choroiditis suppurativa compare: Aeon., Apis., Arsen., Hepar, 
Phxtol. (traumatic origin, lids very hard, red and swollen; conjunctiva 
chemosed and pus in the interior of the eye; severe pain). Rhus tox. is the 
most important remedy. Lids (Edematous, much chemosis, photophobia and 
profuse gush of tears on opening the spasmodically closed lids, hypopion, 
pains at night, etc. (Norton.) Also: Asa/., Bellad., Mercur., Sulphur. 

In Haemorrhage compare: Arnica, Bellad., Cinchona, Crotal., Hamam., 
Laches., Phosphor., etc. 

Glaucoma. 

i. Acute Form. — Its onset ma}' for hours, days, weeks, months, even 
years, be premonitioned by one or the other, or several of the following 
symptoms: a halo, gray or colored, or a circle or several in the same or dif- 
ferent colors around candle-light or luminous objects; flashes or wheels of 
light in the dark, as well as in the light, with or without intercurrent obscura- 
tions of sight; periodic dimness of sight, or dimness of a part of the visual 
field; rapid increase of presbyopia, ciliary neuralgia, headaches. The attack 
itself often commences suddenly with severe throbbing pain in the eyeball 
and the corresponding side of the head ; the eyeball is very sensitive to touch ; 
flashes of a vivid red or deep orange color appear before the eyes with great 
photophobia, increased by exertion, or anything that quickens the heart's 
action, even the taking of food. The eyeball shows signs of inflammation in 
different degrees of intensity, such as: lachrymation and intolerance to light; 
swelling and redness of the eyelids; conjunctivitis with serous chemosis; but 
scarcely an}- purulent discharge; hyperemia of the sclerotica and congestion 
of the anterior ciliary veins; the cornea is hazy and a little roughened, or 
even vesicular in spots, or sometimes opaque interstitially ; its sensibility is 
more or less lost in parts or in its entire structure. The iris loses its color, 
acquiring a slate-like aspect and is pushed against the cornea; the pupil 
becomes dilated, irregular and fixed; its color is less black than usual, but 
more of a drab color, showing sometimes even a shade of green. The eye- 
ball, on palpation, feels harder than natural. The vision gradually grows 
duller, a thick fog appears before the eye in daylight and at night prismatic 
colors surround the candle-light. The visual field usually commences to con- 
tract on the inner side and after a while all vision is lost. Ophthalmoscopic 
inspection reveals: haziness of the vitreous body; in hemorrhagic glaucoma, 
which is rare, there is haemorrhage either from the disc, the retina or the 



THERAPEUTIC HINTS TO GEAUCOMA. 1 63 

choroidea, singly or combined; excavation of the optic disc, called glauco- 
matous cupping, with dilatation of the retinal veins and pulsation of the 
central retinal arteries. 

2. The subacute form, or chronic glaucoma, shows all the symptoms 
above enumerated, only not so sharp and definitely marked, although lead- 
ing in an insidious and slow manner to the same results. Glaucoma always 
begins in one eye, and is very apt to develop in the other, in the course of 
months or years. Its causes have not been sufficiently explained, and the 
nature of the glaucomatous tension of the eyeball is also not fully established. 

Post-mortem examinations have revealed: obliteration of Schlemm's 
canal (Kniess); closure of the drainage channels (Weber); atrophy of "the 
ciliary body, and atrophy or adhesion of the iris (Brailey), all of which are 
supposed to be more or less concerned in producing the increased tension of 
the globe. 

Therapeutic Hints. 

Iridectomy, first recommended by Dr. von Graefe, is by some considered 
as the only remedy worth speaking of, while other eye-surgeons recommend 
frequent tapping of the cornea, and the newest of all is sclerotomy. Which- 
ever may be preferred or deemed necessary, in this I agree entirely with 
Walton, when he says: ' ' Treatment by practical surgery alone is not enough; 
it should be but a part, an auxiliary of a therapeutic system, embracing those 
details which help so much in subduing the abnormal conditions which are 
common to other affections and to glaucoma. I allude, of course, to the 
abnormal conditions of inflammation of the uveal tract, particularly choroid- 
itis, to neuro-retinitis and hyalitis." (Page 1172.) 

Arg. nitr. See Advance, October, 1879. 

Aurum. Pressure from within outward, and from above downward in 
eyeball; heavy; dull aching of the globes; upper half of an object invisible; 
showers of bright, star-like bodies appear in the upper dark section; bright, 
floating streaks and dots in gaslight before the eyes. 

Bellad. Pain in and around the eye, of a pressing nature, as if the eye 
were being pressed into the head, or sometimes as if the eye were being torn 
out; the eyes feel hot, dry and stiff, as if they might protrude. 

Bryon. The eyes feel as if pressed out, often attended with sharp shoot- 
ing pains through the e}^es and head; the}'' feel sore to touch and on moving 
them. 

Cedron. Severe shooting pain along the course of the supra-orbital 
nerve. 

Coloc. Severe burning, aching, sticking, cutting pain in the eye and 
around, always relieved by firm pressure, and by walking in a warm room, 
worse by rest at night and upon stooping. 

Eserine. Is much used at present and in some cases seems to act well. 
(Norton.) 



1 64 OPTIC NERVE AND RETINA. 

Phosphor. Halo around the light, and various lights and colors flashing 
before the eyes. 

Prun. spin. Severe crushing pain in the eye as if pressed asunder, or 
sharp shooting through the eye and corresponding side of the head. 

Rhodod. Periodic pain in and around the eye, worse before a storm and 
better after the storm commences. 

Spigcl. Sharp and stabbing pains through the eye and head, worse on 
motion and at night. 

Besides should be compared: Arnica, Arsen., Chamom., Coccul, Collin., 
Conium, Crot. tigl., Gel son., Hamam., Kali carb., and Jod., Mercur., Nux 
vom., Phytol., Sulphur and Val. of Zinc. 

OPTIC NERVE AND RETINA. 

The optic nerve and the retina may, each of them, be the isolated seat of 
morbid derangement, the first usualh' from some cerebral disturbance, the 
latter from intraocular disorder; but either of them, if extensively affected, 
will also affect the other. We speak therefore of 

Neuro-Retinitis 

As an inflammation of the optic nerve, the optic disk and the retina, a 
separation of which into different forms would be of little practical use. 

Its Subjective Symptoms are: haziness or fogginess in various degrees; 
reduction of acuteness of direct and indirect vision ; contraction of the visual 
field; blind spots in the visual field; distortion of objects looked at; sub- 
jective appearance of light, so-called sparks, or flashes, or photopsia ; sub- 
jective play of colors, colored spectra, or chromotopsy ; the latter two may 
occur even when the case has proceeded to absolute blindness. Still all 
these symptoms may occur also in various other intraocular diseases, and the 
only certain way of making a diagnosis is with the ophthalmoscope. 

The Ophthalmoscopic Symptoms are: optic disc swollen and outlines 
ill-defined, retina hazy and vessels veiled here and there; tortuous appear- 
ance of the veins, which are dark and full; usually haemorrhage, most fre- 
quently observed in the retina, seldom in the disc; occasionally whitish dots 
scattered in groups or dull, glistening patches in the semi- opaque retina. 
There are no external objective symptoms, unless other ocular tissues are 
involved in the morbid process. It may lead to partial or complete atrophy 
of the retina. 

Its Causes are: Albuminuria, and then it is called Retinitis albumi- 
nurica ; haemorrhage into the retina and white spots here and there, espe- 
cially of a stellate arrangement in the maculae lutea are characteristic and 
early symptoms of this form. Syphilis, and then it is called Retinitis syphi- 
litica ; it can be diagnosed only by the precedence or presence of some other 
mark of constitutional syphilis. Diabetes, and then it is called Retinitis 
diabetica, with similar appearance as retinitis albuminurica ; Leucaemia 
(Retinitis leucaeniica ) ; great pallor of the retinal vessels; haemorrhages in 



THERAPEUTIC HINTS TO OPTIC NERVE AND RETINA. 1 65 

retina (Retinitis apoplectica) ; deposits of pigment in the retina (Retinitis 
pigmentosa) ; contraction of field of vision, night-blindness and deposits of 
pigment in retina, extending from periphery to centre of fundus. Direct and 
reflected rays of artificial light or of the sun, and overstraining the eyes 
under imperfect or unsteady light, also traumatic injuries. 

There are other affections of the optic nerve and of the retina which, too, 
inay cause impairment of sight or even total blindness, without showing 
externally any objective symptoms. Such affections were, before the oph- 
thalmoscope was known, classed under the terms Amblyopia (impaired sight) 
or Amaurosis (what renders obscure, dark). These terms have of late been 
stricken out of the books, because where there is impaired sight or loss of 
vision there can now, by the use of the ophthalmoscope, be found also a cor- 
responding change in the optic nerve or retina, a pathological cause of 
amblyopia or amaurosis, from which the affection receives its proper name. 

Therapeutic Hints. 

Aeon. Total blindness produced suddenly by taking cold. 

Ammoniacum. After severe blows upon the head, sight impaired; 
smoke before the eyes, shaping different circles, most distinctly on white 
ground; the margins of the circles are gray and become black upon sudden 
motions of the eye; better in clear, worse in cloudy weather; persons at a 
distance he cannot recognize; by candle-light their faces appear dark. 

Apis. Albuminuria, after scarlet fever. 

Arnica. After a violent blow, loss of sight. 

Arsen. After abuse of liquor and tobacco; urine scanty and albuminous. 

Aur. mnr. After scarlet fever and during childbed (albuminuria); 
sudden loss of vision, with cold perspiration, small pulse, quick and irregular 
breathing. 

Bellad. Optic disc swollen and outlines ill-defined, retinal vessels large 
and tortuous, blue and bluish-gray film seems to cover fundus. (Norton.) 
Haemorrhage of retina, with suppression of menses; cerebral congestion; 
sudden heat of head; vertigo, burning and throbbing pain; noises in ears and 
illusions of vision, while the rest of the body is cold and shivering; pulsation 
of carotids. After suppressed scarlet eruption. 

Bryon. Byes feel full and sore on motion or to touch. 

Cactus. With heart troubles. 

Cinchona. Sudden blindness with violent pain in occiput, extending 
into the eyes; irritability of entire spine; spleen swollen and painful to pres- 
sure; rumbling in the abdomen; sour vomiting; constipation. 

Crotal. Haemorrhages in retina. (Norton.) 

Gelsem. Thirst for light; after apoplexy, congestion to the head; albu- 
minuria during pregnancy, after diphtheritis. 

Kali hydr. Syphilitic form. 

Laches. Haemorrhage of retina; albuminuria. 

Merc. corr. Albuminuric form, especially during pregnancy. 



1 66 HEMIOPIA. 

Merc. sol. Sensitiveness of the eye to the glare of a fire. 

Nux votn. Abuse of stimulants and tobacco. 

Phosphor. Photopsies and chromotopsies, as halo around the light; dry- 
ness of the nose; after sexual excesses. 

Pulsat. "Choked disc," great swelling of optic papillae and enlarge- 
ment of vessels; vision nearly lost, with severe headache, only relieved in the 
open air. (Norton) Menstrual difficulties. 

Secale. Photophobia; suppressed secretion of tears; stitching pain in 
the eyes; dilated pupils; blue and fiery dots flying before the eyes. 

Sulphur. Suppressed itch. 

For impaired sight (amblyopia) and blindness (amaurosis) the following 
remedies also have been found useful: Alum., Bar. carb., Bovista, Calc. 
card., Chclid., Crotal., Cyclani., Elaps, Hepar, Ignat., Kali acet., Lycop., 
Natr. mur.y Ruta, Santon., Sepia, Thuja, Zincum. 

Hemiopia, 

Or half vision, is a contraction of the visual field, either on the two right or 
on the two left sides of the eyes, in consequence of an affection of either the 
right or the left optic nerve tract before the crossing at chiasm; blindness of 
the opposite sides of each retina, occurs when the optic nerve fibres are dis- 
turbed at the chiasma, that is at the point where the nerve fasciculi cross 
each other. Upper half blindness denotes an insensibility of the lower por- 
tion of the retinal nerve fibres, and is usually dependent upon a detachment 
of retina or embolism of a branch of the central retinal artery. Scotomata, 
or blind spots, are insensibility of certain corresponding parts of the retina. 

Therapeutic Hixts. 

Upper half blindness: Aurum, Digit., Phosphor.; right half blindness: 
Cyclam,, Lith. carb., Lycop.; half vision either side: Bovista, Calc. carb., 
Caustic, Chin, sulph.. Lob. infl., Lycop., Mur. ac, Natr. mur., Sepia, Viol, 
od. 

Hemeralopia, Night-Blindness. 

The patient sees well enough, as long as there is enough stimulus of 
bright light, but he cannot discern objects any more, as soon as the amount 
of light required by him is withdrawn, be it daylight or candle-light. It is 
most common among seafaring men. The glare from the sea seems to be the 
exciting cause added to some constitutional weakness; but is also found 
occasionally with harvesters and soldiers, where fatigue and exposure to the 
glaring sunlight seem the elements in its production. 

Therapeutic Hints. 

Cases. have been cured by: Arg. nitr., Bcllad., China, Hyosc, Lycop., 
Pulsat., Ran. bulb., Stramon., Sulphur, Veratr. 



HYPERESTHESIA RETINA. 1 67 

Hyperaesthesia Retinae. 

We understand by it an oversensitiveness of the optic nerve and retina; 
even a small amount of light cannot be borne, and sometimes its impression 
lasts too long. This may be caused by irritation of the optic nerve and 
retina, with or without ciliary irritation. Ciliary irritation is usually accom- 
panied by lachr3 T mation and pain in the eyeball, and associated with many 
affections of the cornea and conjunctiva; this affection is usually spoken of 
as Photophobia. When the overexcitement of the optic nerve and retina 
does not depend on external conditions, we have, with or without intolerance 
to light, subjective appearances before the eyes, such as sparks, bright white, 
or colored patches, flames, colored rings, chromatic clouds, so-called phos- 
phenes, also known under the name of Photopsia and Chromotopsy; and 
in some instances a too long duration of the impressions, especially from 
bright objects, which continue to affect the optic nerve even after the eyes 
have been turned to some other object, whereby confusion arises and the 
objects seem to dance. 

Therapeutic Hints. 

For this affection a great number of remedies may present themselves for 
consideration. We shall have to weigh carefully all the symptoms of the 
case. Perhaps one or the other of the following maybe indicated: Aeon., 
Be/lad., Cinchona, Conium, Ge/sem., Hepar., Hyosc., Ignat., Lad. ac, Merc. 
sol+ Natr. mur., Nux vom., Phosphor., Pulsat., Sulphur, Tart. emet. 

LENS. 
Cataract, 

Is loss of transparency of a part or of the whole, either of the crystalline lens 
(lenticular cataract), or of the capsule (capsular cataract), or of both (cap- 
sulo-lenticular cataract). 

In the course of physiological development the lens commences to change 
after the age of about thirty-five years to greater density, more coloration 
and loss of convexity, and in the senile eye the pupil has lost its blackness, 
appears cloudy or of a light amber tint, or brownish-yellow, yet without loss 
of transparency. This ought to be borne in mind. The cataractous changes 
are different. Consisting in atrophy from loss of nutrition, the lens fibres 
are converted into different solid and fluid materials; the nucleus becomes 
hard and dry, while the cortex may be softening to the state of a semi-fluid 
pulp, which remains of opaque fibres, molecular substance and fatty tissue, 
especially in its hypermature state. This is the nature of the so-called Hard 
cataract. The Soft cataract consists of the conversion of the lens tissue 
into a paste-like material, or a degeneration of it into a soft substance of a 
thin milk-like color with granular flocculi, corpuscles and fatty material. 
The former is the cataract of adults, elderly and old people; the latter is met 
with from birth to puberty. 



1 68 THERAPEUTIC HINTS TO CATARACT. 

The cataractous changes of the capsule are probably the result of inflam- 
matory action; they are mostly attended by a secondary degeneration of the 
lens, or vice versa, accompany a fluid degeneration of the lens. In Trau- 
matic cataract, which originates in consequence of a blow or other external 
injury to the eye, the capsule is nearly always opaque, and the cataract is of 
the soft kind; in the uncomplicated cataract of the aged, however, the capsule 
is seldom altered. 

The Objective Symptoms of these different affections can clearly be 
elucidated only by the ophthalmoscope. They are important to the e3 r e- 
surgeon, who will consult special works thereon, but even the naked eye is 
capable of detecting opacities of the lens. The following are the Subjective 
Symptoms: As soon as the opacity upon either the lens or the capsule is 
dense enough to interfere w T ith the rays of light, the first symptom is indis- 
tinctness of sight or mistiness; at first distant objects are seen as if through 
a mist or fog, or a bit of glass that has been breathed on; after awhile this 
mistiness envelopes near objects also. The adjusting power is lessened, 
because of the lens losing its elasticity. The patient now sees better in twi- 
light; then the pupil expands and more rays are allowed to pass through 
the lens. For this reason the patient shades his eyes in bright light and 
derives benefit from wearing goggles. In some cases there is even intolerance 
to bright light. In other cases the objects appear doubled or even farther 
multiplied, and are seen in fantastic forms. This arises when portions of the 
lens still remain transparent, but vary in the degree of their destiny, whereby 
an irregular astigmatism is produced. Muscae, of all shapes and sizes, and 
sometimes in showers, are of frequent occurrence; but flashes, stars, fiery 
circles, bright metallic light, bright spectra like silver must be attributed to 
other diseases of the eye; they have nothing to do with the cataractous affec- 
tion of the lens. 

Causes. — " Defective nutrition," merely expresses, in other words, what 
cataract consists of, but does not tell the cause, which in fact w 7 e know not. 
We can merely state, that cataract has been observed to develop: after ex- 
ternal injuries of the eye; in consequence of diabetes; after fever; in con- 
sequence of other diseases of the eyes, either active or of a low type; in 
consequence of hereditary influences. After one eye has been attacked the 
other is likely to follow. 

Therapeutic Hints. 

Under certain circumstances the quickest relief may be afforded by an 
operation, but there is no doubt that homoeopathic treatment has succeeded 
not only in checking further development, but also in clearing up existing 
opacities of lens and capsule. Dr. J. C. Burnett bases the curability of cata- 
ract on the homologus nature of the lens with the mucous membrane of the 
common integument, and gives a number of cases cured by him and by 
others in his most interesting monograph on: Curabilility of Cataract with 
Medicines. Boericke & Tafel, 1880. 



REFRACTION AND ACCOMMODATION. 1 69 

The following are the most important remedies: 

Amm. carb. (right eye); Bar. carb.) Bellad. (after acute inflammation 
of the eye); Calc. carb. (scrofulous individuals); Ca?inab., Caustic, (constant 
inclination to touch and rub the eye, which seems to relieve a pressure in it) ; 
Conium (old persons); Euphras. after Sulphur (congenital cataract); Lycop. 
(after typus; suppressed menses) ; Mag?i. carb. (from left to right; previous 
disposition to headache and furuncles); Natr. mur. (Burnett) Phosphor.; 
Saccharum Sacchari (in several cases of old age); Sepia, Silic (after inflam- 
mation of the eye; preceding ringworms; suppressed sweat of feet); Sulphur 
(from right to left; after cutaneous eruptions, especially suppressed itch. 
According to Jahr main remedy.) According to Goullon, Jr., the main 
remedies are: Sulphur, high potency (30th and higher), or Spiritus sulph.; 
Silic, or Aq. silic; Calc. fluor., or Lapis albus ; Calc. carb., Phosphor., 
Caustic, Sepia, Bar. carb. Intercurring remedies: Bellad., Ferr. phosph., 
Euphras., Pulsat., Chelid., Cannab., Colchic, Sec. cor?i. — Allgem. Horn. 
Zeit., Vol. 107, page 125.) 

"Dislocation of the lens often results from injury and may be spontane- 
ous. It is most commonly dislocated backward into the vitreous, though it 
may lie in the anterior chamber or even under the conjunctiva. The lens 
may be seen in any case lying in its unnatural position. When in the vitre- 
ous, the tremulous condition of the iris will call attention to the trouble." — 
(Geo. S. Norton.) 

SIGHT. 
Refraction and Accommodation. 

A luminous body sends off rays of light in all directions, and in whatever 
direction they go they always move in straight lines, unless interfered with 
by a medium of different density. When entering a lens they are bent 
towards its thicker portion; a biconvex lens converges them to a focus; a 
biconcave lens scatters them for the same reason. Now when parallel or even 
slightly divergent rays of light from an object enter the pupil, and pass 
through the crystalline lens of the eye, they are bent by this body towards 
its thicker part and are thus focussed upon the retina. In this bending and 
gathering of the rays of light to a focus upon the retina consists what is 
technically called the Refraction of light. It is a purely mechanical process 
conditioned by the transparency and biconvexity of the lens, which like any 
other biconvex lens focusses the parallel and divergent rays of light at a 
certain distance, according to the amount of its convexity, that is according 
to its refractive power. When an object is sufficiently near the eye to emit 
divergent rays it is said to be at a finite distance; when, however, it is 
sufficiently far away to emit parallel rays of light to the eye, it is spoken of 
as being at an indefinite or indeterminate distance. In either case the rays 
are not entirely and equally parallel, and consequently the focus must vary in 
its distance behind the lens, either fall in front of or behind the retina. 



I JO PRESBYOPIA, OR OLD SIGHT. 

Only if an object were brought in the exact position from which its rays 
could be focussed upon the retina, could it be seen distinctly. We know, 
however, from experience, that for a normal eye such exact position of 
objects as to distance, in order to be seen, is not required. The healthy 
eye possesses a faculty by which it brings both parallel rays and rays in 
various degrees of divergency, to an accurate focus upon the retina; it sees 
clearly and distinctly at different distances, adapting itself for the position 
of the object looked at; and this is called its power of Accommodation or 
Adaptation. The nearest distance to the eye at which a small object can 
be seen distinctly by the maximum of accommodation, or by its greatest 
effort to see, is termed "the near point of vision;" the farthest distance at 
which anything can be clearly discerned, is ' ' the far point of vision. ' ' These 
points vary in different eyes; the interval between the near and the far point 
is termed the range or territory of accommodation. 

Xow the question arises, how is this accommodation of the eye to the 
various distances of objects effected? As the lens is only a passive agent 
of refraction, and as upon its form depends the distance where the transient 
rays are focussed, we must look for the means b} r which this change in the 
form of the lens is effected. And here all the latest researches agree in this, 
that the constant variations in the curvings of the lens, as accommodation 
for near and far objects requires, are brought about by the ciliary muscle of 
the eye. 

Associated with this ever-changing form of the lens by means of the cili- 
ary muscle are also pupillary movements — contraction for near objects to cut 
off the lateral rays of light, and dilatation for distant objects, the sphincter 
pupillse and the ciliary muscle being in a functional connection by nerve- 
fibres; and to this may be added the action of the recti muscles, which in 
accommodating for near binocular vision, turn the eyeballs inwards, while for 
perceiving distant objects, they place them parallel. 

Presbyopia, or Old Sight. 

The constant change in the curvings of the lens, as accommodation 
requires, can readily be affected only so long as the lens is sufficiently soft 
and yielding. As, however, the lens in the course of years grows denser and 
therefore less capable of being acted on by the ciliary muscle in the process 
of accommodation, and as also its shape becomes flatter and in consequence 
its refractive power reduced — the near point of vision gradually recedes, that 
is to say* If we were formerly able to see an object distinctly at a distance 
of four or five inches, etc. , because of the greater convexity to which the 
lens could be shaped by the ciliary muscle for such purpose, we now have to 
hold the same object further off, in order to receive a distinct visual impres- 
sion, showing that the lens is not capable any more of being shaped convex 
enough to gather the divergent rays of the near point to a focus upon the 
retina. The near point of vision has receded to eight, twelve or sixteen 
inches. With all this, distinct objects are discerned as accurately as before. 



HYPERMETROPIA. 171 

This is Presbyopia — a diminution of accommodation for near objects, with 
diminution of refraction , consequent on age. 

This natural change in the crystalline lens commences in early life and 
gradually increases with advancing years. Generally about the age of forty, 
the near point is eight inches from the cornea, and at about forty-five years 
it recedes to twelve or sixteen inches. In some instances the change sets in 
suddenly, so that a month or even a week will make all the difference in the 
condition of the eye. In such cases we should bear in mind that a rapid 
increase of presbyopia is also a prominent symptom of glaucoma. Still later 
the far point for distinct vision, too, declines, and the focal range is thereby 
lessened. With the loss of range, there ma3 T be loss of the acuteness of 
vision, arising from retinal obtuseness. Presbyopia requires convex glasses, 
which ought to be changed as often as the progress in the change of the 
crystalline lens demands it. Lenses will not afford any help to distant vision, 
unless there be hypermetropia combined with it. 

Hypermetropia. 

This affection is caused by a congenital, often hereditary malformation of 
the eyeball, which is smaller than the emmetropic eye; its antero-posterior 
diameter is shorter than that of a normal eye, consequently the parallel rays 
of light entering the pupil do not unite and form a focus on the retina, but 
fall behind it, and were the sclerotica removed posteriorly, they would con- 
verge to a point behind its boundary. Therefore, it is still further impossible 
for divergent rays to be properly refracted for the function of sight. Only 
rays that have been artificially rendered convergent by a convex lens, are 
properly focussed upon the retina. 

Slight degress of this affection are often masked by the great accommodat- 
ing power of the lens during youth; an abnormally distant position of the 
near point, however, in young persons may be taken as., a very conclusive 
evidence of the presence of hypermetropia; after manhood the marked 
removal of the near point, the loss of acuteness of vision, the very decided 
assistance afforded to far vision by a convex lens, and the strong glasses 
needed for seeing small type confirm its presence. 

"In hypermetropia, asthenopic symptoms, as: eyes tire easily, blurring 
of vision, aching in and over the eyes, etc., after using for near work, occur 
early and require immediate selection of the proper convex glass. ' ' (Norton. ) 

Myopia, or Short-sightedness, 

Is the opposite condition to hypermetropia. The antero-posterior diameter 
of the eyeball is longer than in the emmetropic or normal eye, hence distant 
or parallel rays of light are brought to a focus before they reach the retina 
and the image which is formed on the retina is blurred and indistinct. Only 
divergent rays, that is, rays coming from near objects, are accurately focussed 
on the retina. While, therefore, the myopic eye can see near objects, it can- 
not see distant ones well without optical aid. The myopic far-point is always 



1 72 ASTIGMATISM. 

at a definite distance; in bad cases it ma)' be within a few inches of the cor- 
nea; there is in such cases little difference between it and the near point. 
The two are in proportion to each other, the further the far-point, the further 
also the near-point, and vice versa. 

" Myopia may be produced by a spasm of the ciliary muscle, and must 
not be confounded with an elongation of the antero-posterior axis. ' ' ( Norton . ) 

The disposition to myopia is almost invariably congenital and heredi- 
tary; it is, therefore, a most uncommon occurrence for myopia to appear after 
the fifteenth year of age, and it is never acquired after the twentieth in eyes 
that are normal 

Its development is favored by the tension of the eye, which is insepara- 
bly connected with looking at near objects, where, by the constant and strong 
action of the internal recti muscles to produce the necessary convergence of 
the optic axis for the requisite position of the corresponding portions of the 
retinae, the eyeball gradually is drawn into a more or less oval shape, which 
finally may amount to the formation of a posterior staphyloma by atrophy of 
the choroid and sclerotica. Myopia is, therefore, essentially an accompani- 
ment of civilization, where it prevails chiefly among those classes who, from 
childhood on, have had to use their eyes continuously in reading and writing 
or other close work. 

In old age, when the lens grows flatter (see Presbyopia) the near-point 
recedes and consequently the myopic can often read again without the aid of 
glasses. This gain in sight is not an actual improvement of the eye; its 
myopic defect remains the same, but the flattening of the lens by age 
lengthens the focal distance which now reaches the retina. The myopic eye 
can be relieved by concave lenses, which ought to be used carefully and not 
too strong. 

Astigmatism. 

' ' The term astigmatism is used to express a state of sight resulting from 
want of symmetry in the anterior portion of the eyeballs. The rays of light 
do not unite by convergence and form in a regular manner in one point or 
focus on the retina, but reach it partially or irregularly, some of them coming 
to a focus in front of it, or not forming any focus, whereby circles of disper- 
sion or diffuse images fall on the retina, and indistinctness of vision is 
produced." (Walton.) This irregularity in focussing the rays of light is 
mainly due to assymetry of the cornea, and in some cases also to that of the 
lens. The patient usually holds objects close to his eyes, as a myopic; the 
lines of adjoining letters seem to cover each other; parallel lines in different 
directions, one set for instance being vertical and another horizontal, do not 
appear equally distinct, but blurred; things at a distance are sometimes seen 
double, and a square figure will have the appearance of an oblong; in high 
degrees of astigmatism there is chromatic aberration, so that luminous objects 
sometimes appear surrounded by variously colored borders. Astigmatism 
may be combined with myopia or hypermetropia. It is often hereditary or 



ASTHENOPIA. 173 

may be caused by the removal of the pupil from its central position either 
from accident, disease or in consequence of an operation; by the slightly 
irregular manner in which the corneal flap may heal after an operation for 
the extraction of cataract ; by the irregularity in the corneal curves produced 
by inflammation of the cornea; by the dislocation of the crystalline lens from 
accident or disease. 

Its remedies are carefully selected cylindrical glasses, and in case of 
inflammatory diseases of the cornea or traumatical causes, carefully selected 
medicines. Compare Corneitis, etc. 

Asthenopia. 

" This may be defined to be inability to maintain the adjustment of the 
eye for short distances, for a sufficient period without fatigue." (Walton.) 
The asthenopic eye gets tired when employed any length of time in reading, 
writing or other close work, especially by insufficient or artificial light; the 
ciliary muscle, which is the muscle of accommodation, cannot stand the 
strain required by the smallness of the objects and the close approximation 
of the eyes to them; it relaxes and the crystalline lens flattens, whereby the 
focus from the objects is changed and the objects become indistinct and 
blurred. A little rest relieves it all; the ciliary muscle is ready again for 
shaping the lens to the necessary convexity — but soon gives out again. At 
last a pressure and fullness is felt in the eyes and a tension and pain in the 
forehead; sometimes the pupils become contracted and the conjunctiva red- 
dened. The cause of all this is an imperfection in the refraction in the eye- 
ball, which is principally found in a hypermetropic formation of the eye, and 
therefore there is a close relationship between the two affections; in pure 
forms of asthenopia, according to Walton, hypermetropia is never absent. 
This form is called Accommodative Asthenopia. Asthenopic symptoms will 
also occur when the ciliary muscle, in consequence of illness or exhaustive 
diseases, becomes paretic, or when the internal recti muscles, from relative 
or absolute deficiency of power, cannot maintain the proper convergence of 
the eyes for near sight; then this is called Muscular Asthenopia. The 
accomodative form depends chiefly on the degree of the existing hyperme- 
tropia; it may develop itself at the early age of ten. The muscular form 
depends more on general conditions of the system, and as exciting causes 
may therefore be mentioned for the first: long-continued application of the 
eyes to close work, especially by insufficient light; and for the second: gen- 
eral debility; mental troubles; dissipation, etc. 

Therapeutic Hints. 

The accommodative form requires convex glasses for the relief of the 
existing hypermetropia; the muscular form also needs correction of the 
usually existing anomaly of refraction by suitable glasses. A stud}' of the 
general state of the debilitated system will be required for the selection of 
the corresponding remedy. 



IJ4 THERAPEUTIC HINTS TO ASTHENOPIA. 

Aeon. Eyes hot and dry from overuse; relieved temporarily by cold 
water. 

Apis. Stinging pain and lachrymation. 

Arg. nit. Blepharitis; hypermetrophia and weakness of the ciliary 
muscle. 

Calc. card. Fatigue and pain from using the eyes; on looking at near 
objects they become indistinct and blurred; general Calcarca symptoms. 

Chelid. " Letters run together while reading; left eye agglutinated in 
morning; lachrymation in the wind; pain from reading in the eye; worse 
from candle-light; lachrymation from reading." (E. Rushmore.) 

China. Debility after exhausting sickness. 

Cina. Spasmodic twitchings of the orbicular muscle; twitchings in the 
muscles of the face; from intestinal irritation by worms or otherwise; after 
masturbation. 

Cinnab. Pain from inner canthus, extending above and around the eye. 

Conium. Cannot bear bright light or heat. 

Euphras. Blurring of vision relieved by winking. 

Gelsem. Especially in the muscular form from weakness of the external 
rectus. 

Ignat. Nervous, hysterical females; onanism. 

Jabor. Asthenopic symptoms, especially dependent upon an irritable 
condition of the ciliary muscle. (Norton.) 

Lilium. Pain in forehead; photophobia; blepharitis; astigmatism. 

Natr. viur. Stiff and drawing sensation in the muscles upon moving 
the eyes; the eyes smart, itch and burn; feel best on being kept shut and 
pressed upon; muscular form. 

Nux vom. After dissipations. 

Onosmodium. Headache in occipital region, dull, aching pain, extend- 
ing down the back of neck, or over one side of the head, generally the left; 
is accompanied more or less with dizziness and sometimes nausea; is either 
preceded or followed by pain over or in the corresponding eye, with a stiff, 
strained sensation in the eye, aggravated from reading or use at near vision. 
(Geo. L. Norton, N. A. Journal, December, 1886, p. 794.) 

Phosphor. Dull pain deep in the eyes; black spots before the eyes, 
especially when looking at bright objects and by artificial light; better in 
twilight. 

Rhodod. Weakness of internal recti; darting pains through head and 
eyes, w r orse before a storm. 

Rhus tox. After great strain of the eyes; muscular form. 

Rufa. Aching in and over the eyes after straining the eyes at fine work; 
heat in the eyes and lachrymation after close work; accommodative form. 



MYDRIASIS. 175 

MUSCLES AND NERVES. 

Mydriasis. 

This is a dilatation of the pupils. The iris is chiefly composed of non- 
striated muscular fibres, arranged in a circular and in a radiating direction. 
The circular fibres are supplied by the third nerve, and act as a sphincter 
pupillae, while the radiating fibres are supplied by the sympathetic nerve, 
and increase the aperture when stimulated to contract. Mydriasis may there- 
fore be caused either by a paralysis of the third nerve or by stimulation of 
the sympathetic. One of the differences between the two is, that with the 
paralysis of the third nerve there almost alwa} r s is associated a paralysis of 
the ciliary muscle, which more or less destroys the power of accommodation. 
Its exciting Causes maj^ be either peripheral, from exposure to cold winds, 
blows, etc., or cerebral, in consequence of effusion into the ventricles of the 
brain, concussion of the brain, basilar meningitis, diseases of the cerebellum, 
apoplectic effusions at the base of the brain, glaucoma and certain narcotics. 

Myosis 

' ' Is a persistent regular contraction of the pupil below its medium size, with 
immobility and without change of structure in the iris or in the eye." 
(Walton.) It is caused either by a paralysis of the sympathetic nerve or by 
an irritation of the third. In the first case there probably are diseases of the 
neck, or in the spinal cord, which involve the cervical sympathetic, at the 
bottom of the trouble; in the latter case the cause lies in morbid conditions 
of the brain, which irritate the third nerve. 

Special Therapeutic Hints cannot be given. Mydriasis, as well as 
m3 T osis, are mere symptoms of other more deeply seated disorders, which 
must be studied accordingly. Our repertories show a number of remedies 
for both of these symptoms. 

Ptosis, or Falling of the Upper Eyelid. 

This affection may be due: 1st, to a paralysis of the levator palpebrse 
muscle, which is under the control of the third cerebral nerve; 2d, to a loss 
of muscular power in the levator, consequent on age; 3d, to a falling of the 
eyebrow, in consequence of paralysis of the occipito-frontalis muscle; 4th, to 
a congenital deficiency of the levator palpebral; 5th, to a hypertrophy of the 
palpebral integument; or, 6th, to chronic ophthalmia with granular eyelid. 

Therapeutic Hints. 

The most frequently indicated remedies are: Caustic, Gel son., Hvosc, 
Nux vom., Plumbitm, Rhus lox., Sepia and Zincum. A congenital deficiency 
of the levator palpebrse cannot be reached by any medicine. For granular 
eyelid compare the corresponding chapter. 



176 STRABISMUS, OR SQUINT. 

Strabismus, or Squint. 

" Strabismus is deviation of the visual axes. The axis of the one eye 
being directed to the object desired to be seen, while that of the other is 
turned too much inwards (internal squint), or outwards (external squint)." 
1 Walton.) 

Internal squint is the most frequent of the two. It may arise from 
greater or less paralysis of the external rectus, generally of the one eye, ex- 
ceptionally of the two; or from some functional change, some shortening, at 
first dynamically, afterwards at a varying period, organic shortening, with 
or without hypertrophy of the internal rectus; from lesion of the brain or of 
the ocular nerves in cases of inflammation, softening, apoplexy, hydroce- 
phalus, scrofulous tubercles, epilepsy; from intestinal irritation by worms; 
durning teething; from visual defects, in consequence of inflammation w T ithin 
the eye or the cornea ; from diseases which damage the function of the ex- 
ternal rectus, such as tumors, traumatic or specific inflammations, abscesses, 
neuralgia. Its most frequent cause is hypermetropia. 

The External or Divergent suqint seldom appears before puberty, except 
in connection with a diseased brain. It mostly arises from some form of 
impairment of vision affecting either on or both eyes, or from a difference in 
the refraction of the two eyes, or some disparity between them in the func- 
tion of sight, all of which is commonly associated with myopia. Its direct 
cause in most cases is paralysis of the motor oculi nerve. The external 
rectus muscle is influenced in the same way b\ r effusion in the orbit, tumors 
and all mechanical lesions of its muscles, and by cerebral disorders like the 
internal muscle in inward squint. 

Therapeutic Hints. 

Cerebral irritation with corresponding symptoms require: Agar., 
Bcllad., Cicuta, Gelsem., Hyosc, Nux vom., Stramon., Sulphur. 

Alum. Recommended h\ Jahr if Bellad. and Hyosc. have failed. 

Cicuta. After convulsions. 

Calc. card. After ophthalmia, or overstrain by close work; strumous 
subjects. 

Cyclavi. After unsuccessful operation; after convulsions, or measles. 

Intestinal irritation from worms or other causes requires: 

Cina. Picking of nose; restless sleep; grating of teeth; short, hacking 
cough through the night. 

Cyclam. See above. 

Sepia. Nocturnal enuresis during first sleep. 

Spigel. Itching at the anus. 

Sulphur. Nightly itching of the skin; cutaneous eruption; constipation. 

Suitable glasses may be of great help. 

Surgical operation is required where there is an organic shortening of 
the internal or external rectus; paralytic squint is least benefited by it, and 
in mere nervous disturbances it is not called for at all. 



NYSTAGMUS, TREMBLING OF THE EYEBAIJ^S. 1 77 

Nystagmus, Trembling of the Eyeballs. 

It is an involuntary, rhythmical motion of the eyeball, mostly from side 
to side, sometimes in an oblique direction, without impairment of the mus- 
cular movements. These oscillatory motions are nearly always permanent 
during the waking hours, but do not interfere with the simultaneous action 
of the two eyes; sometimes they are associated with internal squint. The 
disease nearly always arises in infancy, and is frequently seen in connection 
with congenital cataract, or other states of the eye which impair sight. It 
is common to the Albinos, when there is an absence of the pigmentum 
nigrum. Although ascribed to a morbid condition of innervation, its true 
nature is unknown. 

Luscitas, or Fixed State of the Eyeball, 

Is limited or lost power of movement of the eyeball, which remains in a 
fixed position either with or without deviation from the orbital axis, and 
cannot in any degree follow the movements of the other eye. Luscitas is a 
symptom either of paral} T sis of the third nerve, when the eyeball is turned 
outward by the abductor muscle, or of paralysis of the abductor, when the 
eyeball is turned inside— all consequences of brain-disease, chronic hydro- 
cephalus especially. But external causes, such as injuries to the muscles of 
the orbit or to their nerves, tumors, staphylomatous enlargements of the 
sclerotica, may also fix the eyeball in any direction. 

Morbid Winking 

Is a clonic spasm of the orbicularis palpebrarum muscle, and frequently 
found in connection with severe conjunctival irritation; sometimes it is of 
constitutional origin. 

Twitching of the Eyelids, or Quivering, 

Nearly related to the above, may affect one lid or both. It sometimes is so 
slight that it cannot be seen, but may plainly be felt; although annoying it 
seldom is attended with pain, and is usually the consequence of deranged 
digestion or feebleness from overwork. 

Blepharospasm. 

The eyelids are violently and persistently closed. It is nearly alwa}^s 
associated with intolerance of light and discharge of tears. 

Its sources are various. They may arise in the eye itself, or in other 
organs, and transmit their influence to the brain at the origin of the portio 
dura, through the fifth nerve, the optic, the vagus, the sympathetic, or 
directly from cerebral disturbance. Thus we see it produced by trichiasis, 
strumous conjunctivitis, corneitis, retinitis; carious teeth, supraorbital neu- 
12 



178 NEURALGIA OF THE EYE. 

ralgia, a blow on the head or other injury; hysterical irritation. It may 
affect one or both eyes, it may last a long time uninterruptedly or in spells; 
it may be associated with spasm of the facial muscles. 

Therapeutic Hints. 

N ystagmus — Hyosc. f 

Morbid winking has been relieved by Agar and Ignat. 

Twitching by Cina, Physost. 

Blepharospasm by Bel/ad., Viola trie, Symphitum (after a blow), and 
other remedies, which must be selected according to the individual state of 
the patient. Compare the chapters which treat of its sources. 

Neuralgia of the Eye. 

It is usually an affection of the ophthalmic and superior maxillary divi- 
sion of the fifth cranial nerve, which supply the eyeball, the ocular append- 
ages, and the circumorbital region. One or the other of the branches of 
these nerve-trunks may be affected. Most frequently we find it located in the 
upper eyelid, the middle of the eyebrow, the nasal extremity of the super- 
ciliary arch, the inner canthus, or the temple; or it follows in the direction 
of the supra and infraorbital nerves; or it is entirely intraocular without any 
affection of the nerves radiating from the orbit. 

The first of these varieties is often intermittent or remittent, and may 
become chronic; it may alternate with nervous pains in other parts of the 
body. The Causes are frequently obscure, often, however, traceable to 
malarial influences or exposure to cold. The second variety may arise out 
of the effects of the fangs of carious upper back teeth. When the pains are 
deep-seated, its origin is intraorbital or even intracranial and may arise from 
thickening of the dura mater, orbital or cranial exostoses, aneurisms or 
tumors. 

Therapeutic Hints. 

These different forms and causes show that not a few remedies ma}' pre- 
sent themselves for our consideration. However, to avoid repetition, I refer 
to the chapter on neuralgia of the face. 

ORBIT. 

Orbital Cellulitis. 

11 Inflammation of the orbit is usually severe and acute in character; is 
marked by great swelling of the lids, extensive chemosis, protrusion of the 
eyeball and intense pain in and around the eye, aggravated on any movement 
of the eye. Movements of the eyeball are impaired. Pus soon forms, when 
we have an abscess in orbit, which may perforate through lids or conjunctiva. 
The inflammation may extend to the eyeball, producing a panophthalmitis, 
or to the brain, or may cause caries of orbit, etc. General febrile disturb- 



EXOPHTHALMIC GOITRE. 1 79 

ances usually accompany the above local inflammation . Trauma is the most 
frequent cause. It may result from extension of inflammation in neighboring 
parts or from constitutional diseases. 

Therapeutic Hints. 

Aeon., Apis, Hepar, Laches., Mercur. and Silic. may be indicated, but 
Rhus fox. is most frequently indicated." (George S. Norton.) 

Basedow's or Graves's Disease; Exophthalmic Goitre, 

Is characterized by palpitation with accelerated pulse, swelling of the thyroid 
gland, and exophthalmus or protrusion of the eyeballs. In its nature it has 
been considered by some as a morbid crasis, by others as a heart disease, and 
by still others as a neurosis of either the cervical sympathetic or the cervical 
medulla spinalis and medulla oblongata. I feel, therefore, at liberty to treat 
of it here as an3^where else. 

Autopsies have shown a considerable development of fat behind the eye- 
balls, which causes their protrusion; also at times fatty degeneration of the 
eye-muscles, probably caused by disease and stretching; and atheromatous 
changes of the ophthalmic artery. Changes in the sympathetic and its 
ganglia have not at all been of a uniform nature, and in some cases have 
been wanting altogether. 

Symptoms. — Usually this disease develops itself very slowly, though some 
few cases of sudden origin have also been observed. Its first symptoms in a 
majority of cases is palpitation conjoined with acceleration of the pulse, 
without any abnormal symptoms of the heart on physical examination* 
occasionally there are epigastric pulsation, increased force of the pulse in 
the carotids and their larger branches, especially in the thyroids, and a 
whirring and blowing that may be heard by auscultation before the struma 
is developed; pulsation of the retina and in rare cases pulsation of the liver. 
Some weeks or months later, slowly or rapidly, struma is developed, a soft, 
elastic swelling of the entire thyroid gland, which, however, does not attain 
to a very great size and is moreover subject to frequent changes. The surface 
of the tumor is often marked by veins, greatly dilated and crowded with 
blood, and auscultation reveals loud blowing sounds, often increased durino- 
systole. Struma seldom appears before palpitation and still more rarely is 
it wholly absent. Exophthalmus, the third prominent symptom, makes its 
appearance soon after the struma — in a few cases before it — and still more 
rarely as the initial symptom, preceding the struma and the palpitations. 
It always attacks both eyes, but sometimes appears on the one eye earlier, or 
remains at least more prominent than on the other. It seldom is wholly 
wanting, while in other cases it forms the only cardinal symptom, when it 
is associated with other kinds of general disturbances. In degree it varies 
greatly, from a slight prominence of the eyeballs to an excessive protrusion 
of the same, that no part of the globe is covered by the eyelids and even 
may amount to a luxation of the globe. The eyes protrude; the eyeballs 



I So THERAPEUTIC HINTS TO EXOPHTHALMIC GOITRE. 

have an unusual lustre; appear stiff and gradually lose their mobility in 
part or wholly. But this protrusion is not at all times the same, it increases 
and decreases proportionate!}' to the force of the pulsations of the heart, and 
sometimes may be diminished by light pressure upon the eyeball. Von 
Graefe has observed, that " the upper lid loses its power to move in harmony 
with the eyeball in the act of looking up or down," and he considers it a path- 
ognomonic sign of exophthalmus, which, however, others do not admit, as 
its occurrence, although frequent, is not constant. As a secondary group of 
symptoms in some cases may be mentioned; dryness of the conjunctival sac, 
distention of the conjunctival veins, and conjunctivitis; the lachrymal secre- 
tion is often increased. In bad cases: insensibility, diffuse desiccation or 
even perforation of the cornea. Ophthalmoscopic examination usually 
shows dilatation and increased tortuosity of the retinal veins, and in some 
cases spontaneous pulsation of the retina. The temperature of the body has 
been found increased to 101.8 F. in some cases, while in others it remained 
entirely normal. x\lso nervous disturbances have been observed, but the} 7 
are so varied and so little characteristic, that they may be omitted without 
injur}' to the diagnosis of this malady. Its duration is protracted; months 
and years may pass with alternate improvement and relapse; some cases get 
well, others hasten to a fatal issue by the consecutive changes of the heart, 
the permanent increased labor of which leads to dilatation of both ventricles 
and compensating hypertrophy. In other cases marasmus and other inter- 
curring diseases or complications may end the scene. 

Women are more subject to it than men; in chilhood it is rare, it occurs 
mostly during the time of puberty and climacteric years, seldom later. As 
predisposing Causes have been mentioned: chlorosis, anaemia and neurotic 
tendencies; as exciting causes have been found: injuries, traumatic or other- 
otherwise, and mental excitement, violent fright. 

Therapeutic Hints. 

As this affection is not poor in symptoms and mostly of long standing, 
by a careful examination will be able to detect leading symptoms for one or 
another remedy, even not mentioned below. 

Amy I nitr. Frequent flushes of face and head; oppression of chest; 
tumultuous palpitation. (Olfaction.) 

Ba diaga . ( Norton . ) 

Bellad. Has cured cases in allopathic hands, although the doses applied 
were certainly too massive, as they produced headache, nosebleed and angina. 

Calc. card. In combination with a diet of nitrogenous substances, re- 
lieved greatly in a case of pronounced lymphatic constitution. 

Ferrum. In cases with disturbances in the sexual sphere, scanty or 
suppressed menses and great nervousness. 

Ly copies. Has relieved the protrusion of the eyes and the cyanosis, but 
had no effect upon the glandular enlargement, which yielded to Iodine. 



THERAPEUTIC HINTS TO EXOPHTHALMIC GOITRE. l8l 

Nair. mur. Depressed vegetative vitality; despairing, hopless feeling 
about the future; dryness of the mouth; sore tongue; map tongue; chronic 
constipation with hard stool; chlorotic symptoms, with dirty, flaccid, torpid 
skin; fluttering of the heart; intermitting and irregular pulse. 

Secale. Has been successfully used by the old school. 

Spongia. Easily frightened, especially at night, as if suffocating. 

It appears from this that the most efficient remedies used thus far were 
such which are capable of acting especially upon the heart and the thyroid 
gland; under certain circumstances, therefore, Bar. carb., Bromium, Cad. 
grand., Phosphor., Silic. and Sulphur may likewise be indicated. 



EARS. 



Analogy Between the Ear and the Eye. 

At first sight, these organs appear so entirely unlike each other, that it 
would seem scarcely possible to discover any analogy between them; yet on 
closer inspection, the similarity between the two is quite striking. 

As I consider this similarity in the structure of the eye and ear of great 
importance in clearing up the rather occult affections of the ear (the treat- 
ment of which is often very difficult), I shall point out, with some detail, the 
following remarkable features of similarity between the organ of sight and 
the organ of hearing. 

The pinna corresponds to the upper and the tragus to the lower eyelid. 
In animals the auricle is even movable, to collect or reject sounds, as the 
eyelids are to take in or to keep out the light. 

The eyelashes are represented by the bristly hairs at the mouth of the 
meatus extemus; to keep out dust and insects. 

The meatus externus is lined by a semi-mucous membrane, secreting 
ear-wax, corresponding to the conjunctiva of the eye, which secretes eye- 
butter; both are subject to similar inflammations and mucous or purulent 
discharges. 

The membrana tympani corresponds, not only in function, but also most 
strikingly in structure, with the cornea. It collects sounds, while the cornea 
collects light; and it is, at least, of a half-transparent texture. The diseases 
to which it is liable correspond with those of the cornea: inflammation, 
thickening, ulceration and perforation. 

Immediately back of this membrane, in the middle ear or tympanum, 
we find the ossicula auris, by which sound is broken and communicated to 
the auditory nerve, in the labyrinth, just as light, by means of the crystal- 
line lens, is refracted upon the optic nerve. The middle ear or tympanum, 
with its ossicula, corresponds, therefore, precisely to the anterior and posterior 
chamber of the eye with the lens. 

Still further back we come into the labyrinth of the ear, which is filled, 
in its membranous portion, with a limpid fluid, first well-described by Scarpa, 
and which corresponds to the vitreous humor of the eye; while the numerous 
filaments of the two branches of the auditor)* nerve, the vestibular and 
cochlear nerves, spread out into a nervous membrane, closely resembling 
that of the retina, so that the labyrinth of the ear corresponds to the posterior 
part of the eye with its vitreous humor and its retina. The nerve-mem- 



GENERAL OBSERVATIONS ON THE EAR. 183 

brane of the ear terminates in fine fibrils or ciliae (Corti's mechanism), and 
the retina in a layer of rods and cones. 

There is one appendix to the ear — the Eustachian tube — which starts at 
the tympanum and opens into the lateral wall of the throat, and there is 
also one appendix to the eye — the lachrymal duct — which starts at the inner 
canthus of the eye and opens into the nose; while lastly both organs are 
situated in close proximity to porous bones: the ear on the mastoid portion 
of the temporal bone, and the eyes below the frontal sinuses of the frontal 
bone. 

This striking similarity in the structures of the ear and eye at once 
brings the diseases of the ear (by comparing them with those of the eye) 
nearer to our comprehension, and may even influence the choice of a remedy 
in a given case. 

General Observations on the Ear. 

The auricles grow pale from fright, chills, spasms, loss of vital fluids, 
exhaustion and frost. A marked paleness of the left auricle denotes inflam- 
mation of the spleen. 

Redness of the auricles is found in congestive and inflammatory condi- 
tions of the head and ears. 

Flushes are caused by mental emotion; or occur before bleeding of the 
nose, delirium, apolexy. 

An habitual or frequently-occurring redness of the auricles denotes dis- 
turbed actions in the abdominal organs; or else menstrual and hemorrhoidal 
affections. Hyperaemia of the auricle, and sometimes of the middle ear, is 
often associated with the climacteric period. 

A striking redness of the auricles in new-born children is a sign of pre- 
mature birth. 

Small, inflammatory, purplish, suppurating spots on the auricles are a 
sign of chronic syphilis. 

A slight inflammatory, painful redness of the upper part of the auricle 
is often the forerunner of an attack of gout. 

Swollen auricles, if inflammatory, are caused by erysipelas, injuries, 
eruptions; if habitual, not inflammatory, it is a sign of scrofulous conditions; 
if oedematous, a consequence of abscesses or Bright' s disease. The auricles 
are: 

Hot, in inflammatory and congestive conditions of the head and ears, 
also in consequence of great exertion of the voice, and in diseases of the 
larynx. 

Cold, in chills, spasms, and from exhaustion. Auricles habitually cold 
are found in weak and chlorotic individuals. In hysteric persons, cold 
auricles are the forerunners of a hysterical spasm; while in delirium and 
mania they denote a cessation of the paroxysm. 

Discharges from the ears may originate either in the meatus auditorius 



184 ECZEMA. 

externus, in the middle ears (the tympanum), or in the cavity of the skull. 
They are of various characters. 

If, after a fall or external injury of the head, there be a discharge of 
blood, it denotes a fracture of the skull. The ears bleed also in scorbutic 
affections; from too great a pressure, or from insufficient pressure of the at- 
mospheric air (cannon-shot; on high mountains;), from too great exertions 
in screaming, coughing, vomiting, straining, blowing musical instruments. 

Pus or ichorous matter is the product of a previous inflammation, either 
in the meatus auditorius or in the middle ear. In rare cases the pus comes 
from an abscess in the brain, which has broken through the petrous portion 
of the temporal bone. 

Thin earwax is, in most cases, the consequence of a chronic inflamma- 
tory state of the meatus auditorius externus. 

THE AURICLE. 
Eczema. 

Various kinds of eruptions may befall the auricle, either spreading to it 
from adjacent parts or originating there. From among them eczema is the 
most common, differing in no way from its kind on other parts of the body. 
We meet it in its acute as well as in its chronic form, and very often asso- 
ciated with similar eruptions on the scalp, or face or other parts of the body. 
It may affect the entire lobe, or select only certain portions of it ; the sharp 
crevice behind the ear, where the auricle joins the mastoid process, is fre- 
quently its favorite seat. 

Therapeutic Hints. 

Bar. carb., Calc. card., Graphit., Hepar, Lycop., Merc, sol., Nitr. ac, 
Oleand. , Petrol. , Rhus tox. , Sulphur, are the main remedies. For particulars 
compare Eczema of the Scalp. 

By their position the auricles are naturally exposed to various external 
injuries, from blows, cuts, heat or cold, and the} 7 also are not unfreqnently 
the seat of depositions of urate of soda in arthritic patients. Their lower 
lobe is often disfigured by hypertrophy or little, round, hard tumors in con- 
sequence of previous piercing. 

THE AUDITORY CANAL AND THE DRUMHEAD, OR MEM- 

BRANA TYMPANI. 

Examination of these Parts. 

The canal is not straight but curved on its anterior and lower wall, and 
often obstructed by hair growing from its cartilaginous walls. The drum- 
head is placed obliquely across the canal at its furthest extremity, which it 
shuts off from the middle ear. In consequence of the crooked structure a 
simple look into the ear does not give us a full view of its walls nor of the 
drumhead. We have to straighten its curved course and push aside obstruct- 



THE AUDITORY CANAL AND THE DRUMHEAD. 1 85 

ing hair or other impediments, as far as possible. This can best be done by 
an ear-speculum, which consists of a simple funnel-shaped tube, made of 
polished metal. There are usually three of different diameters fitted to- 
gether, for the purpose of giving choice to select that which best corresponds 
to the dimensions of the canal under examination. Its application is the 
following: Draw the article upwards and backwards, and insert the tube by 
gentle turning and twisting into the meatus as far as it can be done without 
using force or causing pain. Keep it then in its position and illuminate 
through it the parts to be examined. The best light is clear daylight or 
lamplight; the direct rays of the sun may be too dazzling. In order to pre- 
vent the intervention of the head of the observer with the rays of light, an 
ordinary laryngoscopy mirror or reflector fixed upon the forehead of the ob- 
server, or one of shorter focus made for the purpose of aural requirements, 
or, for preliminary examination, even a common hand-looking-glass can so 
be held as to reflect the rays of light into the tube, that by a little manage- 
ment and turning of the ear-speculum we are enabled to inspect readily the 
drumhead and the walls of the external canal in all their parts. 

The membrana tympani, or drumhead, is a thin, semi-transparent, 
parchment-like membrane, spread obliquely across the external auditory 
canal at its farthest extremity. In its normal state its surface, as seen 
through the ear-speculum, appears concave. Its shape is that of an irregu- 
lar oval disc, the long axis of which is directed from above downwards; it 
is attached to a well-marked bony groove upon an elevated ridge upon the 
bony canal — the Annulus tympanicus, being fixed to it by a cartilaginous 
ring — the Annulus cartilaginus , just as is the crystal of a watch to its 
bezel. 

It is composed of " three distinct structures, the external layer being a 
prolongation of the skin of the meatus externus, the internal being derived 
from the mucous membrane of the middle ear, while between these two 
comes the fibrous layer, and which is itself composed of two distinct layers, 
the one external, the fibres of which radiate, the other internal, the fibres of 
which take a circular course." 

"When we look at the healthy membrane, we may observe at its upper- 
most edge a whitish prominent part, the short process of the malleolus, and 
extending from this downwards and backwards nearly to the centre of the 
membrane, we see a whitish or pale yellow stripe, and which is the malleus 
handle, widening out at its lower end into the form of a spatula. In front 
of and below the manubrium we see a triangular reflection, the cone of light, 
its apex being at the umbo, or deepest point of the convexity of the mem- 
brane, its base forwards and downwards towards and slightly short of the 
periphery; and then we may, on looking closely, sometimes see shining 
through the membrane the promontory of the middle ear, and the long pro- 
cess of the incus. ' ' ( Cooper. ) 

The color of the membrane is a peculiar gray of different shades, con- 
ditioned by its transparent nature, by the bodies which lie behind it and the 



1 86 EARWAX DIMINISHED OR INCREASED. 

light which strikes upon it. If the mucous membrane which lines its inter- 
nal surface, or that of the entire middle ear is congested, we find the natural 
gray mixed with a faint or deep red; or with a yellowish tint when the mid- 
dle ear is filled with yellowish secretion. Indeed pathological changes have 
a marked influence upon the color of the membrane. So also is the natural 
soft gloss of the membrane greatly altered, or even extinguished by patho- 
logical processes. The brightest reflection from the health}- membrane is 
the " cone of light," a triangular reflex of light in the anterior and inferior 
quarter of the membrane, which has its apex in the umbo and its base near 
along the periphery of the membrane ; it is analogous to the reflex of light 
of the cornea. Its locality and brightness too changes from .various patho- 
logical conditions. 

The external auditory canal is lined by a continuation of the external 
skin, which grows thinner as it approaches the drumhead, but is not 
changed to a mucous membrane. It is studded by numerous sebaceous and 
ceruminous glands from which the earwax is derived. 

Earwax Diminished or Increased. 

The lining of the auditory canal being a continuation of the external 
skin, great dryness of the same is usually found in persons whose skin in 
general is of a dry nature. It seldom has anything to do with nervous hard- 
ness of hearing. It may, however, be in connection with torpid processes 
within the middle ear, especially the drying up and hardening process of its 
mucous membrane. 

An increase of earwax may be caused by frequent picking and boring 
with hard instruments* in the ear, whereby a congested state of its lining 
membrane is induced; we find it in persons whose scalp produces much 
sebaceous secretion and who are inclined to sweat easily about the head; it 
is sometimes connected with a chronic eczema of the canal. Its accumula- 
tion usually goes on slowly and the forming of hard plugs of cerumen takes 
frequently a long time, the patient being not at all aware of their formation, 
until a gradually increasing deafness reminds him of something wrong in his 
ears. In other cases indurated earwax causes quite annoying symptoms. 
Besides hardness of hearing, amounting sometimes to deafness, there is great 
itchiness of the meatus, or a feeling of fullness and heaviness in the head, or 
there are spells of pain deep in the ear, and in some cases even serious 
attacks of vertigo. These attacks of vertigo in consequence of hardened 
earwax are caused by its pressure upon the drumhead, which is propagated 
by the chain of the ossicula to the fluid of the labyrinth. Vertigo, however, 
is a symptom also of other affections of the labyrinth. 

The hardened plugs of cerumen consist either of an amorphous, dark 
brown-red mass, principally made up from the secretion of the sebaceous and 
ceruminous glands, or they are strongly mixed with scales of the epidermis 
and in old persons with hair; some old plugs, w T hich shine like mother-of 
pearl, are mixed with cholesterin; and in still others we find an admixture 



THERAPEUTIC HINTS TO THE AUDITORY CANAL. 1 87 

of cotton, seeds, dirt and other substances from the surrounding atmosphere. 
There are, however, cases where the hardened masses which obstruct the 
auditory canal have originated in the middle ear, and consist of dried pus 
mixed with blood, in consequence of catarrh of the middle ear and perfora- 
tion of the drumhead; in still other cases the plugging up material consists 
of accumulated masses of fungi or the formation of polypi. All this must 
be borne in mind. Deafness from hardened plugs of cerumen will certainly 
be cured by the removal of this obstruction, while in complications with 
affections of the middle ear this is by far not so certain. Here the tuning 
fork will give us the best instruction. When deafness is caused by mere 
obstruction of the external meatus, the tuning fork vibrating on the vertex 
is heard better in the obstructed ear, contrary to the patient's expectation. 
When, however, we find that it sounds louder in the ear which is not 
affected, or is heard, at least, no better in the obstructed ear, we may assume 
that there is some complication in the inner ear, and need not expect a full 
return of hearing after the removal of the obstruction. 

Therapeutic Hints. 
Plugs of hardened earwax must be removed, and to do this there is nothing 
so expedient and harmless as injections of hike- warm water, by a suitable 
ear- syringe. It is not necessary to do it forcibly and if, as in some cases, 
the plug is very hard, and adheres very tightly to the walls of 
the canal, it is better to take for its accomplishment two or three 
sittings and in the meantime have the hardened substances softened by 
occasional application of warm water, than to try to force it in one sitting. 
"Carbonate of soda added to the warm water hastens the removal of ceru- 
men." (Houghton.) Often the hearing maybe worse and a feeling of 
fullness come on after the first sitting, in consequence of swelling of the 
hardened mass, and the entire closing up of the canal. The patient ought 
to be advised of this possible seeming aggravation. After the earwax is 
removed it will always be advisable to put some cotton or wool into the ear 
in order to protect the drumhead from shrill sounds and cold. But why 
does the earwax accumulate and harden in some persons, and not in others? 
There surely must be some constitutional reason for it, which we must try 
to mend, otherwise the same process will go on again. The following 
remedies must be considered: 

Carb. veg. ' ' Has served me well in malsecretion of cerumen with ex- 
foliation of dermoid layer of meatus. " (Houghton.) Discharge of flesh- 
colored, offensive moisture from right ear; deficient or badly-smelling 
cerumen. 

Conium. Accumulation of earwax, looking like decayed paper (scales of 
epidermis) mixed with pus or mucus, or blood-red; hardness of hearing 
ceasing when the wax is removed and returning with the wax. 

Graphit. In young persons with habitual herpetic eruptions in the 
meatus; or meatus dry and scabby. 

Laches. Want of wax; ears very dry. 



188 FURUNCLES OF THE EXTERNAL CANAL. 

Mur. ac. Accumulation of wax which is dry and hard, and of a brown- 
red color, with hardness of hearing. 

Petrol. Large quantities of thick or thin wax; sensation of rushing of 
water in the ear; old, aged persons. 

Furuncles of the External Canal. 

The}- correspond entirely to boils on an}- other part of the body. Start- 
ing at first as an inflammation of a hair-follicle or of a glandular follicle, by 
spreading, the surrounding subcutaneous connective tissue is drawn in the 
same process and a limited abscess is formed. In the auditory canal their 
size is naturally still more limited; they may, however, for a time completely 
close the canal, until they break and discharge the core. They are quite 
painful and sometimes we find several together or following each other. 
They correspond to styes on the eyelids. As a diagnostic sign from abscesses, 
Cooper states that when they discharge the pillow-case in the morning will 
be studded over with stains so closely resembling small sized buttons, as to 
deceive the most clear-sighted at a distance. 

Therapeutic Hints. 

Hepar., Merc, sol., Pulsat., Sulphur. 

' ' Picric ac. Is as near a specific for small furuncles in any part of the 
body as any remedy can be. In the meatus externus it aborts the furuncle 
if seen early and mitigates, if advanced, as well as corrects the habit." 
(Houghton. ) ' ' Furuncles in external auditory canal dependent upon mental 
overwork." (Geo. S. Norton.) 

Otitis Externa, or Diffuse Inflammation of the Auditory Canal. 

In its Acute form it commences frequently with itching, heat and a 
sensation of dryness in the ear, which gradually changes to a dull pain or a 
boring and tearing deep in the ear, and being generally worse in the night, 
deprives of sleep and causes feverish restlessness. In severe cases the pain 
may extend all around the ear and to the corresponding side of the head. 
A jar from sneezing or coughing, or the motion of chewing or gaping make 
it worse. The hearing grows duller in the degree in which the outer lining 
of the drumhead becomes involved. On inspection we find it congested and 
swollen and also the lining of the canal; gradually exudation ensues, which 
at first is watery, but finally becomes yellowish and purulent. With the 
establishment of otorrhcea the pain decreases, the epidermis loosens and the 
canal fills up with the products of desquamation. This state of things may 
gradually wear off and heal, or it may become chronic; the otorrhoea may 
continue for years. Usually Chronic otitis externa takes its origin in an 
acute attack as described above; but there are cases where such acute and 
painful outbreaks are not remembered; very often the commencement dates 
back to infant life. Sometimes the otorrhcea ceases for a time, especially 
during summer, but comes back again with damp and cold weather or from 



THE MIDDLE EAR. 1 89 

aii} T other exciting cause. This form is often characterized by the presence 
of fungi. Chronic otitis may lead to ulceration, deep opacity and extensive 
thickening of the drumhead, to narrowing of the external canal by hyperos- 
tosis, to polypous growths within the canal, or to an extension of the inflam- 
matory process to the middle ear or the neighboring diploetic bony struct- 
ures, or even to the dura mater and brain. Deafness of various degrees is 
a usual concomitant. 

The Causes of external otitis are various. Acute and chronic exanthe- 
mata; eczematous eruptions; pemphigus; irritating substances; fungi of the 
aspergillus kind; exposure to cold draughts. Most liable to its attacks are 
children. 

The Prognosis of an acute attack may be called favorable, the chronic 
form is mostly difficult to manage. 

Therapeutic Hints. 

As soon as otorrhoea has commenced, great care should be taken to keep 
the ear clean. Occasional injections of luke-warm water, administered care- 
fully, are of great benefit. "Aurists are now beginning to advise dry appli- 
cations, avoiding warm water except in acute troubles." (Houghton.) As 
regards the remedies, compare Otitis Media. 

THE MIDDLE EAR. 

The ca vitas tympani is bounded exteriorly by the drumhead; interiorly 
by the wall of the labyrinth; its roof divides it from the brain; under its 
floor, which is very irregular in shape and greatly varying in thickness and 
compactness in different persons, even sometimes in the two ears of one and 
the same person, lies the vena jugularis interna; on its posterior wall we 
find the inlet to the antrum mastoideum, and on its anterior wall, nearer to 
the roof than the floor, just opposite to the antrum mastoideum, is the 
mouth of the Eustachian tube. 

The entire cavity is lined by a mucus membrane, which is smooth, 
whitish, very thin and tender. It does the service of the periosteum, as it 
contains the vessels which nourish the bony structure underneath. 

The antrum mastoideum and the numerous air-containing cells of the 
mastoid process are a kind of air-reservoir and resonator, a very important 
appendix to the middle ear, as by it the sonorous vibrations are more or less 
controlled. The Eustachian tube on the other hand is the draining canal for 
the secretions of the middle ear, and also its ventilation tube. For its outlet, 
which in grown persons resembles the mouth-piece of a trumpet, opens into 
the naso-pharyngeal cavity, where it is constantly exposed to the stream of 
atmospheric air during respiration, by which communication the air in the 
middle ear is kept in the nearest possible equal tension with that of the 
atmosphere. 



I90 EXAMINATION OF THE MIDDLE EAR. 



Examination of the Middle Ear. 



2. By Means of the Ear Speculum. — We can ascertain by its application 
the color and condition of the drumhead. When it is of a reddish tinge, 
there is inflammation of its inner lining, in consequence of catarrh of the 
middle ear; when it bulges there is an accumulation of mucus or pus behind 
it; when it is perforated we ma)* be able to view the condition of the ossicula 
behind it. 

By Means of Vasalva's Method. — This consists of a forced expiration by 
the patient himself, by keeping mouth and nose tightly shut. The effort of 
blowing without allowing the air to pass out either of the mouth or the 
nose forces it into the Eustachian tubes, through which it enters into the ears, 
where it causes a sense of fulness and a crackling in the drumheads, which 
from the internal pressure are made to bulge, provided the Eustachian tubes 
be pervious. If this sense is not produced, or only in one ear, we know that 
then and there the Eustachian tube or tubes are closed. This method re- 
quires intelligent patients. ' ' In many cases the testimony of the patient is 
negative as regards the passage of air, when test with the watch shows that 
it did pass into the tympanum. ' ' (Houghton. ) 

3. By means of Politzer's Method. — This consists of blowing, by means 
of an india-rubber bag with a tube, a current of air into one or both nostrils 
of the patient in the moment when he is made to swallow a sip of water. 
The nostrils of course must be held shut so that the current of air cannot 
return through them, while the act of swallowing closes the upper portion 
of the pharynx, preventing the air from escaping through the mouth. Thus 
it has to pass through the Eustachian tubes into the ears of the patient, of 
which he will be cognizant by a certain fulness and pressure in the ear, or 
in- case of perforation of the drumhead, by a whistling sound and a simulta- 
neous ejection of collected mucus into the external meatus. This method, 
too, requires intelligent patients, but it excels over Valsalva's method in this, 
that it acts more energetically. 

" Politzer's method of inflation can be made available without the use of 
water in most cases, by directing the patient to close the mouth and blow 
steadily as in the act of whistling, or blowing out a candle. In children the 
tympanum can usually be inflated without either expedient; a forcible emp- 
tying of the air-bag will dilate the Eustachian tube and fill the cavity." 
(Houghton.) 

4. By Means of Catheterism. — It consists of blowing air into the middle 
ear by means of an Eustachian catheter. Here are Kramer's directions for 
the introduction of this instrument: "As a rule, the catheterism of the 
Eustachian tube should be accomplished with one of the catheters of size 1 to 
4, introduced through the corresponding nasal meatus of the ear that is to 
be examined. For this purpose the patient is to be placed upon a chair with 
a common back, or with one somewhat higher than usual, in order that the 
head may be supported." "After the patient has blown his nose (partly for 



EXAMINATION OF THE MIDDLE EAR. 191 

the purpose of clearing away a too abundant secretion, partly, in case the 
nose is too dry, to moisten it, and thus enable the instrument to slide alcng 
it with greater facility) , we dip the catheter into pure olive oil, and blow 
through it to assure ourselves of its permeability. The head of the patient 
is then fixed with the left hand; the catheter is held with the thumb and 
finger of the right hand close to the funnel-shaped extremity, in such a 
manner that the ring attached is downward; the beak is placed in the nasal 
meatus, resting upon its floor, close to the septum, with the convexity 
upwards. From this point it is pushed backwards with 2, very light hand, 
sweeping as much as possible along the floor of the nostril, with continual 
elevation of the handle, till the instrument becomes horizontal and its ex- 
tremity rests against the posterior wall of the pharynx. The thicker the 
catheter, the more easily are these movements executed." 

"Irregularities in the form of the inferior turbinate bone and strong 
lateral displacement of the septum may render the first introduction of the 
catheter very difficult, and test severely the delicacy of the sense of touch in 
the hand of the operator. As the point of the beak arrives at the posterior 
wall of the pharynx, the funnel-shaped end of the catheter is to be raised a 
little above the horizontal line, and at the same time to be lightly withdrawn. 
The beak then sinks and rests upon the posterior wall of the soft palate, 
which at that instant contracts, performs a swallowing movement, raises 
itself, and when assisted by a quarter turn upon its axis from within out- 
wards, lifts the beak of the instrument into the tube." 

1 ' If this rapid movement is not successful in the hands of an inexpe- 
rienced person, the beak of the catheter must be conducted back to the upper 
part of the pharynx, in order that it may be slowly drawn forwards and 
turned at the same time laterally a quarter turn upon its axis towards the 
outside, by which means the ring of the funnel-shaped end is directed hori- 
zontally. It now slides over and into the swelling of the tube itself, where 
the beak of the catheter is directed, with its gravity against the anterior 
swelling of the tube, and here it hooks into it and can be clearly felt to be 
grasped by it upon quickly withdrawing it. The catheter lies here quite 
conveniently, being in no way a source of annoyance to the patient, even in 
speaking, in swallowing or in any of the movements of the head. For the 
sake of security we now elevate the beak of the catheter above the horizontal 
line, directing it upward and outward, the position of the beak being deter- 
mined and rendered evident by the direction of the ring upon the funnel- 
shaped end." 

After a successful introduction of the instrument, the operator blows 
either with his mouth or by means of an india-rubber ball into the tube, 
through which the current of air is transmitted into the middle ear. On lis- 
tening during this operation by either putting the ear to the ear of the 
patient, or by means of an otoscop, we hear the air rush in and beat on the 
drumhead, which produces a harsh sound when the drumhead is very dry, 
and a soft or moist sound when the drumhead is moist. A thin, interrupted 



192 EXAMINATION OF THE MIDDLE EAR. 

or whistling sound indicates an obstruction of the Eustachian tube; a rattling 
noise, as from some distance, indicates that the Eustachian tube is lined with 
mucus; a rattling sound, which appears to originate nearer, indicates a col- 
lection of mucus or pus in the middle ear; a fine, sharp whistling, with 
ejection of pus into the external meatus, indicates perforation of the drum- 
head; a distant, faint and indistinct noise proves that the air does not reach 
the middle ear at all, either because the catheter is not correctly inserted 
into the outlet of the Eustachian tube, or because there exists an obstruction 
in the tube which the air-douche cannot overcome. 

5. By Means of the Watch. — If we want to ascertain the distance at 
which a patient is able to hear, we must use an instrument which gives a 
sound always of the same nature and strength, and which can easily be held 
at different distances from the ear to be examined. Such an instrument is 
the watch. We commence by holding it at a distance and bring it gradually 
nearer to the ear until its tick is perceived; the reversed order might give 
rise to mistakes. As soon as the patient can indicate the tempo of the tick, 
we are sure that he hears it, and we know the distance in which he hears 
by exact measurement. 

6. By Means of the Tuning-fork. — It is a known fact that the sound 
of a watch or a vibrating tuning-fork, when placed on the bony structure of 
the head or on the teeth, is heard at once louder as soon as we shut the ears, 
by lightly inserting one finger into each ear. If we close only one ear, we 
hear the sound louder on this side than on the other. This physiological 
fact has been made use of in the diagnosis of ear diseases, where, in some 
cases, it gives valuable hints. 

The same effect, namely, which is produced by closing the ear with a 
finger, must be brought about by any morbid obstruction within the ear 
which interferes with the normal conduction of sound. And what prevents 
the sound from entering into the ear must necessarily prevent the sound- 
waves also from passing out of the ear, when produced by and conducted to 
the inner ear by vibrations of the skull bones; consequently they must be 
reflected back to the labyrinth and thus be perceived doubly as loud. 

The causes, which may act similar to an artificial closure of the external 
meatus, are various. It ma}* be a collection of cerumen, a foreign body, or 
a furuncle in the external canal, or obstruction of the Eustachian tube, or 
myringitis, or thickening of the drumhead; it ma}- be a collection of secre- 
tion about the ossicula, or a want of flexibility, or even t a partial destruction 
of the same, or a softening or thickening of the membranes of the fenestrae 
to the labyrinth. In any of these conditions the patient will surely hear the 
tuning-fork, which, by the way K gives the best and truest results, when placed 
on the median line of the top of the head, loudest in that ear which is thus 
affected. 

If the patient, on the contrary, should hear the tuning-fork better in 
the sound or comparatively well ear, and less distinctly in the affected one, 



OTITIS MEDIA. 1 93 

we may assume with tolerable probability that the affection of the bad ear 
consists of a loss of sensibility of the Acusticus in the labyrinth. 

However, even here we must not be too rash in our conclusions, and 
remember that there is a great difference in the capacities which patients, and 
even persons in health, manifest with regard to their power of distinguishing 
the vibrations of a tuning-fork placed upon the head. Aged persons as a 
rule have much less capacity of perceiving the vibrations of a tuning-fork 
than persons below fifty years of age. It will be well in all cases to place 
the tuning-fork, as a controlling experiment, also upon the front teeth of the 
lower jaw. A peculiar observation of Von Trcelsch is, that the tuning-fork, 
when placed on the head, very quickly ceased to vibrate in cases of a very 
unfavorable nature. 

Otitis Media. 

Under this name I intend to treat what Von Trcelsch has separately and 
elaborately described as simple catarrh and purulent catarrh of the middle 
ear. Both forms represent an inflammatory state of the mucous lining of 
the cavit}^ of the middle ear, the mastoid cells and the Eustachian tube, either 
in part or in toto. The first is the lighter form, producing a mucous secre- 
tion which, however, at times may be mixed with pus and blood; the second 
is the more serious form, characterized by its purulent secretion, and mostly 
ending in perforation of the drumhead. It may be the result of simple 
catarrh, and I do not find any characteristic signs by which the two could 
positively be distinguished from each other at the commencement. 

The catarrh of the middle ear is either acute or chronic. Its Acute form 
is mostly very painful; only exceptionally it runs its course without pain, 
especially in tuberculous individuals. The pain is felt deep in the ear, is 
sometimes excruciating and extends over the whole of the affected side of the 
head; it is usually not increased by pulling at the auricle or by pressure 
upon the parts before the ear, but gets decidedly worse from swallowing, or 
any quick movement of the head, or any concussion from a hard step, and 
at nights. If the mastoid process becomes involved, there is pain in that 
region and sensitiveness to pressure, and according to Cooper, even at an 
early stage ' ' we can find a little gland situated midway over the mastoid 
process and on a line with the anterior opening of the auditory canal, im- 
mediately behind the auricle, become tender and swollen, while its immediate 
surroundings are insensitive to pressure." This inflammatory process is 
further attended by high fever and sleeplessness, when it may indeed simulate 
an acute meningitis; by deafness of various degrees, developing either sud- 
denly or gradually, and caused by the exudation which covers the ossicles 
and destroys their natural mobility; by " catarrh in the head." In fact it 
may have spread from a catarrhal inflammation of the naso-pharyngeal 
mucous membrane, through the Eustachian tube into the middle ear. 

There is no age exempt from it, but in childhood it is especially preva- 
lent, though it is often not recognized. 
*3 



194 THERAPEUTIC HINTS TO OTITIS MEDIA. 

I might for its diagnosis in little children draw the attention to the fol- 
lowing Symptoms : high fever; great restlessness; crying and screaming 
without apparent cause, sometimes in spells or incessantly for days. The 
child gets worse from any motion, especially of the head, from being rocked, 
from swallowing and especially when sucking. In fact it cannot be made to 
suck, it lets the nipple go at each attempt of drawing. Often the little ones 
bring their hands automatically to the affected side of the head. In some 
cases the pressure of the exudation within the ear causes vomiting, somnolence 
alternating with great restlessness, delirium, partial or entire loss of con- 
sciousness, convulsions of the limbs or of the facial muscles. If all this is 
complicated with an exanthematic fever, or typhoid fever, pneumonia or 
bronchitis, its diagnosis is indeed difficult. A nasal catarrh or an angina 
might better lead to its discover}'. At all events it will be well to try the 
application of warm water to the ears in suspicious cases, which gives more 
or less relief if the ears are affected. An examination of the auditory canal 
in otitis media by the ear speculum reveals a slight redness of the canal near 
the drumhead; the drumhead itself appears slightly reddened from its con- 
gested mucous layer inside, or sometimes shining and red, like a polished 
copper-plate; afterwards or sometimes from the first its mild lustre grows 
dimmer or is lost entirely and with it also the cone of light. When the se- 
cretion in the middle ear increases, the drumhead is marked by single radiat- 
ing blood-vessels and partial bulging, especially of its upper and posterior 
portion. Sometimes the collected pus shines through the drumhead and 
gives it a yellowish appearance. Externally we find swellings of the glands 
around the ear and redness and swelling of the naso-pharyngeal mucous 
membrane. Otitis media terminates often in perforation of the drumhead. 

Its Causes are exposure to cold, which, especially in persons prone to 
catarrhal affections, will often excite this complaint. We find it frequently 
associated with tuberculosis, syphilis, exanthematic fevers, typhoid fever, 
diphtheritis and croup; we must not lose sight of it during the process of 
dentition. 

It yields in most cases kindly to homoeopathic treatment. 

Therapeutic Hints. 

Aeon. Excruciating pain often in the whole affected side of the head 
with high fever, dry skin, anguish, crossness and restlessness; great sensi- 
tiveness to noise; auricles hot and red; meatus externus dry and red; drum- 
head red, almost copper-colored, with visibly engorged and throbbing ves- 
sels; after exposure to wind and cold. 

Arg. nitr. Ulceration of the drumhead; muco-purulent discharge from 
the ear; naso-pharyngeal inflammation. 

Arnica. Deep pain and heat extending to the mastoid process; feeling 
of being bruised about the ear; stitches in and about the ear; hardness of 
hearing. Traumatic origin; from getting chilled after being heated; typhoid 
fever; pysemic symptoms. 



THERAPEUTIC HINTS TO OTITIS MEDIA. 1 95 

Arsen. Typhoid symptoms, with suppression of discharge; lymphatics 
inflamed; high temperature; collapse; profuse, cold perspiration; pysemia; 
pain relieved by warm applications. Burning, itching and crawling in 
external meatus; red, burning pustules in the canal and upon the auricles. 

Bel lad. Sticking in and behind the ear; digging, boring and tearing; 
coming and going suddenly, extending to the throat; inflammation of the 
throat; ringing, buzzing and roaring in the ear; face flushed; eyes brilliant 
and staring; congestion to head; delirium; deafness or sensitiveness to light 
and noise; auricle red and sensitive to touch; erysipelas of scalp. Drum- 
head congested, enlarged vessels covering its entire surface. After exposure 
to cold draughts; cold foot-baths; having the hair cut; dentition. 

11 The frequent instillation of warm water (as warm as it can be borne), 
either alone or with the addition of a few drops of Bellad., will usually 
relieve the terrible pains while the remedy is administered internally." 
(Norton.) 

Borax. Stitch-pains, with involuntary starting; lancinating headache; 
itching in the ear; mucous discharge; hot ear; external meatus swollen. 
Children fret and cry and fear downward motion. 

Calc. carb. Beating pain, with knocking, buzzing and roaring; pain 
from ear to neck and under jaw; w r orse from evening till midnight; better 
from perspiration; thick discharge; swelling of lymphatic glands about ear 
and neck; perspiration about the head; scrofulous subjects; sensitiveness to 
cold and damp air; period of dentition; teeth carious and bluish-black at 
the roots. 

Cap sic. Itching deep in ear; shooting, pressing pain in and about the 
ear; deep-seated pain under the ear, opposite the angle of the inferior max- 
illary, not extending down the jaw; mastoid process swollen; middle ear 
and mastoid cells filled with pus; external meatus closed; drumhead per- 
forated. 

' ' Cap sic. is specially valuable in acute necrosis of mastoid process, or in 
acute symptoms arising in chronic diseases of the mastoid. The full pulse, 
fever and haggard look of the patient are marked features of the picture of 
the drug. In abscess of the mastoid in very young children it has not 
proved as effective. ' ' (Houghton. ) 

Chamom. Catarrhal inflammation; pain in paroxysms; excruciating; 
patient beside himself from pain; irritable and cross; screaming. Auricle 
red and hot; face changing color, now red and hot and then again pale; or 
only one cheek red and the other pale; hot sweat about the head; green, 
colicky discharges from the bowels; dentition. 

Ferr. phosph. Catarrhal affection of the Eustachian tube and ear, often 
combined with catarrh in chest, or bowels, or both. 

Gelsem. Catarrhal inflammation at the beginning; cold in head and 
closure of Eustachian tube; tense, dull, bound, giddy sensation in head with 
chilliness; stupor, drowsiness. 

Hydrast. After frequent gatherings and earache, deafness. The right 



196 THERAPEUTIC HINTS TO OTITIS MEDIA. 

membrane is bulged outward, looks purplish, and the malleus handle is of a 
pinkish suffusion; left membrane of the same character, though not bulged. 
(R. T. Cooper.) 

Kali carb. Stitch-like pain and drawing, especially behind the right 
ear; head and right ear hot; face pale, sometimes flushed; strong fever, 
with dizziness; chilliness, shuddering; anxiety in chest; weary in all the 
limbs. 

Kali. hydr. Otitis in rickety children with great tenderness of the 
head. 

Merc. sol. Deep-seated, tearing and shooting pain, extending to the 
malar or inferior maxillary bone; worse from evening till midnight, by 
warmth in bed; enlarged, sensitive cervical glands; stomatitis or ulcerated 
sore throat; tongue large, flabby, indented; fauces inflamed; perspiration 
from least exertion; otitis, accompanied by facial paralysis. 

Merc. dulc. Especially when the Eustachian tube and mucous mem- 
brane of the pharynx are affected. 

Natr. sulph. Sharp, lightning-like stitches in the ear; catarrhal affec- 
tion from damp and rainy weather, cold bathing, playing on wet ground; 
hydrogenoid constitution. 

Nux vom. Great pain in ear; hardness of hearing, with roaring, sing- 
ing and other noises; auditory canal dry and sensitive; cold in head; itching 
in Eustachian tube; headache; vertigo; periodical nausea and vomiting; 
constipation; creeping chilliness. Better in warm, worse in cold and damp 
weather. 

Phosphor. Painful gathering, first in left and then in right ear, and 
shooting pains through ear, worse at night; stopped up feeling in ear; itching 
in ears; rather deaf in left ear; deafness to human voice; re-echoing of his 
own words. When the ear gets better, styes appear on eyelids, or eruption 
at the septum of the nose; constipation. 

Plant, maj. Pain in the ear, with pain in the teeth and face. The 
pains are sharp, twinging, running. (Houghton.) 

Pulsat. Sharp pain, increasing gradually to great intensity, then ceas- 
ing suddenly, but soon increasing again; shooting pain; hardness of hearing; 
headache and toothache; carious teeth; auricle sensitive; external meatus 
red and swollen; profuse discharge; phlyctenular inflammation on drum- 
head, or ulceration and perforation; dryness of auditory canal; catarrh of 
Eustachian tubes; swelling of cervical glands; mild disposition; thirstless- 
ness; constant change of position; shifting pains on different parts of the 
body; catamenial irregularities. Worse in the evening; from heat or close 
room; better in open air. 

Rhus. tox. Pain worse at night and at rest; from cold, damp and rainy 
weather; deafness to human voice. 

Sulphur. Drawing, shooting pain; heavy pressure and heat at vertex, 
extending to both ears, with soreness of the brain ; hot flushes of the face, 
followed by cold sweat; hardness of hearing, especially for the human voice. 



THE CHRONIC FORMS OF OTITIS MEDIA. 1 97 

In children who suddenly cry out with pain, while they appear listless and 
unobservant, and where it seems doubtful whether the irritation be in the 
brain or in the intestinal canal. Styes ; swollen nose ; eruptions on different 
parts of the body. In complication with meningitis, eruptive fevers. 

Tcllur. Pain day and night, of a dull, throbbing character ; itching 
and swelling (left ear), with painful throbbing in the external meatus ; dis- 
charge of a watery fluid, smelling like fish-pickle, which causes a vesicular 
eruption upon the external ear and neck, wherever it touches the skin ; the 
ear bluish-red, as if infiltrated with water; hearing impaired; rough, angu- 
lar disposition; after scarlet fever. 

Tereb. Dental caries and otitis ; dental irritation, with symptons either 
of cerebral or abdominal irritation; burning soreness and interstitial disten- 
tion of the gums; suppression of urine and convulsions; wakeful at night, 
screaming as if frightened; staring look; clenching of fingers; twitching of 
different parts of the body; picking of nose; dry, short cough; aching of 
limbs and head; feverishness; changeable temper; cross and irritable. Eczema 
in front of left ear. (Cooper.) 

Ver: vir. Acute otitis. 

' ' Paracentesis of the membrana tympani is advisable, if the pains are 
not readily relieved by remedies, and if there is an accumulation in the 
middle ear, causing the drumhead to bulge; for a spontaneous rupture may 
leave a permanent perforation, while a simple puncture leaves no bad results, 
besides at once giving the patient relief from the agonizing pain." (Norton,) 

Digest after chronic forms of Otitis media. 

The Chronic Forms of Otitis Media. 

Chronic catarrh of the middle ear and its appendices is often developed 
in consequence of acute attacks, sometimes, however, without these. It con- 
sists either of an interstitial solidification or sclerosis of the middle ear tissue 
(dry catarrh), or of a swelling, tumefaction and thickening of the lining 
membrane, either of the middle ear or the Eustachian tube alone, or of both 
together, or of an ulcerative destruction of the mucous membrane and con- 
sequent perforation of the drumhead (chronic suppurative catarrh). 

The Sclerosis of the middle ear tissue yields no discharge, therefore it 
is called " dry catarrh." Its nature is quite obscure, and only from post- 
mortem examinations we know that this pathological process gradually pro- 
duces a stiffness and unyieldiness of the lining membrane of the middle ear, 
that greatly interferes with the normal vibrating capacities of the drumhead, 
the ossicula and the membranes of the fenestra rotunda et ovalis. Many 
cases of deafness produced in this wa}^ have, no doubt, formerly been classed 
under ' ' nervous deafness. ' ' 

The Moist catarrh is characterized by hypersecretion and tumefaction 
of the mucous membrane. This originally thin transparent and smooth 
membrane gradually becomes whitish or bluish- gray, its substance thickened, 
and its vascularity increased; patches of granulations form upon its surface. 



I9S THERAPEUTIC HINTS TO CHRONIC FORMS OF OTITIS MEDIA. 

and fatty, cheesy or calcareous deposits in its periosteal layer. The whole 
lining of the middle ear ma}- thus be changed,. and the pathological process 
may extend into the Eustachian tube, making it impervious for ventilation. 

The Suppurative form manifests itself by its purulent otorrhcea ; the 
mucous membrane appears, in some cases, greatly swollen and red, in others 
only moderately so and pinkish-yellow, and in still others, whitish-gray and 
cicatrized; it is covered with pus. At times we find this morbid process at- 
tended with caries of the bony structure and almost always with perfora- 
tion and greater or less destruction of the drumhead. 

The patient with chronic catarrh does not often know when his trouble 
began; only by a gradually increasing hardness of hearing his attention is 
drawn to it. The grade of deafness depends not so much on the extension 
of the catarrhal affection as on its location, by which it is apt to interfere 
more or less with the conduction of sound waves to the labyrinth. A slight 
degree of catarrh, if it destroys the mobility of the fenestral membranes, 
caused greater deafness than a much more extensive catarrh, if it affects the 
walls of the middle ear or even the drumhead. 

Impaired hearing, when it is better in clear and dry and worse in damp 
and rain}- weather; when it is momentarily relieved by Valsalva's or Po- 
litzer's method, or after an act of swallowing from which the patient perceives 
a kind of crack in the ear; when the own voice gives a more resonant sound, 
or the tuning-fork on the vertex is perceived louder in the affected ear — it 
usually denotes an affection of the Eustachian tube. When, on the con- 
trary, under all these conditions, the degree of hearing is not altered, we 
may infer that the trouble is located in the articulations of the ossicula or in 
the fenestral membranes. A perforation of the drumhead is not necessarily 
attended with great impairment of hearing, even an entire destruction of the 
same does not cause entire loss of hearing; of greater importance in regard 
to hearing are the changes from aural catarrh already referred to, which 
affect the articulations of the ossicula or the fenestral membranes on the 
labyrinth wall. The drumhead, if perforated, as a rule, heals kindly, but 
if it is kept open from continued inflammation and discharge, or even de- 
stroyed the middle ear loses its protection against external influences and is 
thus continually subjected to new irritations. 

Chronic otitis media suppurativa often leads to the formation of polypi 
and caries. Caries of the temporal bones may lead to abscesses in the brain 
or meningitis purulenta, to paralysis of the face, to haemorrhages, emboli, 
septic infection and phlebitis. 

Its Prognosis must be made according to these different characters and 
states. 

Therapeutic Hints. 

Valsalva's or Politzer's method, or catheterism, will prove beneficial in 
cases of imperviousness of the Eustachian tube, where it is important to pro- 
cure a better ventilation of the middle ear, or in cases of perforated drum- 



THERAPEUTIC HINTS TO CHRONIC FORMS OF OTITIS MEDIA. 1 99 

head and copious collection of slime and pus in the middle ear, to cleanse it 
of these secretions. The main work even here will have to be done by care- 
fully selected remedies. Besides those mentioned under the acute form of 
aural catarrh, compare: 

Arsen. Profuse, ichorous, cadaverously-smelling discharge; sinking 
and prostration. 

Asaf. Purulent discharge; after abuse of mercury. 

Au rum. Fetid discharge; caries of mastoid process with pain like a 
bruise, worse at night, by uncovering and at rest; better by motion in the 
open air. Meatus externus lined by fetid pus, like decay of necrosed bone; 
drum perforated; ossicula destroyed; middle ear denuded; fistulous openings 
through mastoid processes; offensive nasal discharge. Syphilis and abuse 
of mercury. 

Bar. carb. In cases involving the external meatus, Eustachian tube 
and structures of the pharynx, especially tonsils. 

Bar. mur. " Has served me better than Bar. carb. after long trials 
with the latter. Baryt. corresponds to an extra patency of Eustachian tubes 
caused by pharyngeal weakness or paresis. Clacking sound on swallowing, 
sneezing, or eructation, and by the two latter actions air is forced into the 
tympanum. Large tonsils reduced under its action." (Houghton.) 

Calc. carb. Profuse discharge; chronic deafness; sensitive to shrill 
sounds; crackling sounds when chewing; singing in the ears, with snapping 
as from electric sparks; roaring in the ears. Drumhead perforated; edges 
covered with granulations, extending to external meatus; polypous growths. 
Sore eyes; sore, ulcerated nostrils; smell of rotten eggs as gunpowder in 
the nose; nasal discharge; catarrh of Eustachian tube. 

Ca? r b. veg. Offensive discharge; aural meatus and drumhead inflamed; 
pain from ear down to neck; after itch-like eruptions. 

Caustic. Offensive discharge; paralsis of face; hardness of hearing; 
own voice re-echoes; roaring and whizzing in ear; throat reddened, with 
increased mucus; meatus dry, with little brown wax. 

Cinchona. Haemorrhage from ear after prolonged suppuration. 

Conium. Hardness of hearing; ears stopped up by dark brown wax 
and pus; pain in head; ringing in ears; enlarged liver, with pain on pressure; 
jaundice; urine scanty, brown and bilious; constipation, alternating with 
bilious diarrhoea; cervical glands hard and tender. 

Elaps. Deafness; offensive, yellow-greenish discharge; buzzing in ears; 
frontal and occipital headache, worse from motion and stooping. Dull pain 
from nares to ears; when swallowing, pain goes to the ears; posterior wall 
of pharynx dry, mucous membrane fissured and covered with crusts ; offensive 
discharge from nose; subject to epistaxis and eruption about nose and face; 
snuffles and pain from root of nose to forehead. Skin dry and hot, but 
always complains of feeling cold. 

Ferr. met. Discharge from left ear; chlorotic complexion; impaired 
hearing; murmur in left jugular vein; palpitation of the heart. 



200 THERAPEUTIC HINTS TO CHROXIC FORMS OF OTITIS MEDIA. 

Fluor, ac. Hardness of hearing, with rheumatism; ringing in the ears 
and numb feeling in the bones of face, near the right ear. Hearing is bet- 
ter on bending the head backwards; scalp sensitive; hair matting. 

Gelsem. Deafness after massive doses of morphine or quinine. 

Graphit. Deafness; hears better when riding in a carriage; catarrh of 
right tube; roaring in right ear; feeling as if a skin were covering the ear 
inside; sensation as of a valve opening and closing in the ear; detonation 
and cracking in the ear when swallowing or sneezing; own voice resounds; 
roof of mouth and fauces red. Eruption behind the ears, with sticky secre- 
tion; eczematous eruption of the face; mucous membrane of meatus red and 
excoriated; or dry and scabby; or oozing of water and pus, or blood; or 
thin, watery offensive discharge from both ears after scarlet fever, with 
deafness. 

Hepar. Detonation in the ear when blowing the nose; drawing, tear- 
ing, stitching pain, worse in night and cold air; soreness of surface in spots 
when touched; skin ulcerates from slight injury; scabs behind the ears; on 
ulcerated surface white shreds, which are removed with difficulty; wants 
to be wrapped up warmly even if hot. Abuse of mercury. 

J odium. Deafness, with tonsillitis and catarrh of Eustachian tube; in- 
dolent ulceration of the drumhead; glandular enlargement in front of the 
tragus; pinched, dried- up look of the face. 

Kali. bich?'. Thick yellow discharge, mixed with stringy mucus ; sharp 
pain coming and going quickly and changing location; stitches from ear up 
into the head and down into the neck; better from heat. Naso-pharyngeal 
catarrh; rop}^ mucus; " clinkers " in nose. 

Kreosot. Deafness with hereditary syphilis. 

Laches. Dryness of left ear; roaring and drumming in the ear; sense 
of coldness in the affected ear and side of head; dry, scurfy condition of 
nostrils; discharge of blood and pus from the nose. 

Lycop. External meatus excoriated by an offensive discharge; drum- 
head destroyed. Patient cannot bear to be covered. After scarlet fever 
with affections of the parotid glands, e/uptions and abdominal troubles. 

Mercur. Deafness; offensive discharge; polypi; external meatus and 
drumhead inflamed; itching in the ears; vesicular eruption in the face and 
itching pimples on legs. Syphilis. 

Me?r. bijod. Follicular catarrh in pharynx; enlarged tonsils. 

Merc. dale. "Is more effective than the other forms of Mercur. in 
overcoming closure of Eustachian tube, and probably it is in this way that 
it relieves the deafness of advancing years. " (Houghton.) 

Merc, prcec. rub. Purulent discharge; leaden heaviness in occiput; fall- 
ing out of hair. 

Mezer. Deafness after the suppression of an eruption of the scalp char- 
acterized by the formation of crusts, beneath which, when pressed, oozes a 
purulent or semi-purulent fluid. 

Natr. carb. Hardness of hearing and roaring in left ear with caries of 



DIGEST TO ACUTE AND CHRONIC OTITIS MEDIA. 201 

the left molar teeth; pain in left side of face; stiffness of neck and left 
shoulder; pain in small of back and left leg, worse from motion, better in 
rest; menses irregular, scanty; all worse before the monthly. 

Nitr. ac. Difficult hearing; obstruction of tube with swollen tonsils 
after scarlet fever; caries of the ossicula or mastoid process, from syphilis or 
abuse of mercury. Shooting pains; pain in bones, worse from every change 
of temperature, at night, on washing, on rising from a seat and from touch; 
better while riding in a carriage. 

Phosphor. Deafness to the human voice; resounding of own voice; 
sensation as if a foreign body were lodged in the ear; great itching in the 
ears. 

Picric ac. Noises in the head and sinking in the pit of the chest, being 
worse when tired and fatigued; deafness. (R. T. Cooper.) 

Psorin. Offensive discharge; offensive exhalation from whole bod}^; 
itching in ths ears; tinea capitis; scabs over fetid ulcers on and behind the 
ear. Similar to Sulphur but not reached by it. 

Pulsat. Catarrh of Eustachian tube with hardness of hearing. 

Sepia. Sensitive to musical sounds; herpes on the lobe, behind the ear 
or on the nape of the neck. 

Silic. Hardness of hearing, worse from washing and changing linen; 
otorrhcea and bad cough after scarlet fever; constant watery, curdy and 
ichorous discharge, without pain, except after a fresh cold. Ulceration, caries 
and necrosis; pain drawing and shooting, worse at night and from change 
of weather or movement; also after being long seated. Wants to have the 
head wrapped up. External meatus dry at outer portion, ulcerated further 
in and at drumhead. Child bores into its ear with its fingers when asleep, 
causing a discharge of blood and pus; it enjoys having the ear cleansed. 
Feeling of sudden stoppage in the ear relieved by gaping or swallowing. 
' ' Silic. is especially curative in cases in which the ulceration covers with a 
firm scab, under which pus abounds. One subjective symptom I have found 
a guiding one; hissing sounds in the ear which is perforated." (Houghton.) 

Sulphur. Deafness, especially for the human voice; purulent, offensive 
discharge, worse in damp weather, after meningitis. Drawing, shooting 
pains in the ears; pressure in the ears when swallowing or sneezing; ulcers 
in the middle ear; rusty ulcers on the drumhead. Frequent styes; swollen 
nose; eruptions on different parts of the body; worms and itching of anus; 
hot and sleepless in the night; hot feet and burning of soles in bed with in- 
clination to uncover the feet; disinclination to being washed. 

Thuja. Discharge which smells like putrid meat; granulations in the 
middle ear similar to condylomata; polypi. 

Digest to Acute and Chronic Otitis Media. 
PAIN AND SENSATIONS. | Burning : Arsen. 

Beating, with knocking, buzzing and Cold sensation in ear and side of head: 



roarinsr : Calc. carb. 



Laches. 



Bruised feeling about ear : Arnica. Digging, boring and tearing : Bellad, 



202 



DIGEST TO ACUTE AND CHRONIC OTITIS MEDIA. 



Drawing", shooting : Sulphur. 

, , worse at night and from change 

of weather, or movement : Silic. 

, stitching, worse in night and cold 

air : Hepar. 

Dull, throbbing, day and night : Tellur. 

Foreign body, as if lodged in ear : 
phor., Psorin. 

Itching, Borax, Capsic, Mercur. ^ Phos- 
phor. 

Pain in ear : Nux zvm., Plant, maj. 

, when swallowing : Elaps. 

Pressure, when swallowing or sneezing : 
Sulphur. 

Paroxysms, excruciating, patient beside 
himself from pain : Aeon., Chamom. 

Sharp, twitching, running : Plantago. 

, increasing gradually to great inten- 
sity, then suddenly ceasing, but soon 
commencing again : Pulsat. 

, coming and going quickly: Bellad. ; 

and changing location : Kali bichr. 

Shooting : Nitr. ac, Pulsat. 

, worse at night : Phosphor. 

, pressing in and about ear : Capsic. 

Sticking in and behind ear : Bellad. 

Stitches in and about ear : Arnica. 

, with involuntary startings : Borax. 

, sharp, lightning-like : Natr. sulph. 

Stitch-like and drawing, especially be- 
hind ear : Kali card. 

Stopped-!) p feeling in ear : Phosphor. 

EXTENT AND DIRECTION. 

Deep pain and heat extending to mas- 
toid process : Arnica. 

, tearing and shooting, extending to 

malar or inferior maxillary bone : Merc, 
sol. 

Pain from ear and neck : Card. veg. 

, and under jaw : Calc. carb* 

, to throat, coming and going sud- 
denly : Bcllad. 

Stitches up into the head and down to 
neck : Kali bichr. 

Deep-seated pain under the ear, oppo- 
site the angle of the inferior maxillary, 
not extending down the jaw : Calc. 
carb. 

Painful gathering first in left and then in 
right ear : Phosphor. 

Excruciating pain often in the whole 
affected side of the head : .Icon. 

Dull pain from nares to ears : Elaps. 



Heavy pressure and heat at the vertex, 
extending to both ears, with soreness of 
the brain : Sulphur. 

AURICLE. 

Sensitive Pulsat. 

Hot: Borax, Sulphur. 

, right ear and head : Kali carb. 

and red : Aeon., Chamom. 

Bluish-red, as if infiltrated : Tellur. 

Itching and swelling (1. ear) with painful 
throbbing in external meatus : Tellur. 

Red, burning pustules, outside and in- 
side : Arsen. 

Vesicular eruption outside from dis- 
charge : Tellur. 

Herpes on lobe, behind the ear, or on 
nape of neck : Sepia. 

Ulceration covers with a firm scab under 
which pus abounds : Silic. 

Scabs over fetid ulcers : Psorin. 

Behind ears, scabs : Hepar. 

over fetid ulcers : Psorin. 

eruption with sticky secretion : 

G rap hit. 

In front Of tragus : Glandular enlarge- 
ment : Iodum. 

of left ear : Tereb. 

EXTERNAL MEATUS. 

Burning, itching and Crawling : Arsen. 
Dry : Pulsat. , Silic. 

left ear : Laches. 

and scabby : Sulphur. 

with little brown wax : Caustic. 

and red : Aeon. 

and sensitive : Nux zvm. 

Inflamed: Bar. carb., Carb. veg., Merc. 
Red and swollen : Borax Pulsat. 
Closed: Capsic. 
Red and execriated : Graphit. 
Ulcerated, white shreds, which are re- 
moved with difficulty : Hepar. 
Lined by fetid pus : Aurum. 
Polypi: Calc. carb., Mercur., Thuja. 

DRUMHEAD. ' 

Inflamed : Carb. veg. , Mercur. 
Bulging and purplish : Hydrast. 
Copper-colored, engorged, throbbing 

vessels : Aeon. 
Enlarged vessels all over : Bellad. 
Phlyctenules upon it : Pulsat. 



DIGEST TO ACUTE AND CHRONIC OTITIS MEDIA. 



203 



Ulceration: Arg. nitr., Pulsat., Silic. 

, indolent : Iodum. 

Rusty ulcers : Sulphur. 

Perforation: Aeon., Capsic, Lycop., 

Pulsat. 
, edges covered with granulations, 

extending to external meatus : Calc. 

card. 

MIDDLE EAR. 
Feeling 1 as if a skin were covering the 

ear inside : Graph it. 
Denuded: Aurum. 
Ulceration: Silic, Sulphur. 
Caries, necrosis: Aurum., Nitr. ac, 

Silic. 
Granulations like condylomata : Thuja. 

MASTOID PROCESS. 

Swollen: Capsic. 
Caries : Aurum. 
Fistulous opening : Aurum. 
Necrosis: Capsic, Silic. 
Abscess : Capsic. 

in children not proved successful : 

Capsic. 

EUSTACHIAN TUBES. 

Itching" : Nux. vom. 

Catarrh: Bar. carb., Calc. carb., Ferr. 

phosph., Pulsat. 

, right side : G 'rap hit. 

with hardness of hearing : Pulsat. 

with catarrh of pharynx : Merc dulc 

Obstruction with swollen tonsils : Nitr. 

ac. 
Closure: Gelsem., Merc dulc. 

DISCHARGE. 

Discharge from left ear : Ferrum. 

like decay of necrosed bone: Aurum. 

mucous : Borax. 

muco-purulent : Arg. nitr. 

offensive, fetid : Arsen., Aurum., 

Carb. veg., Caustic, Flaps., Graphit., 
Mercur., Psorin., Sulphur. 

, excoriating parts : Lycop. , Tellur. 

, smelling like putrid meat : Thuja. 

Discharge, smells like fish pickle : Tel- 
lur. 

, yellow-greenish : Flaps. 

Haemorrhage after prolonged suppura- 
tion : Cinchona. 

Otorrhoea: Silic 

Profuse: Arsen., Calc. carb., Pulsat. 



Purulent : Asa/. , Merc prcec. rub. , Sul- 
phur. 

Pus and blood, after boring with fingers 
in ears during sleep : Silic. 

Thick : Calc carb. 

Watery, ichorous: Arsen., Graphit., 
Silic, Tellur. 

, yellow, mixed with stringy mucus: 

Kali bichr. 

Water, pus or blood: Graphit. 

Suppressed discharge with typhoid symp- 
toms: Arsen. 

HEARING. 

Buzzing: Calc carb., Flaps. 

Clacking on swallowing, sneezing or 
eructation: Bar. mur. 

Cracking when eating: Calc. carb., 
Graph it. 

Deafness, impaired hearing, hardness of 
hearing: Arnica, Bellad., Caustic, 
Conium, Flaps., Ferrum, Graphit., 
Mercur., Nitr. ac, Pier, ac, Pulsat., 
Silic, Tellur. 

, chronic: Calc. carb., Pier. ac. 

, in left ear: Phosphor. 

, for human voice: Phosphor., Rhus 

tox., Sulphiir. 

, with hereditary syphilis: Kreos. 

, with tonsilitis: Iodum. 

, with roaring in left ear: Natr. carb. 

, with rheumatism: Fluor, ac. 

, after suppression of crusts on scalp, 

with purulent secretion underneath: 
Mezer 

, of advancing years: Merc. dulc. 

Detonation, when swallowing or sneez- 
ing: Graphit. 

, when blowing the nose: Hepar. 

Hearing better on bending head back- 
wards: Fluor, ac 

, when riding in a carriage: Graphit. 

Hissing in perforated ear: Silic 

Resounding of own voice: Caustic, 
Graphit., Phosphor. 

Ringing : Conium. 

, buzzing and roaring: Bellad. 

and numbness in bones of face near 

right ear: Fluor, ac. 

Roaring: Bellad., Calc. carb., Pier. ac. 

and drumming: Laches. 

and whizzing: Caustic. 

in right ear: Graphit. 

Sensitiveness to musical sounds: Sepia. 



204 



DIGEST TO ACUTE AXD CHROXIC OTITIS MEDIA. 



to shrill sounds: Calc. card. 

to noise and light: B til ad. 

Singing" with snapping as from electric 

sparks: Calc. carb. 
Steppage by dark-brown wax and pus: 

Coniutn. 
relieved by gaping or swallowing: 

Siiic. 
As of a valve opening and closing in 

the ear: Graphit. 

SYSTEMIC SYMPTOMS. 

Stupor: Gd st ui. 

Listless and unobservant: Sulphur. 

Delirium : Bellad. 

Suddenly cry out with pain, otherwise 

listless: Sulphur. 
Fret and cry: Borax. 
Screaming : Chamom. 
Disinclined to being washed: Sulphur. 
Enjoys having the ear cleaned: Si lie. 
Pear downward motion: Borax. 
Anxiety in chest: Kali carb. 
Anguish: Aeon. 
Mild disposition : Puhat. 
Changeable temper : Tereb. 
Rough, angular disposition: Tellur. 
Cross : Aeon. 
and irritable: Chamom., Tereb. 



Headache : Bellad., Conium l Nux vom. 

, frontal and occipital, worse from 

motion and stooping: Flaps. 

, lancinating: Borax. 

, tense, dull, bound, giddy sensation, 

with chilliness: Gelsem. 

, and toothache: Puhat. 

, and aching of limbs: Tereb. 

Noises in head and sinking at pit of 

chest: Pier. ae. 
Leaden heaviness in occiput : Merc. 

prcrc. rub. 
Vertigo : Gelsem., Nux vom., Pier. ae. 
Congestion : Bellad. 
Meningitis : Sulphur. 
Perspiration about head : Calc. carb., 

Silic. 

, hot : Chamom. 

Scalp sensitive : Fluor, ae., Kali hydr. 

Erysipelas : Bellad. 

Tinea : Mi zer., Psorin. 

Palling out of hair : Merc, prcrc. rub. 

Matting of hair : Fluor, ae. 



Brilliant and staring : Bellad. 
Staring look : Tereb. 
Frequent styes : Pier, ae., Sulphur. 
Styes appear when the ear gets better : 

Phosphor. 
Sore eyes : Calc. carb. 



Smell of rotten eggs or gunpowder : 

Calc. carb. 
Cold in head : Gelsem, Nux vom. 
Discharge : Calc. carb. 

, offensive : Aurum. 

of blood and pus : Laches. 

Snuffles and pain from root of nose to 

forehead : Flaps. 
Ropy mucus, " clinkers :" Kali bichr. 
Dry, scurfy nostrils : Laches. 
Ulcerated nostrils : Calc. carb. 
Eruption at septum : Phosphor. 
about nose and face and subject to 

nosebleed ; Flaps. 
Swollen nose : Sulphur. 
Picking of nose : Tereb. 

Pain in face and teeth : Plantago. 

in left side : Natr. earb. 

Paralysis : Caustic., Merc. sol. 

Flushed : Bellad. 

Hot flushes followed by cold sweat : Sul- 

phor. 
One cheek red. the other pale: Chamom. 
Changing, now red, then pale: Chamom., 

Kali carb. 
Chlorotic complexion : Ferrum. 
Jaundice : Conium. 
Eruption, vesicular : Merc. sol. 

, eczematous : Graphit. 

Pinched, dried-up look : Lodum. 
Haggard look : Capsic. 

Stomatitis : Mere. sol. 

Tongue large, flabby, indented : Merc, 
sol. 

Roof of mouth and fauces red : Graphit. 

Gums sore, burn and swollen : Tereb. 

Teeth and face painful : Plantago. 

. carious: Pulsat., Tereb. 

, left molar : Natr. carb. 

, and bluish-black at roots : Calc. 

carb. 

Dentition, period of : Bellad., Calc. carb., 
Chamom. 

with cerebral or abdominal irrita- 
tion : Tereb. 



DIGEST TO ACUTE AND CHRONIC OTITIS MEDIA. 



205 



Nasopharyngeal inflammation : Arg. 

nitr., Kali bichr. 
Fauces inflamed: Bar. card., Bellad, 

Merc. sol. 

, with increased mucous : Caustic. 

, follicular : Merc. bij. 

, mucous membrane fissured and 

covered with crusts : Elaps. 
Tonsils enlarged : Bar. card., Merc. bij. 

reduced under its action : Bay . mur. 

Thirstlessness : Pulsat. 

Cervical glands swollen : Merc, sol., 

Pulsat. 

, hard and tender : Conium. 

Lymphatic glands about ear and neck 

swollen : Calc. card. 
Neck and left shoulder stiff : Natr. carb. 
In left jugular vein murmur : Ferrum. 



Periodical nausea and vomiting : Nux 

vom. 
Green, colicky discharge : Chamom. 
Constipation : Nux vom., Phosphor. 
, alternating with bilious diarrhoea : 

Conium. 
catarrh in bowels or chest, or both : 

Ferr. phosph. 
Abdominal troubles : Lycop. 
Enlarged liver : Conium. 
Worms and itching of anus : Sulphur. 
Urine, scanty, brown, bilious : Conium. 

suppressed, with convulsions : Tereb. 

Menses, irregular and scanty : Natr. 

carb., Pulsat. 
Cough, bad : Silic. 

, dry, short: Tereb. 

Palpitation : Ferrum. 
Full pulse : Capsic. 



Dry skin : Aconite. 

, but always complains of feeling 

cold : Elaps. 
Eruptions : Lycop. 

, on different parts : Sulphur. 

Pimples, itching on legs: Mercur. 
Soreness of skin in spots when touched : 

Hepar. 
Ulcerates from slight injury : Hepar. 



Chilliness : Nux vom. 

, shuddering : Kali carb. 

Feverish : Tereb. 

Fever : Aeon., Arsen., Capsic. 



, with hot soles and inclination to un- 
cover feet : Sulphur. 

, with dizziness : Kali carb. 

, typhoid : Arnica. 

, eruptive : Sulphur. 

Perspiration from least exertion : Merc, 
sol. 

, profuse, cold : Arsen. 

Exhalation offensive from whole body : 
Psorin. 



Drowsy : Gelsem. 

Sleepless : Sulphur. 

Wakes up screaming as if frightened : 

Tereb. 
Restless : Arsen. 

Changes position constantly : Pulsat. 
Pains shifting in different parts : Pulsat. 
Weary in all limbs : Kali carb. 
Twitching of different parts : Tereb. 
Clenching of fingers : Tereb. 
Sinking, prostration, collapse : Arsen. 
Anaemia : Arsen. 

Hydrogenoid constitution : Natr. sulph. 
Lymphatics inflamed : Arsen. 
Pysemic symptoms : Arnica. 
Rickets : Kali hydr. 
Scrofulous children : Calc. carb. 
Syphilis : Kreos., Merc. sol. 

CIRCUMSTANCES THAT 
CAUSE IT. 

Cold bathing : Natr. sulph. 

foot-baths : Bellad. 

Chilled after being heated : Arnica. 
Exposure to cold draughts : Bellad. 

wind : Aeon. 

Having hair cut : Bellad. 
Itch-like eruptions : Carb. veg. 
Meningitis : Sulphur. 
Mercury, abuse : Asa/., Aurum, Hepar, 

Nitr. ac. 
Morphine and quinine : Gelsem. 
Playing on wet ground : Natr. sulph. 
Scarlet fever : Nitr. ac, Tellur. 

with deafness : Graphit. 

with swollen parotid glands : Lycop. 

Sulphur, after if not sufficient : Psorin. 
Syphilis : Aurum, Nitr. ac. 
Traumatic : Arnica. 
Vaccination: Silic, Thuja. 
Weather damp, cold and rainy ; Natr. 

sulph., Rhus tox. 



206 POLYPI. 



WORSE. 



Being tired and fatigued : Pier. ac. 
BETTER. 



In evening : Pulsat. 

till midnight: Calc. card., Merc. 

so j Cleansing the ear is enjoyable : Silic. 

At night and at rest : Rhus tox. Motion in open air : Aurum. 

Damp weather : Calc. card., Nitr. ac, Riding in a carriage : Nitr. ac, Graphit. 



Xu.v vom., Sulphur. 
Washing and changing linen : Silic. 
Heat or close room : Pulsat. 
Warmth in bed : Merc. sol. 

, cannot bear covering : Lycop. 

Before monthly : Natr. card. 
After being long seated : Silic. 
On rising from a seat : Nitr. ac 



Warmth : Nux vom. 

, wants head wrapped up : Silic 

I erspiration : Calc. card. 

, wants to be wrapped warmly 

Hepar. 
Heat '• Kali bichr. 
Warm applications : Arsen. 
Open air : Pulsat. 



Polypi. 

These morbid growths are more frequently found in combination with 
chronic suppurative catarrh of the middle ear. It is probable that in most 
cases they are the product of this morbid process, although it is possible, also, 
that having originated primarily, they ma}* by constant irritation cause in- 
flammation, ulceration and perforation of the drumhead. Their substance is 
yen* vascular, soft, red and easily bleeding when being touched; sometimes 
the}' are of greater consistence, have a smooth and shining surface, and grow 
grape-like on pedicles. Their size differs greatly. From mere tiny excres- 
cences they may increase to masses which fill the entire external meatus and 
even overlap it. They have been found to grow from the surface of the ex- 
ternal meatus, from the drumhead and from different parts of the surface of 
the middle ear. According to Von Trcelsch their most frequent origin is the 
middle ear; Toynbee and Wilde, on the contrary, observed them most fre- 
quently to originate on the posterior part of the external meatus. In regard 
to their histological nature, they are either a hyperplasia of the mucus lining 
of the middle ear — Mucous polpyi — or a proliferation of connective tissue — 
Fibrous polypi — or a growth of a jelly-like substance — Gelatinous polypi. 
The first are the most frequent, the last the rarest form. 

Therapeutic Hints. 

Alumen usia, 3d cent., "will reduce granulation on the drumhead or 
inner extremity of meatus. ' ' (Houghton. ) 

Calc. curb. Large polypi, filling the whole external meatus and over- 
lapping it; bleed occasionally; chronic nasal discharge. 

Calc. jod. Offensive, thick, yellow discharge from the ear; deafness; 
pain in region of the heart, worse on going up stairs; frequent urging to 
urinate, as if the bladder were full, worse in afternoon and evening. 

Merc. sol. Offensive discharge; polypi in external meatus, which is 
inflamed. 

Sa ng u in ., Ten criu m . 

Thuja. Large polypi with otorrhcea; bleed easily. Shooting pain in 
ear. Granulations in middle ear. 



NERVOUS DEAFNESS. 207 

Nervous Deafness. 

Under this name a number of ear affections have heretofore been classed, 
which now are diagnosed as one or the other form of chronic middle ear 
catarrh. Other affections still remain, which must be favored with this 
title, until bj~ further experimentation and improved means of diagnostic 
researches, we shall have gained a more precise knowledge of their nature. 
1 ' Nervous deafness ' ' comprises all those defects of hearing which take their 
origin in affections of the labyrinth, of the acoustic nerve and its origin, or 
of the brain. Various as these affections are and may be, we seldom have 
the means of accuratel} T defining their nature during the life of the patient. 
We meet nervous defects of hearing after the abuse of Quinine; in hysteria 
and chlorosis; in consequence of injuries to the head; various affections of 
the brain. 

Meniere's Disease. 

The following are Meniere's observations: "1. Attack of noises of 
various kinds, intermitting or continuous, and impairment of hearing coming 
on suddenly in heretofore well organs of hearing. 2. These functional dis- 
turbances have their seat in the inner ear and are capable of producing 
apparent brain-symptoms, such as vertigo, stupefaction, uncertain gait, turn- 
ing motions of the body and sudden falling down, attended with nausea or 
vomiting and fainting. 3. These attacks recur from time to time and are 
always followed by a higher or lower grade of deafness, even sudden entire 
loss of hearing. 4. It is most probable that the material change which lies 
at the botton of these sudden disturbances, has its seat in the semi-circular 
canals." In one case post-mortem revealed an apoplectic effusion in these 
parts. This affection is also known under the name of Labyrinthine or 
Auditory vertigo, and according to Hinton is at times attended with uncon- 
scious divergence of the eyes and "seeing double" when inattentive. It 
seems, however, that not in all cases the primary affection lies in the laby- 
rinth. The same symptoms have been observed when in consequence of 
obstruction of the external meatus, or of catarrhal affections of the middle 
ear, with profuse exudation, or with sudden stoppage of the Eustachian 
tube — an undue pressure is exercised upon the labyrinth. It is clear that in 
this case the prognosis is much more favorable than when the labyrinth is 
originally affected. We can distinguish a primary affection of the labyrinth 
from one secondarily caused by external pressure, by the suddenness with 
which it attacks without any premonitory symptoms, and by the absence of 
all obstructions, either in the external meatus or in the Eustachian tubes. 

Therapeutic Hints. 

A case of suppurative inflammation of the labyrinth after cerebrospinal 
meningitis is recorded by Dr. Searle. Total deafness; straddling, gathering 



20S TINNITUS AURIUM. 

gait. Xo conduction of sound of a heavy tuning-fork through forehead and 
head. St'ltc. 30 improved. Kali brom. -^ cured. 

There are recommended by R. T. Cooper: Salicylate of soda, Chin. 
sulpk.j Comum, Cicuta, Amyl nitr., all of which produce more or less deaf- 
ness and vertigo, the leading symptoms of Meniere's disease. 

"Salicylate of soda seems to correspond most closely to the usual 
symptoms and has served me better than any other remedy." (Norton.) 

Arnica. Vertigo worse when rising and walking, but also when lying. 
Great thirst; belching and vomiting of sour masses; feeling of coldness in 
occiput. (J. Leeser.) 

The secondarv form must be treated according to its causes, which com- 



pare. 

Tinnitus Aurium. 

Variable as sounds and noises, so also is the character of tinnitus 
aurium. We might, however, discern two distinct groups of tinnitus 
aurium: i, noises in consequence of an irritability of the auditor}' nerve, 
and 2, noises in consequence of irritation in or on the blood-vessels or 
adjacent parts of the hearing apparatus which the normal auditor}- nerve 
perceives. 

The first class — so-called subjective sounds or noises — are the conse- 
quence of cerebral disorders, as hyperemia of the brain, intoxication by 
quinine or alcohol, faulty composition of blood in chlorosis, and exaltation 
or depression of the nervous system in general. But even here we may 
already have trespassed the proper boundary line between the two groups; 
irritation of the nervous and vascular system cannot be kept asunder, as the 
one is dependent upon the other. 

The second class — objective sounds or noises — are much more frequent 
and manifold in their causes. All kinds of irritations of the drumhead, or 
middle ear, or Eustachian tube, or labyrinth, either from circulation, inflam- 
mation, exudation, alternation of tissue, or foreign bodies, may give rise to it. 
Pulsating noises are probably mostly of a vascular origin; ringing noises 
may be caused by clonic or tonic spasms of the muscles in the middle ear or 
of the Eustachian tubes; the crackling noise in the ear during an act of 
swallowing originates by the contraction of the abductor tubes; many other 
and various noises may be caused by vibrations of pus or dried scales of 
mucus, or by foreign bodies on the drumhead, or by the bursting of small 
bubbles of slime in the ear, when shaking the head, etc. 

Tinnitus aurium is often aggravated by worriment, mental and bodily 
depressions; by sudden changes of weather, especially damp weather; in 
illy- ventilated rooms; after sumptuous meals, the use of spirituous drinks 
and tobacco, and from bodily exertions if long continued. The patient 
usually feels better in the open air and in the company of friends, when a 
lively conversation withdraws his attention from the constantly annoying 



OTALGIA NERVOSA. 209 

noise, provided he hears well enough to participate in the conversation and 
the room be not overheated or badly ventilated. 

Pressure with the finger upon the mastoid process or upon the first cer- 
vical vertebra changes and often ameliorates the noise in ears, while in many 
cases by reflex action an irritation of the trigeminus causes an irritation of 
the acusticus, so that many patients complain of an increase of the noise as 
soon as the}- touch single parts of the face, or are being shaved. To this 
reflex action from the skin we must count also those aggravations which fre- 
quently take place in consequence of changing the linen, of standing with 
bare feet upon a cold floor, and so on. 

Tinnitus aurium is, as may be seen from its various causes, often asso- 
ciated with various degrees of deafness. In chronic catarrh of the middle 
ear a continuous noise is an unfavorable sign. Sometimes tinnitus and deaf- 
ness increase and decrease in like proportions; other times tinnitus increases 
as the deafness decreases. 

Therapeutic Hints. 

It is obvious that special hints cannot be given. We must necessarily 
in each case consider its cause, for which necessary hints will be found in 
the foregoing chapters. Tinnitus, however, may in some cases by its peculi- 
arity hint to a remedy by which the entire aural affection may be removed. 
Here I must refer to our repertories and Materia Medica. 

Otalgia Nervosa 

Is a hypersesthesia of the sensible nerves of the ear, and must not be con- 
founded with the pain caused by inflammatory processes in the ear, as met 
with in otitis media. It is of much rarer occurrence than otalgia accompany- 
ing otitis. It characterizes itself frequently by its typical course. Often it is 
associated or caused by caries of a molar tooth on the same side, or by ulcera- 
tion of the epiglottis, as a reflex action -of the vagus. 

Therapeutic Hints. 

Compare facial neuralgia, toothache, etc. 

Plant maj. , "is our sheet-anchor for otalgia independent of organic 
lesions." (Houghton.) 

Sodium seleniate™ ', has just relieved a pure otalgia of years standing. 
(Norton.) 



H 



NOSE. 



General Observations. 

1. Concerning the indications from its form and shape. 

A thick, swollen nose is either a sign of inflammation (if accompanied by 
pain, heat and redness) or of rachitic and scrofulous diseases. Lovers of 
intoxicating drinks are generally blessed with a suspicious looking nose of 
such a shape. 

The nose becomes pointed, pinched, during spasms; during a chill, and 
in collapse. 

When in children the nose becomes suddenly pointed, it is a sign of im- 
pending spasms; an habitually pointed nose denotes derangement in the 
mesenteric glands, and general atrophy. 

If the nose becomes pointed suddenly during the act of parturition, it is 
a sign of internal haemorrhage, or complete exhaustion, or threatening con- 
vulsions. 

The pointed nose of a nursing mother indicates her complete unfitness 
for being wet-nurse. When it sets in suddenly in severe illness, it is always a 
bad symptom; being a sign of extreme exhaustion and collapse. A heavy 
motion of the nasal wings during respiration is a sign of impeded respiration, 
either from asthma, pneumonia, croup, dropsy in the chest, or incipient 
paralysis of the respiratory muscles, and utter prostration. 

2. In regard to color. 

A red nose ma}' result from a variety of causes: extremely cold air, con- 
gestion, crying, being overheated, cold in the head, worms, scrofula, in- 
temperate use of ardent spirits. In young girls it denotes the setting in of 
menstruation. 

Circumscribed redness of the point of the nose, of the cheeks, and of the 
forehead, with paleness and coldness of the other parts of the face, denote, 
in pneumonia, that suppuration has taken place. 

A coppery shining redness of the root of the nose is a sign of existing 
syphilitic ulcers within the nose. 

The copper nose of wine and liquor drinkers is well known. 

A pale nose is found in various morbid affections; during a chill, during 
syncope, in spasms, from nausea, after great exertions, from sexual excesses, 
profuse haemorhages, and so on. In women it is a sign of approaching 
menses or disturbed menstruation; profuse leucorrhcea; chlorosis. During 
pregnancy it is a sign that the foetus is dead. In eruptive fevers it denotes a 
disturbance in the exanthematic process and probably metastasis to internal 



EXAMINATION OF THE CAVITY OF THE NOSE. 211 

A grayish, lead-colored nose is found in dropsy of the chest and peri- 
cardium, in induration of the lungs and some malignant typhoid fevers. 

Single lead colored stripes have been observed in the obstinate obstruc- 
tion of the portal vein. 

A bluish color of the nose is found in some cases of apoplexy; in croup, 
in catarrhus suffocativus, in diseases of the lungs, heart and larger blood- 
vessels; in short, in all morbid conditions which cause a stagnation of blood, 
cyanosis. 

Brownish, yellowish spots on and over the nose, like a saddle, indicate 
mostly a diseased liver or chronic leucorrhcea. 

A blackish fur at the nostrils is found in typhus, epidemic dysentery, 
cholera, altogether in conditions of great prostration. 

3. In regard to temperature. 

A hot nose we find in violent coryza, inflammation, before bleeding, dur- 
ing delirium, sopor, apoplexy. 

Coldness of the nose we find during a chill, spasms, nausea; from loss of 
blood, exhaustion, and in consequence of inflammation of the bowels. 

An habitually cold nose is found in disordered states of the abdominal 
viscera, in dropsical complaints and in chlorosis. 

To all this I have to add one more pathognomonic sign: 

The constant picking and boring at the nose, which is found frequently 
in consequence of irritation in the intestinal canal from worms, or in typhoid 
fevers and cerebral affections. In these latter cases there is always a want 
of natural secretion in the nose; it is as dry as a powder-horn; its getting 
moist again is one of the favorable signs in such cases. 

Examination of the Cavity of the Nose. 

In order to get a full view of the Anterior nasal cavity, it is necessary 
to dilate the nostrils. This is best done by means of Fraenkel's or Von 
Troeltsch's speculum narium, instruments which after being introduced into 
the nose can be made to expand so as to push off the side walls of the nose 
from the septum. If we now place the patient in a position where the direct 
rays of the sun fall into the dilated nostrils, or in the absence of sunlight, 




It 

concentrate by a reflector the rays of candle-light or diffused da}dight into 
the nasal cavity, we will be able to seethe entire anterior part of it, from the 
superior turbinated bone to the floor; the anterior portion of the middle 
turbinated bone; the anterior and inferior surface of the inferior turbinated 



212 EXAMINATION OF THE CAVITY OF THE NOSE. 

bone; the surface of the septum, and in many cases the posterior wall of the 
pharynx through the inferior meatus. The turbinated bones appear in a 
normal state as pale, red protuberances, covered with mucus. Any alteration 
from the normal color, any swelling or hypertrophy, or change in configura- 
tion, the amount of secretion, the presence of ulceration, etc., will thus be 
admitted to our view. 

In order to get a view of the Naso-pharyngeal cavity and the Posterior 
portion of the nasal cavity, we must inspect these parts through the pharynx. 
For this purpose we need a tongue spatula, a reflector and a pharyngeal 
mirror which, in some cases, may be substituted by an ordinary laryngoscopic 
mirror. The tongue ma}' be held down with the spatula by the patient him- 
self, if he be intelligent enough, after the physician has depressed it in a 
manner that it cannot obstruct our view and still remain behind the lower 
incisor teeth. Free passage being thus provided the physician "introduces 
the mirror into the pharynx by passing it as closely as possible over the lower 
teeth and along the back of the tongue in the median line, until it is in the 
free space between the base of the tongue, the laryngeal opening, the posterior 
wall of the pharynx, and the velum palatinum. It should not stand directly 
in the median line, on account of the uvula, which would lie in front of it 
and obstruct the view, but rather on the right or left side, under one or the 
other of the arches of the soft palate, with its upper edge brought close to 
the posterior wall of the pharynx. The problem to be solved in introducing 
and placing the mirror is, not to touch the patient." — (Fraenkel.) This 
requires practice, and it is not an easy matter to handle the instrument in 
such a manner as to receive clear pictures from the parts above and behind 
the velum palati. The illumination is best achieved by a reflector fixed upon 
the forehead of the examiner, as mentioned under the examination of the 
ear. If successful in our operations, we will see posteriorly in the rhinoscopic 
picture the fornix pharyngis or vault of the pharynx, which is attached to 
the base of the skull; its surface is covered with ridges, running irregularly, 
and its structure consists of a dense adenoid tissue, on which account this 
region is called tonsilla pharyngea. Laterrally we will see the recessus 
pharyngei, or the fossa of Rosenmuller, from which anteriorly rise on either 
side the pharyngeal openings of the Eustachian tubes. In front and above 
we see the posterior nares, the septum, the posterior portion of the middle tur- 
binated bone, and part of the middle meatus of the nose. With the exception 
of the septum, the mucous membrane, covering the walls of this region, has 
a fresh red color; the turbinated bones, usually covered with more or less 
mucus, appear as steel-gray or yellowish-red protuberances. The erectile 
bodies found on the posterior portion of the turbinated bones frequently lead 
to sudden swellings. Further down we see the posterior surface of the 
velum, on the sides of which run downward and inward two folds of mucous 
membrane. 



CATARRH, CORYZA, COLD IN THE HEAD. 213 

Catarrh, Ooryza, Cold in the Head. 

Catarrhal inflammation of the mucous membrane, lining the nasal cavity, 
is characterized by redness and swelling of this membrane, and a discharge 
from it, which at first is watery and lastly becomes muco-purulent, therefore 
the name Catarrh, meaning a flowing down, namely of impurities from the 
head, according to the Ancients' idea of this trouble. It is usually preceded 
by a feeling of lassitude and chilliness, and a sensation of weight and pressure 
in the head, which latter symptom gives rise to the name of Gravedo or 
Coryza, while Cold in the head expresses its principal cause. The hyper- 
baric state of the mucous membrane is at first attended with prickling and 
dryness of the nose and a frequent disposition to sneeze; then follows the 
discharge, at first, as mentioned above, watery and by-and-by muco-purulent. 
If mild, the morbid process may end with this. But often it spreads from 
the mucous membrane to the epidermis, inflaming the nose wings and upper 
lip, or may even provoke erysipelatous inflammation of the face; or it spreads 
upwards into the frontal sinuses; or through the lachrymal duct to the 
lachrymal sac and conjunctiva; or sideways into the Highmorian cavities; 
or backwards into the retro-nasal cavity, where it not unfrequently affects 
the Eustachian tubes; causing ringing in the ears, difficulty of hearing, etc.; 
or it extends downwards into the larynx, trachea and bronchial tubes pro- 
ducing cough, or diarrhoea when it affects the mucous lining of the intestines. 
Nasal catarrh is often attended with neuralgia of the fifth pair of nerves. 

Coryza occurs sporadically and in the form of an epidemic. There is no 
doubt that some persons show a decided predisposition to it. Taking cold 
by means of sudden changes in the temperature, or exposure to sudden 
cooling of the surface after being heated, is one of the principal causes of this 
affection, but also irritants of various description, vapors of iodine or acrid 
gases, or the pollen of plants, compare "hay fever," are fruitful sources of 
this complaint; we find it also associated with the initial stage of measles, 
while typhoid fever and scarlatina exclude it. The epidemic form seems to 
have its cause in peculiar (unknown) states of the atmosphere — deficiency 
or superabundance of ozone ? 

"The question of the contagiousness of coryza must, in spite of the 
negative result of inoculation, be considered as one and the same with the 
question of the contagiousness of catarrhal or purulent secretions in general, 
and in the light of clinical observations must, for the present, be answered 
in the affirmative, especially as regards purulent secretions." (Fraenkel. ) 

The duration of a simple catarrh is usually from two to three days. 
Complicated cases last much longer. An acute attack, if neglected, or if 
dependent on some dyscrasia, may run into the chronic form. 

The Purulent nasal catarrh, or Nasal blennorrhcea, characterized by its 
purulent secretion, we find often in new-born children, as the consequence 
of infection by the leucorrhoeal discharge of the mother; it may be caused 
also by the action of gonorrhceal matter; it develops itself during the course 



214 THERAPEUTIC HINTS TO CATARRH, &C. 

of scarlet fever or variola, in diphtheria and in consequence of cauterizations 
of the mucous membrane. It is a much graver form than simple catarrh 
and may also lead to chronic catarrh. 

Therapeutic Hints. 

Aeon. In the commencement, dry state; from cold winds. Headache, 
sneezing; running of the nose; watering of the eyes; roaring in the ears, 
flushed face; thirst; scant}', hot urine; dry, short cough, with crying; 
accelerated pulse and breathing; hot, dry skin; sleeplessness or dozing, with 
starting. 

Amm. card. Stoppage, especially at night; acrid, water}', burning dis- 
charge; congestion of blood to tip of nose when stooping. 

Amm. mur. Coryza, with stoppage; great soreness and tenderness of 
nose; loss of smell. 

A'nac. Fluent; frequent sneezing, sense of smell acute, or illusory, like 
pigeon dung or burning tinder. 

Aral. rac. Coryza, with frequent sneezing, soon followed by asthma; 
excessively sensitive to slightest depression of temperature. 

Arsen. Burning, excoriating, watery discharge, w T ith a feeling of being 
stopped up; or stoppage alternating with running of nose and burning. 
Cold, worse in morning, with throbbing headache; frequent sneezing; 
hoarseness; rawness and burning in throat; tickling in throat-pit and dry 
cough at night. Xosebleed; pale face; great thirst; sleepless and restless; 
lassitude. Great inclination to catarrhal affections. 

Arum triph. Discharge of burning, ichorous fluid, excoriating nostrils, 
upper lip and corners of mouth. Stoppage. Constant boring and picking 
at nose and lips. 

Asar. Fluent coryza, with deafness and sensation as if the ears were 
plugged with something. 

Bellad. Watery and acrid discharge, with burning in nose; or dryness 
of nose, with acute or dull smell; frequent sneezing, which painfully shakes 
the head; erysipelatous redness and swelling of the nose, with chilliness and 
heat in the face; intense redness of face; severe throbbing headache; dull 
pain in frontal sinuses; hallucinations or delirium, with injection of con- 
junctiva, photophobia and lachrymation. Great dryness in fauces; difficulty 
of swallowing ; soft palate, inflamed and glistening; tonsils swollen. Children 
either cry continually, and nothing seems to please them, or they are drowsy, 
apathetic and desire nothing; grown persons are either very sensitive to 
slightest noise, excited or stupefied. Worse afternoon and evening. 

Bryon. Extending into frontal sinuses or chest; stitch-pain. 

Calc. carb. Sudden colds, with dropping of clear water from the nose 
in spells; mouth dry, fauces rough; heat and dullness of head; frequent and 
profuse urination; great liability to catarrhs in scrofulous children; stoppage 
of nose. 



THERAPEUTIC HINTS TO CATARRH, &C. 215 

Camphora. Fluent coryza, with chilliness at commencement; thin, sal- 
low, nervous, sensitive people with cold hands and feet. 

Cepa. Profuse watery discharge, with sneezing, excoriating nose and 
lip; itching, burning and stinging in eyes; flow of tears; headache. Worse 
in evening and warm room; better in open air. Laryngeal cough, with 
pain, as if the larynx would be torn. Northeasterly storms. 

Ckamom. Chilly, feverish; thirsty; one cheek red, the other pale; 
rattling cough. 

Cyclam. Sneezing and profuse discharge; loss of smell and taste; pain 
in head and ears. 

Eupat. perf. Hoarseness; cough, worse in evening; aching in all the 
bones. 

Euphi-as. Profuse discharge of mild mucus; upper lip stiff, as if of 
wood; eyes inflamed and full of acrid tears; cough, only throughout the 
day. 

Gelsem. Summer colds, with violent sneezing in the morning; edges of 
nostril red and sore; pharyngeal inflammation, with pain on swallowing, 
shooting up into the ear; deafness. Hands and feet cold in p. m.; then 
drowsy; fever until morning; half waking and talking in sleep during night. 
Disposition to catch cold at any change in the weather. 

Hepar. Nose swollen and red, sensitive to touch; blowing the nose 
causes whizzing and snapping in the ear and a raw feeling inside of nose; 
feverish and sensitive to cold air; wants to be covered, even when hot. When 
fluent coryza suddenly stops and is followed by hoarseness and croupy cough. 
Disposition to taking cold after the abuse of mercury. 

Hydrast. Posterior nares clogged with mucus; obstruction of nasal 
passages; frontal headache. 

Iodium. Glassy mucus; watery discharge at night, with sneezing; stop- 
page worse in evening; loss of smell. Eustachian tubes affected with dull- 
ness of hearing and noises in the ears. 

Kali bichr. A sense of tight pressure at the root of the nose, and dull, 
heavy headache in forehead, better from pressing tightly the bridge of the 
nose; discharge is acrid, excoriating nose and lip. Worse in warm, better 
in cool temperature. 

Kali hydr. Inflammation of Schneiderian membrane, extending to 
frontal sinuses, Highmorian cavities, lachrymal ducts and fauces. Nose red 
and swollen; discharge watery, acrid, continually, with violent and painful 
sneezing. Eyelids swollen, conjuctiva injected; lachrymation. Sticking 
pain in ears. Red face, with anxiety and restlessness; hammering pain in 
forehead with a sensation as if the head were compressed from both sides, or 
enlarged three times its size. Frantic excitation; fever with great thirst, 
hot, dry skin, alternating with drenching sweat; heat preponderates with 
intermitting shuddering, and dark, hot urine. 

Laches. Profuse discharge of a thin, watery slime, soreness of nostrils 
and lip; preceded often for a few days by a feeling of soreness, rawness and 



2l6 THERAPEUTIC HINTS TO CATARRH, &C. 

scraping in the throat. Violent headache in forehead, when the discharge 
suddenly dries up. 

Lycop. Inflammation of frontal sinuses with tearing headache, worse 
evenings; nightly stoppage, with breathing through the mouth. 

Merc. sol. Sneezing and dropping of watery fluid from the nose, 
which is swollen, red and sore. Inflammation of eyes, frontal and Highmo- 
rian cavities, of larynx, trachea and bronchi, of tonsils and fauces. Profuse 
sweat at night, not relieving. Rheumatic pains, worse in the night; in 
warmth and in cold. Epidemic form or common colds. 

Ntix vom. Ordinary colds at the commencement; when dry or fluent 
only through the day and stopped up at night; tingling in nose, scraping in 
throat; heat in head and pain in forehead; hot and feverish and chilly on 
moving. Smell as of old cheese, sulphur or tinder. Constipation. Colds 
of newborn children. 

Phosphor. Frequent alternation of fluent and dry coryza; obstruction 
often in the morning; or discharge from one and stoppage of the other nos- 
tril; sneezing causes pain in throat or head and constriction of chest. 
Fauces feel raw and burning and appear dry and glistening. Hoarseness 
and bronchial catarrh. Smell and taste gone. 

Phytol. Flow of mucus from one nostril, while the other is stopped; 
total obstruction of nose when riding. 

Pidsat. At the commencement, w T hen dry and fluent alternately, or 
stopped up in the evening, with loss of smell and taste and appetite; thirst - 
lessness; chilliness; or later with profuse, thick, yellow or greenish discharge, 
nosebleed. Conjunctiva inflamed; pressure at root of nose; tearing in High- 
morian cavity extending to ear. Dry cough at night when lying down, 
better on sitting up; stomachache; slimy, painful diarrhoea. All symptoms 
are worse in the evening and in a warm room; better in open air. 

Rhus tox. Thick, yellowish discharge; eczema on both sides below 
nose; nose swollen and now and then bleeding. Aching in all the bones, 
worse in rest. 

Scmguin. Pain over root of nose; eyes sore to touch; sore throat; 
cough, and finally diarrhoea. 

Sepia. Profuse and mild discharge, coming on suddenly, combined 
with rheumatic pains in the limbs and intense occipital headache. 

Spigel. Copious discharge, badly tasting and smelling; flows during 
night from posterior nares down into the throat, and causes choking. 

The snuffles of infants require : 

Amm. carb. When the child in the act of going to sleep starts up 
again on account of not getting any breath. 

Chamom., Nuxvom., Pidsat. 

If of a syphilitic nature, compare Chronic Catarrh. 



CHRONIC CATARRH. 217 

Chronic Catarrh, Ozaena. 

An acute atack may in consequence of bad management or neglect be- 
come chronic, especially in its purulent form, or when there is a scrofulous 
or syphilitic dyserasia in the person. At first ' ' the mucous membrane be- 
comes thickened and livid," later it seems to shrink, "becomes thin and 
pale, apparently consisting of connective tissue and blood-vessels alone, and 
hardly worth the name of mucous." "The epithelial cells are partly de- 
stroyed or they become turbid, and the mucous membrane, losing its natural 
lustre, appears opaque and uneven." 

The secretion is generally of a purulent character, profuse or scanty. 
Often it forms crusts, which adhere firmly to the membrane underneath; 
their color is frequently of a greenish cast, or they are mixed with blood. 
And when the secretion undergoes a specific decomposition, a peculiar, pene- 
trating stench is produced, which is communicated to the expired air. From 
this symptom the complaint has been called Ozaena, or Stinknose. Mostly 
ozaena grows on a dyscratic soil, although cases occasionally occur without 
either syphilis or scrofula being present. 

Chronic catarrh is prone to frequent acute exacerbations. It may 
assume a suppurative character, destroy the periosteum and cause caries; or 
it may lead to polypoid excrescences. It may spread to the frontal and 
Highmorian cavities, or to the skin surrounding the nostrils, causing excori- 
ations of upper lip and infiltration of the cervical glands. It usually is 
attended with loss of smell, either partial or total, and its annoying and 
intractable character is well known to both patient and physician. 

Therapeutic Hints. 

Agar. Profuse fetid discharge; accumulation of mucus in nose, with 
sensation as if the nose were entirely filled with it; bad smell from mouth. 

Alum. Soreness and scabs in the nose; thick, yellow mucus. 

Ant. crud. On inhaling cold air, it feels as if it went over a raw, very 
sensitive surface. Nostrils crusty and corners of mouth cracked and sore. 

Arg. nitr. Discharge of pus, with clots of blood. Chilliness, lachry- 
mation and stupefying headache. Violent itching of nose. 

Asa/. Greenish, offensive discharge. Mercurial complication. 

Aurum. Nose inflamed; nasal bones sore to touch; caries of nasal 
bones; fetid discharge; nostrils ulcerated and agglutinated; whole nose pain- 
ful, worse at night. Mercurial and syphilitic complication. 

Aur. mur. Small, painful sores inside of nose; blowing out of blood; 
mucus from head to throat; headache; constipation; haemorrhoids. 

Bar. carb. Scabs form in posterior nares and behind the uvula. 

Berber. Extending to antrum Highmorianum, especially left side. 

Calc. carb. Purulent discharge fetid, thick, yellow-reddish, making 
lip sore: slimy discharge through the day, with sensation of stoppage; stop- 
page and dryness at night; stoppage worse in morning on getting awake. 



2l8 THERAPEUTIC HIYTS TO CHRONIC CATARRH. 

Xose swollen, especially at root; soreness on edges and septum, also ulcera- 
tion; upper lip swollen. Smell dull, or like rotten eggs, dung or gun-pow- 
der. Hoarseness in morning; rough voice, which improves from hawking. 
Scrofula. 

Coral. Discharge resembling molten tallow. Profuse secretion of 
mucus through the posterior nares, obliging to hawk frequently. 

Cuprum. Affection of frontal sinuses, with pain in forehead, worse over 
left eye and root of nose, worse from motion, better when lying. Nose feels 
stuffed, and yet sometimes discharges yellow and again watery matter. Smell 
gone; taste imperfect. 

Curare. Fetid lumps of pus; scanty menses; pain in os uteri; slight, 
watery, starch}' leucorrhcea. 

Elaps. Partial stoppage and stuffiness high up in the nostrils, with 
dull aching to forehead; worse in wet weather, occasionally bad smell from 
the nose; offensive discharge; posterior wall of throat covered with a dry, 
greenish-yellow scab, wrinkled and fissured, extending to the nose; occasional 
nosebleed; pain from root of nose to ears on swallowing; sneezing at night; 
sense of smell gone; profuse and dark catamenia. 

Graphit. Stoppage with secretion of tough, fetid slime; stoppage with 
periodical attacks of fluent coryza of short duration; hard masses of slime, 
or crusts in nose; purulent, fetid discharge worse during the menses; bloody 
discharge; smell as from an old cold in nose, or as of burnt hair; ulcerative 
nostrils; moist eruption behind the ears; eruptions around anus and genitals. 
Great inclination to take cold. 

Hepar. Nose extremely sensitive to touch; swollen and red; the nos- 
trils feel raw 7 after the discharge of mucus; the interior of the nose is sensi- 
tive to air. 

Iodum. Fetid discharge; nose swollen and painful. Scrofula. 

Kali bichr. Constant snuffing in warm, damp weather; discharge of 
crusts slightly tinged w 7 ith blood; perforating ulcers on septum; ulceration 
of mucous membrane; ulceration of frontal sinuses with violent pain in 
that region, if discharge stops. Fetid smell from nose; loss of the sense of 
smell. 

Kali card. Obstruction worse in the room, better in open air; yellow- 
green or bloody discharge; or purulent and fetid from one nostril; crusts 
closing the nostrils; collection of mucus in throat and feeling of a lump in 
the throat; convulsive and tickling cough at night with choking and gag- 
ging, especially in the morning; rheumatic and gouty symptoms. 

Kali hydr. Syphilitic origin after abuse of mercury with pain in shin 
bones, especially at night. 

Kaliphosph . — Schiissler . 

Lycop. Stoppage at night, breathing with open mouth; <( discharge of 
elastic plugs; " catarrhal headache and despondency. 

Merc. prof. " Dark redness of the fauces; elongation of the palate, 
with collection of the mucus behind; enlargement of the tonsils, which are 



THERAPEUTIC HINTS TO CHRONIC CATARRH. 219 

sometimes covered with yellowish or whitish patches, small in size; collection 
of tough, yellow mucus in the posterior nares which partially drops into the 
throat, causing constant inclination to hawk and spit in order to clear the 
throat and nose." (Fisher.) 

Natr. Card. Profuse discharge of thin, white mucus; or thick, yellow- 
greenish, musty smelling mucus, ceasing after a meal, or at night; stoppage 
of nose at night. Worse from exposure to slightest draught, or when re- 
moving an article of clothing. Loss of smell and taste. 

Natr. 17I7W. Stoppage high up in nose, with sudden dribbling at times of 
clear water from nose; posterior nares feel dry in the morning, with scraping 
in larynx and rough voice. Continual lachrymation from obstruction of the 
nasal duct; roaring and buzzing in the ears and head with inability to work, 
read, or think. Loss of smell and taste. 

Nitr. ac. Often mucous discharge only from posterior nares; red, 
scurvy tip and nostrils, feels like splinter on touching it; fetor. Mercurial 
poisoning. 

Petrol. Obstruction of posterior nares; copious collection of slime in 
the fauces with a feeling of dryness. Eustachian tubes obstructed, with 
whizzing, roaring and cracking in the ears; hardness of hearing. Bad 
smell from mouth. 

Phosphor. Discharge yellow, or yellow-green, or bloody; nose swollen 
and sore to touch; nostrils ulcerated. In scarlatina, with swelling of neck 
and staring eyes, icy-cold and bluish hands; discharge flows down into the 
throat on lying. 

Psori7i. Great fetor; bad smell of all secretions and excretions. In- 
tractable cases where other remedies have failed. 

Pulsat. Thick, yellow or green and fetid discharge; nose swollen and 
itching in the evening; wings ulcerated; oozing of watery fluid from nose; 
loss of smell and taste. Young girls with menses too late, scanty and pale, 
followed by leucorrhcea; chilliness, intermingled with heat. Timid, whining 
mood; disposed to internal vexation and grievance; mild, yielding disposi- 
tion; slow, phlegmatic temperament. 

Rhodod. One nostril stopped, the other free; unpleasant tingling up in 
the nose to forehead; follicular catarrh in forehead; constant hemming and 
hawking. 

Sepia. Greenish crusts with bloody borders; eczema behind the ears; 
symptoms of portal congestion. 

Silic. Secretion tough, slimy, purulent; stoppage in the morning fol- 
lowed by hawking of thick, green-yellow, fetid masses after getting up. 
Acrid water from nose making it sore and bloody; septum sore, and smart- 
ing crusts high up in nostrils; frontal sinuses inflamed with pounding and 
throbbing pain in forehead; fauces dry and painful; uvula swollen; Eusta- 
chian tubes itching; chronic inflammation of tonsils and swelling of sub- 
maxillary glands. 

Sulphur. Slimy, acrid discharge with burning in eyes and upper lip; 



220 



DIGEST TO ACUTE AND CHRONIC CATARRH IX HEAD. 



or dryness of nose like parchment and a feeling of stiffness of the nose 
followed by discharge of thick, bloody slime and then again dryness with 
sneezing. Inclination to draw the phlegm down through posterior nares. On 
blowing the nose the ears feel obstructed, or it feels as if air were entering 
the ears. Soreness inside of nose and of septum. The interior of nose is 
sensitive to the inhalation of air in a warm room ; not in open air. 
Besides compare therapeutic hints under acute catarrh. 

Digest to Acute and Chronic Catarrh in Head. 



Common cold at commencement: Nux 

vo VI. 

of newborn children: Nux vom. 

, epidemic: Merc. sol. 

Dry at first: Aeon. 

, with acute or dull smell: Bell ad. 

or fluent only through day, stopped 

up at night: Nux vom. 
, with stiff feeling of nose, followed 

by discharge of thick, bloody slime 

and then dryness, with sneezing: Sulph. 
Fluent: Aeon., Anac. 

, alternating with dry: Phosphor. 

only through day, stopped at night: 

Nux vom. 

in spells: Calc. carb. 

in one and stopped up in other nos- 
tril: Phosphor., Phytol., Rhodod. 
, with chilliness at commencement: 

Camphor. 
, with deafness and plugged up feel- 
ing in ears: Asar. 

, with sneezing: Cyelam. 

, with frequent sneezing, followed by 

asthma: Aial. rac. 
, if suddenly stopped, is followed by 

hoarseness and croupy cough: Hepar. 
Discharge acrid, watery and burning: 

Amm. carb. 

, with burning in nose: Bellad. 

in eyes and upper lip: Cepa. 

, with excoriating nose and lip: Cepa, 

Kali bichr. 
and of corners of the mouth: Arum. 

triph. 
, with making nose sore and bloody: 

Silic. 
, with swollen, red and sore nose: 

Mere. sol. 
, with sneezing: Cepa, Iodnm, Kali 

hydr. 

, with stopped up feeling: Arscn. 

Bloody: Graphite Kali carb., Phosphor., 

PulsaL, Sulphur. 



Burning: Amm. carb., Arsen., Arum 

triph. 
Fetid: Agar., Asa/., Aurum, Elaps, 

Iodum, PulsaL, Spigel. 
Fetid lumps of pus: Curare. 
and purulent from one nostril: Kali 

carb. 

, worse during menses: Graphit. 

, thick, yellow-reddish, making lip 

sore: Calc. carb. 
Purulent, tough, slimy: Silic. 

, with clots of blood: Arg. nitr. 

Greenish, offensive: Asa/. 

or yellow, thick: Pulsat. 

and nosebleed: Pulsat. 

Yellowish, thick: Rhustox. 
Yellow-green or bloody: Kali carb., 

Phosphor. 
During Day, with stoppage: Calc. carb. 
MUCUS, slime, glassy: Iodum. 

, like molten tallow: Coral. 

, profuse, mild: Euphras., Sepia. 

, thin and watery: Laches., Natr- 

carb. 

, thick, blood}-: Sulphur. 

, yellow: Alum. 

, thick, yellow-greenish, musty smell- 
ing, ceasing after a meal, or at night: 

Nat r. carb. 

, thin, watery: Laches. 

, white: Natr. carb. 

Oozing of watery fluid: Pulsat. 
Blowing out of blood: Aur. mur. 
Nosebleed occasionally: Elaps, Arsen. 
Crusts, tinged with blood: Kali bichr. 

, greenish, with bloody borders: Sep ia. 

, or masses of hard slime: Graphit. 

Elastic plugs: Lycop. 

POSTERIOR NARES. 

MUCUS clogs posterior nares: Hydrast. 

from head to throat: Aur. mur. 

discharges only from posterior nares: 

Nitr. ae. 



DIGEST TO ACUTE AND CHRONIC CATARRH IN HEAD. 



221 



discharges into throat on lying: 

Phosphor. 

, at night, causing choking: Spigel '. 

, obliging to hawk: Coral. 

yellow: Merc. prot. 

, inclination to draw phlegm down 

through posterior nares: Sulphur. 
Dryness in the morning, with scraping 

in larynx and rough voice: Nal. mur. 
Scabs in posterior nares behind the 

uvula: Bar. carb. 
, dry, greenish; wrinkled and fissured 

on posterior wall of throat, extending 

up to nose: Elaps. 
Stoppage, obstruction: Arum triph., 

Calc. carb., Hydras I. 

, evening: Iodum. 

, morning on getting awake: Calc. 

carb., Phosphor. 
, followed by hawking of thick mucus: 

Silic. 
, night: Amm. carb., Natr. carb., 

Nux. vom., Silic. 

and dryness: Calc. carb. 

, must breathe through mouth: Lycop. 

when falling asleep, starts up to get 

breath: Amm. carb. 

, when riding: Phytol. 

, in warm room, better in open air: 

Kali, carb., Pulsat. 
, alternating with fluent coryza: 

Amm. mu?., Ar sen., Cuprum, Graphit, 

Nux. vom., Pulsat. 

, with tough, fetid slime: Graphit. 

, as if nose were entirely filled with 

mucus: Agar. 

of posterior nares: Petrol. 

, with dull aching in forehead: Elaps. 

, with sudden dribbling of clear water 

from nose: Natr. mur. 

of one side and the other free: Rhodod. 

Constant snuffing in warm, damp 

weather: Kali bichr. 

INTERIOR NOSE. 

Sensitive to air: Hepar. 

to cold air, as if it went over a raw 

surface: Ant. crud. 
to air in a warm room, not in open 

air: Sulphur. 
Soreness and scabs: Alum. 

, and of septum: Silic, Sulphur. 

Sores, small and painful: Aur. mur. 
Tingling: Nux. vom. 



worse even- 

worse over 
worse from 
Cuprum. 



Ulceration: Kali bichr. 

, perforating septum: Kali bichr. 

Crusts on nostrils: Ant. crud. 

, closing nostrils: Kali carb. 

Rawness of nostrils from discharge: 

Hepar. 
Soreness of nostrils and septum: Calc. 

carb. 

and lip: Laches. 

and redness: Gelsem. 

Ulcerated nostrils: Aurum, Calc. carb., 

Graphit:. Phosphor., Pulsat. 
Inflammation extending into frontal 

sinuses or chest: Bryon. 
, Highmorian cavities, left side: Ber- 
ber. 
lachrymal ducts and fauces; Kali 

hydr. 
, with tearing headache, 

ing: Lycop. 
, with pain in forehead 

left eye and root of nose, 

motion, better when lying 
, with pounding and throbbing pain 

in forehead : Silic. 
Dull pain in frontal sinuses: Bellad. 
Pain in frontal sinues, after suppressed 

coryza: Laches. 
Ulceration in frontal sinuses with violent 

pain there, when discharge stops: Kali 

bichr. 
Pain over root of nose: Sanguin. 

and ears on swallowing: Elaps. 

Pressure at root of nose: Pulsat. 

, and dull, heavy headache, better 

from pressing tightly the bridge of nose 

Kali bichr. 
Caries of nasal bones: Aurum. 

EXTERNAL NOSE. 

Red and swollen: Aurum, Bellad, Hepar, 

Kali hydr. 

and sensitive to touch: Hepar. 

and scurvy tip and nostrils, feels like 

splinter on touching it: Nit. ac. 
Erysipelatous redness and swelling with 

chilliness and heat in the face: Bellad. 
Swollen and itching in evening: Pulsat. 

and painful: Iodum. 

and especially at rest: Calc. carb. 

and sore to touch: Phosphor. 

and now and then bleeding: RJnts 

tox. 



222 



DIGEST TO ACUTE AND CHRONIC CATARRH IN HEAD. 



Congestion to tip when stooping: Amm. 
card. 

Soreness and tenderness: Amm. mur. 

to touch: Hepar. 

, worse at night: Aurum. 

of nasal bones to touch: Aurum. 

Wing's ulcerated: Pulsat. 
Violent itching of nose: Arg. nitr. 
Boring" and picking at nose and lips: 
Arum, triph. 

SMELL. 

Loss of smell: Amm. mur., Cuprum, 

Elaps, lodum, Kali bichr. 
and taste: Cyclam., Natr. card., 

Natr. mur., Phosphor. , Pulsat. 
Illusory, like pigeon dung or burning 

tinder: Anac. 
. like dung, rotten eggs or gun- 
powder: Calc. card. 
, like from an old cold, or burnt hair: 

Graph it. 
, like old cheese, sulphur or tinder: 

Xux. vom. 
Fetor from nose: Kali bichr., Nitr. of. 

, worse in wet weather: Elaps. 

, and of all secretions and excretions: 

Psorin. 

SNEEZING. 

Frequent: Aeon., Anac, Aral, rac, 

Arsen. 

, night: Elaps. 

, morning in summer colds: Gelsem. 

, with profuse discharge: Cyclam. 

, which painfully shakes head: Bellad. 

, causing pain in head or throat, and 

constriction of chest: Phosphor. 
Blowing" the nose causes the ears to feel 

obstructed, or as if air were entering 

the ears: Sulphur. 
, whizzing and snapping in ear, and 

a raw feeling inside of nose: Hepar. 

SYSTEMIC SYMPTOMS. 

Stupefied: Bellad. 

Inability to work, read, or think: Natr. 

mur. 
Excited: Kali hydr. 
Delirium or hallucinations with injected 

conjunctiva: Pel lad. 
Anxiety and restlessness: Kali hydr. 
Children cry continually and nothing 

pleases them: Bellad. 



Timid, whining mood, internally vexed 
and grieved; mild disposition: Pulsat. 
Drowsy, apathic, desire nothing: Bellad. 
Desponding with headache: Lycop. 

Headache: Aeon., Aur. mur., Cepa. 

and despondency: Lycop. 

and earache: Cyclam. 

in forehead: Hydrast, Kali hydr., 

Laches., Xux. vom. 
when discharge suddenly dries up: 

Laches. 
as if compressed from both sides, or 

enlarged ten times its size: Kali hydr. 
in frontal sinuses: Bellad, Laches , 

Lycop. 
in occiput with rheumatic pain in 

limbs: Sepia. 

, stupefying: A/g. nitr. 

, throbbing: Bellad. 

Heat and dullness: Calc. card. 

and pain in forehead : Xux. vom. 



Conjunctiva inflamed: Kali hydr., 

Pulsat. 
Eyes inflamed with acrid tears: Euphras. 
Eyelids swollen: Kali hydr. 
Inflammation of eyes, frontal and High- 

morian cavities, larynx, trachea, 

bronchi, tonsils and fauces: Merc. sol. 
Itching, burning and stinging in eyes: 

Cepa. 
Lachrymation: Aeon., Arg. nitr., Cepa. 
from obstruction of nasal duct: Natr. 

mur. 

and photophobia: Bellad. 

Soreness to touch: Sanguin. 



Eustachian tubes itch: Si He. 

obstructed, with noises in ears: 

Lodum, Petrol. 
Dullness of hearing: Gelsem, Lodum, 

Petrol. 
Sensitive to slight noise: Bellad. 
Eczema behind ears: Sepia. 
Eruption, moist, behind ears: Graph it. 
Roaring in ears: Aeon. 
and buzzing, with inability to read 

or think: Natr. mur. 
Sticking pain in ears: Kali hydr. 
Tearing from Highmorian cavity to ear: 

Pulsat. 



Rodness of face: Aeon., Bellad., Kali 
hydr. 



DIGEST TO ACUTE AND CHRONIC CATARRH IN HEAD. 



223 



of one, paleness of other cheek: 

Chamom. 
Paleness: Arsen. 
Eczema below nose: Rhus tox. 
Comers of mouth cracked and sore: Ant. 

crud. 
Upper lip stiff, as if of wood: Euphras. 
swollen: Calc. carb. 



Mouth dry: Calc. carb. 

Thirst: Aeon., Arsen. y Chamom. 

Thirstless: Pulsat. 

Taste imperfect: Cuprum, Pulsat. 

Bad smell from mouth: Agar., Petrol. 

Fauces dry: Bellad. 

, glistening, raw and burning: Phos- 
phor. 

and painful: Silic. 

, with collection of slime in fauces: 

Petrol. 

inflamed, with pain on swallowing, 

shooting up into ear: Gelsem. 

dark red: Merc. prot. 

Throat, feeling of lump and collection of 
mucus in: Kali carb. 

, raw and burning: Arsen. 

, scraping in: Nux vom. 

, sore: Sanguin. 

, and scraping, raw before coryza: 

Laches. 

Swallowing" difficult: Bellad. 

Palate elongated, with mucus behind: 
Merc. prot. 

inflamed and glistening: Bellad. 

swollen: Silic. 

Tonsils inflamed and submaxillary glands 
swollen: Silic. 

, swollen: Bellad. 

Tonsils sometimes covered with yellow- 
ish or whitish patches: Merc. prot. 



Stomachache: Pulsat. 

Portal congestion: Sepia. 

Slimy, painful diarrhoea: Pulsat. 

Ending" with diarrhoea: Sanguin. 

Constipation: Aur. mur., Nux vom. 

Haemorrhoids: Aur. mur. 

Eruptions around anus and genitals: 

Graphit. 
Scanty, hot urine : Aeon. 
Frequent and profuse urination : Calc. 

carb. 
Pain in os uteri : Curare. 
Scanty menses : Curare. 



, too late and pale in young girls : 

Pulsat. 
Profuse and dark menses : Elaps. 
Leucorrhcea follows menses : Pulsat. 
, slight, watery, starchy: Curare. 



Hoarseness: Arsen., Eupat. perf. 

in morning: Calc. carb. 

with bronchial catarrh: Phosphor. 

Roug"h voice which improves from hawk- 
ing: Calc. carb. 

Cough only through day: Euphras. 

, worse in evening: Eupat. perf. 

at night: Arsen. Kali carb., Pulsat. 

, convulsive with choking and gag- 
ging in the morning: Kali carb. 

, dry: Aeon., Arsen., Pulsat. 

when lying down, better on sitting 

up: Pulsat. 

from tickling in throat-pit: Arsen. 

, with crying: Aeon. 

, with pain in larynx as if it would be 

torn: Cepa. 

, followed by diarrhoea: Sanguin. 

, rattling: Chamon. 

Inclination to catarrhal affection: Arsen. 

Stitch pain in chest: Bryon. 

Accelerated pulse and breathing: Aeon. 



Chilly: Arg. nitr., Chamom., P til sat. 

, intermingled with heat: Pulsat. 

Cold hands and feet in p. m. : Gelsem. 
Feverish: Chamom. 

in morning: Gelsem. 

and hot, and chilly on moving: Nux 

vom. 

, intercurrent shuddering: Kali hydr. 

Hot, dry skin: Aeon. 

, alternating with drenching sweat, 

and hot, dark urine: Kali hydr. 
Profuse sweat at night, not relieving: 

Merc. sol. 
Scarlet fever with swelling of neck, 

staring eyes, icy-cold and bluish hands: 

Phosphor. 



Rheumatic and gouty symptoms: Kali 

carb. 

pains worse in night: Merc. sol. 

Aching" in all the bones: Eupat. perf. 

, worse in rest: Rhus tox. 

Pain in shin bones, worse at night: Kali 

hydr. 
Lassitude: Arsen. 



224 



YEARLY COLD, &C. 



Drowsy: Gelsem. 

Sleepless or dozing with starting: Aeon., 
Bellad. 

Half waking" and talking in sleep dur- 
ing night: Gelsem. 



Phlegmatic: Gelsem. 

Scrofulous: Iodnm. 

with inability to catarrhs: Calc. 

carb. 

Nervous, thin, sallow, sensitive with 
cold hands and feet: Camphor. 

Disposition to take cold: Graph it., 
He par. 

at any change in weather: Gelsem. 

from slightest depression of temper- 
ature: Aral rac. 

BETTER AND WORSE. 

> In open air: Cepa, Pulsat. 



> in cool temperature: Kali bichr. 

> when covered even when hot: Hepar. 

< in warm room: Cepa, Kali carb., 
Pulsat. 

< from exposure to slightest draught, or 
when removing an article of clothing: 
Natr. carb. 

<T in cold and warm: Merc. sol. 

<" in afternoon and evening: Bellad. 

< in evening: Cepa, Pulsat. 

< in morning with throbbing headache : 
Arsen. 

CAUSED BY : 

Mercurial poisoning: Asa/., Aurum, 

Hepar, Kali hydr. , Nitr. ac. 
North-easterly storms: Cepa. 
Intractable : Psorin . 



Yearly Cold, Rose Cold, Hay Fever, Hay Asthma. 

It is a slight febrile catarrh, which affects the conjunctiva?, the mucous 
membrane of the nose and upper air passages, and frequently, but not always, 
is attended by asthmatic difficulties, which sometimes are of great intensity. 
It attacks only people peculiarly disposed to it, and regularly recurs every 
year when the roses bloom (rose cold), or when ha}* is made (hay fever, hay 
asthma), during the months of May till September (summer catarrh). In 
regard to its Exciting Causes we glean from Blackley's careful experi- 
ments the following: A thorough observation of atmospheric conditions 
showed that the attacks do not run at all parallel with extremes of light and 
heat. Ozone, benzoic acid, and cumarin produced only a very unimportant 
influence upon the respirator}* organs and none which resembled the symp- 
toms of hay fever. Dust, which, besides, is differently constituted in different 
regions, may occasion cough and catarrhal symptoms at various seasons; but 
these have little similarity to hay fever, and are not at all confined to the 
summer season. The fragrance of flowers of various kinds has little effect, 
although the smell of chamomilla matricaria produces disagreeable symptoms, 
headache, etc. The effect of spores of penicillium glaucum was hoarseness, 
increasing to aphonia, bronchial catarrh, etc., which lasted for some days. 
On the other hand there has been complete success in developing the features 
of hay fever by the operation of pollen upon the organs of respiration, and 
it is therefore a certainty that the exciting cause of hay fever must be as- 
cribed to the pollen, fresh or dried, of different plants, especially grasses, 
floating in the air. For this reason the attacks are milder in-doors than in 
the open air, and may be prevented altogether by removing to regions 
which are free from this exciting cause. 



kpis taxis. 225 

Therapeutic Hints. 

Hay fever being the result of irritation of the Schneiderian membrane 
by the pollen of different plants, especially of grasses, it can be mitigated 
by a sojourn at the seaside, especially- an island or a narrow peninsula, 
where the air is least pregnated by such pollen. A sea voyage prevents it 
altogether. High mountain air is also nearly always free of these exciting 
causes, as are the centres of large cities, where the patient feels best on keep- 
ing in-doors. A number of remedies have been tried and some found bene- 
ficial. They are: Ailanth., Arsen., Arum triph., Camphor. Cyclam., 
E?cphorb., Euphtas., Gelsem., Glanderin, Grindelia, Hydr. ac, /pec, Iodum., 
Kali bichr., Kali hydr., Laches., Lobel., Merc, corr., Merc, sol., Moschus, 
Natr. carb., Natr. mur., Phosphor., Pulsat., Sabad., Silic, Sticta pulm., 
Tart. emet., Tax. bacc, Zincum. Their special applicability must be studied 
from the hints under nasal catarrh and asthma. 

Naja trip. Hay fever after sneezing stage and asthmatic trouble remain- 
ing. In asthma when all other medicines had failed to touch, and had been 
well nigh abandoned. (M. Preston.) 

Arum mac. 30 . In water " until the throat troubles are better." 
Euphorb. off.™. " When the eyes get lachrymose." (Th. Meurer.) 
Naphthali?i. Where asthmatic symptoms predominate. " I have been 
obliged to use the remedy in the 2x or 3X trit." (Ivins, " Diseases of the 
Nose and Throat.") 

Epistaxis, Nosebleed. 

This affection is a mere symptom of the most different conditions of the 
organism. We observe it in consequence of congestive as well as in conse- 
quence of anaemic and chlorotic conditions. It may sometimes bring relief 
to headache and congestive states; and it may be an unfavorable sign in 
ad}mamic and contagious diseases, as small-pox and measles, when they 
assume a typhoid character. In diseases of the heart, lungs and spleen, it is 
never a good sign. In old age it is a sign of threatening apoplex}^ 

Its^most frequent Exciting Causes are: mechanical injuries; a fall or 
blow upon the nose; straining when coughing; and suppression or irregu- 
larity in menstrual discharges, or a suppression of an habitual haemorrhoidal 
flow. 

The blood itself varies greatly in character. It may be bright red or 
dark — almost black; it may easily coagulate, and it may be quite thin and 
never coagulate. 

Generally, one nostril only bleeds; seldom both. The blood discharges 
either through the nostrils in front, or backwards, through the posterior 
nares, into the fauces, thence into the stomach or the larynx. This last 
phenomenon requires a little attention, so as not to confound it with vomit- 
ing of blood, or bloody expectoration from the lungs. 
15 



226 therapeutic hints to epistaxis. 

Therapeutic Hints. 

In general, bright blood, Aeon., Arnica, Be/lad., B?yo?i., Dulcam., 
Hyosc, Mi lief., Rhus fox., Sabdb. 

Dark blood, Croats, Nux vom. 

Clotted blood, Chamom., Mercur., Rhus tox., Platina. 

Aeon. In arterial congestive bleeding; palpitation of the heart; 
children . 

Agar. In old people with relaxed state of the circulator}* system. 

Amm. carb. In the morning, when washing. 

Argent. With tickling and crawling sensation of the nose. 

Arnica. After external injury; always worse from washing the face or 
blowing the nose. 

Arsen. After a fit of passion or vomiting; great heat and restlessness. 

Be Had. Congestion to the head; answers questions as if frightened ; 
pupils dilated; vertigo on stooping. Worse from motion, noises and bright 
light; sparks before the eyes; noise in the ears; fainting; chronic cases. 

Bryon. In the morning after rising; after being overheated; vicarious 
menstruation. 

Carb. veg. Profuse and long-continuing; paleness of face; small, inter- 
mitting pulse; in convalescents from fever; excited by emotion, jarring; 
short and hot breath; numbness; tenderness in region of liver; jaundice. 
Also daily at 9 o'clock A. m. 

China. Anaemic state; singing, ringing in the ears; great paleness of 
face and fainting. 

Conium. Suppressed menstruation by taking cold; frequent ebullitions 
of blood; jerking sensation about the heart. 

Crocus. Black, viscid blood, with cold sweat on forehead; yellowish, 
face; fainting. 

Eriger. Congestion of the head; febrile action; red face. 

Ferrnm. In anaemic children, with frequent changing of color in the 
face. Haemorrhophilia. 

Hamam. In combination w T ith haemoptysis. 

Indigo. W 7 ith dry cough. 

Kali carb. When washing the face, every morning at 9 o'clock. 

Melilot. Is said to stop nosebleed immediately. 

Merc. sol. Blood coagulates in the nose, and hangs down like icicles. 

Moschus. With all the signs of depletion; spasmodic jerking of the 
muscles. 

Nux vom. Congestion to the head; pain in forehead; constipation; 
suppressed hemorrhoidal flow. 

Pulsat. Vicarious menstruation; catarrhal affections; anaemic children. 

Rhus. tox. At night; during stool from bending forward, and any 
bodilv exertion. 



POLYPI IN THE NOSE. 227 

Sccale. Anaemic state, either from exhaustive diseases or artificial 
depletion ; the blood is thin and does not coagulate. Aged persons. 

Thlaspi bursa pastoris is recommended by Bonninghausen as one of the 
most efficient remedies, but without special indications. 

Trill, pend. Passive haemorrhage. 

Ver. alb. Deadly paleness of face, getting red when rising; coldness of 
body; slow, intermitting pulse. 

Sometimes nosebleed may be immediately stopped by compressing the 
facial artery, on the side of bleeding, against the superior maxilla near the 
angle of the nose. 



L o- 



Polypi in the Nose 

Are mostly of the mucous variety. They have been cured by Calc. carb., 
Calc. Jod., Kali nitr., 3dtrit., Phosphor., Pulsat., Sanguin. and Teucrium. 
Cepa. (Riickert.) 

Inflammation of the Nose. 

It attacks the deeper layers of the mucous membrane and the perios- 
teum, and is usually circumscribed. The mucous membrane is highly 
inflamed and the external skin cedematously swollen. The nose is very 
painful, and at times, when the inflammation extends higher up, brain symp- 
toms appear, with more or less fever. It may be caused by external injuries, 
may be associated with catarrh or blennorrhoea, or appear without any 
demonstrable cause. 

Therapeutic Hints. 

It is usually quickly relieved by Bellad. ; Hepar or Silic. may in some 
cases be required. 



FACE. 



The face of a patient tells a long story, and it will be well for the 
student to closely observe its features, expression, color and temperature. 
The experienced physician reads in it not only the degree of severity of 
a disease, but often also its whole general nature. But that must be learned 
by practice. There are shades so fine that the}' could not be well described, 
but which, nevertheless, stamp upon the whole a peculiar character. 

1. The aspect of the face. 

a. A delicate appearance, with long-fringed eyelashes and brilliant eyes, 
often serves to point out the tubercular diathesis. 

b. The thickened alse of the nose and upper lip of scrofula are most 
marked in childhood. 

c. The pallor of anaemia is very important; it is waxy in chlorosis and 
pasty in diseases of the kidneys. 

d. A puffy appearance about the eyelids along with anaemia is very gen- 
erally an indication of albuminuria. 

e. A bloated, blotchy face generally indicates irregular habits of living. 

f. The features undergo remarkable changes in erysipelas, parotitis, 
facial paralysis, etc. 

g. A sunken face indicates exhaustion, either from too great exertion, 
or loss of sleep, want of nourishment, or profuse diarrhoea, or disturbed 
digestion. If it sets in suddenly during pregnancy, it is a premonitory sign 
of abortus. If you find it in the incipiency of a disease, without previous 
weakening causes, it denotes a severe illness. If it sets in suddenly, dur- 
ing a disease, without chill or spasm, by which it might be caused, it is a 
sign of extreme exhaustion, collapse, or metastasis, mortification, orapoplexia 
nervosa. 

h. The hippocratic face is characterized in the following way: 
The skin upon the forehead is tense, dry or covered with cold perspira- 
tion; the temporal regions are sunken in; the eyelids are pale and hang 
down; eyes are dull, without lustre, turned upwards and sunken; the alae 
nasi are pinched together, and the nose is very pointed; the malar bones 
stick out, and the cheeks are sunken in and wrinkled; the ears appear to be 
drawn in, and are cold; the lips are pale, livid; the lower jaw sinks down, 
and the mouth is open. It is always a sign of extreme prostration of 
vital power, and is found in cholera, in mortification, and during death 
struggle. 

i. A wrinkled face is natural to old age, but in children it is a sign of 
imperfect nutrition, and is found in consequence of exhausting diarrhoea and 



FACE. 229 

atrophy. In boys and half -grown lads a wrinkled face, without loss of appe- 
tite or sleep, is a sign of onanism, or other bad habits. Such a young, old 
and wrinkled face is a pitiful sight. 

The linea ophthalmia zygomatica is a line or fold, commencing at the inner 
canthus of the eye, running towards the zygoma : where it ends. It shows mo- 
mentarily, when children cry, but becomes more permanent in children with 
affections of the brain. Its appearance in simple catarrh is said to indicate 
the setting in of whooping-cough. 

The linea nasalis is a line or fold, which commences at the upper part of 
the alee of the nose, and runs towards the orbicularis oris (the sphincter of the 
mouth), forming a more or less perfect half-circle. This line, if found in 
children, denotes abdominal diseases, especially inflammation of the bowels, 
also rachitis, scrofula and atrophy. In grown persons it is said to have been 
observed as a concomitant symptom of albuminuria, ulcer and cancer of the 
stomach, and degeneration of the liver. 

The linea labialis is a line or fold, which commences at the corner of the 
mouth, and runs down towards the side of the chin, where it ends, and wherby 
the chin appears to be elongated. This line is said to be a characteristic 
sign in children of inflammatory diseases of the larynx and lungs. Very 
marked, it has been found in grown persons who suffered with ulceration of 
the larynx and bronchial affections, attended with difficulty in breathing 
and much mucus discharge. 

k. The risus sardonicus, a spasmodic distortion of the face, which 
resembles a kind of a laughing, is found in irritation and inflammation of the 
brain, in inflammation of the pericardium and diaphragm, in irritation of the 
intestinal canal, in abnormal conditions of the menses, even after mental 
excitement, fright and depression of spirits. 

/. Marshall Hall says that in general it may be observed that the brow 
is contracted by pain within the head; the nostrils are drawn acutely up- 
wards by pain in the chest; and the upper lip is raised and stretched over 
the teeth or gums by painful affections of the abdomen. 

2. The expression of the face is, in health, the reflex of the mind, and 
in disease it has a distinct reference to the nervous system. 

In general, I may say. 

a. A rigid, staring, stupid, troubled, but sometimes also a smiling counte- 
nance, is found in affections of the brain, and in typhoid conditions. 

b. An anxious, sad and restless expression is found in lung and heart 
diseases. 

c. A morose, long-faced, apathetic expression is found in abdominal dis- 
orders. 

3. The color of the face. 

a. Redness, if habitual, denotes a tendency to gout and haemorrhoids; 
and is a sign of indulgence in good-living and alcoholic drinks. 

Flying, often changing redness is seen in children during dentition, in 



230 FACE. 

women before menstruation, or after conception, and is also found in inflam- 
mation of the lungs. 

Bright, vivid redness is found in nervous diseases, listeria and tendency 
to haemorrhages. 

Dark, purplish redness is found in congestive, apoplectic and suffocative 
conditions. 

Redness, coming and going in spots, I have often found in brain diseases 
of little children, and also in pneumonia. 

One-sided redness, with paleness and coldness of the other side, in en- 
cephalitis, is, according to Schonlein, a sign of the formation of pus in that 
half of the brain which corresponds to the red sid of the face. It is found 
also in diseases of the lungs, heart and abdomen, and in children during 
dentition. 

The circumscribed hectic flush is characteristic of phthisis. 

Redness of the cheeks, with a white ring around the alee of the aose and 
the mouth, are frequently met with in different fevers, especially scarlatina, 
and is a sign of pretty severe illness. 

b. Paleness. 

Sudden paleness, especially around the mouth, is found in children with 
colicky spasms in the abdomen. 

Great paleness, alternating with flushes of redness, is found in inflamma- 
tion of the lungs and brain; also during dentition. 

A pale, peculiar white and wrinkled face is found in children with 
chronic hydrocephalus. 

A sudden paleness, after an inconsiderable limping, in children, combined 
with great lassitude, is a sign of lingering hip-disease. 

In women, paleness is a sign of profuse or suppressed menstruation or 
chlorosis. 

Sudden paleness during pregnancy prognosticates threatening metror- 
rhagia, or abortion, or the dying of the foetus. 

Sudden paleness about the nose is in scarlet fever a bad sign; it denotes 
a metastasis to the brain ; during the period of desquamation it is a forerunner 
of dropsy. 

Sudden paleness after a fall indicates concussion of the brain. 

Pale lips are characteristic of chlorosis. 

c. Blue color of the face. 

Is found in organic diseases of the heart, especially in dilation of the 
ventricles and disorganizations of the valves, whereby the oxygenation of the 
blood is interfered with. In the highest degree it exists in cyanosis, a state 
in which, consequent upon structural faults in the heart, the venous and ar- 
terial blood becomes mixed. In newborn children, the refore, if it is lasting, 
it is a sign of such malformation; if it, however, soon passes off, it may have 
been caused by hard labor-pains, face-presentation, or by the naval string 
being wound around the neck of the child. 

We meet it likewise in consequence of strangulation or suffocation. 



CRUSTA EACTEA, MILK CRUST, ECZEMA. 231 

d. Livid, grayish, lead-colored face denotes deep-seated organic diseases, 
scirrhus, gangrene. 

e. Yellowish color of the face is found mostly in diseases of the liver. 

The yellowness of jaundice varies from a pale orange to a deep green- 
yellow. The yellowish color of infants does not always denote jaundice; it 
is very often merely a discoloration by haematin, which remains in the skin 
until absorbed, and is analogous to the effects of a bruise; there is no yellow - 
ishness of the white of the eyes attending it. 

There is a certain yellowness of a malignant aspect, which is distin- 
guished from jaundice by the pearly lustre of the eyes. It is associated with 
a cancerous diathesis. 

f. Brown spots in women are mostly signs of pregnancy, or irregularity 
in menstruation; they are also said to be found in liver complaints. 

Irregular brownish spots a little raised above the skin and covered with 
small pustules, which sometimes discharge a bloody fluid, are in children a 
sign of congential syphilis. 

Fat, short, and broad persons, with dark brown or black hair, dark eyes, 
yellow-brownish, dark color of the skin, are mostly affected on the right side 
with liver complaints and so on. 

g. Telangiectasias on the face, especially on the upper parts of the cheeks 
and on the lower eyelids, are almost always connected with some obstruction 
or stasis; often in the chest, but more frequently in the abdomen, and a 
diminution of chlorides in the urine. 

Telangiectasias, if ever so small, on the right side of the face, denote an 
obstruction in one of the organs on the right side; and if on the left, a stasis 
in one of the organs on the left side. 

Bright red telangiectasias denote an arterial, whilst purplish-looking 
indicate a venous obstruction, either in the chest or abdomen of the corre- 
sponding side. 

Small varices on the left side of the nose, or lips, or glans penis, indicate 
a venous obstruction in the heart or kidney. 

So also are ringworms almost always indicative of some kidney affec- 
tions. 

4. The temperature of the face. 

a. Heat of the face is found in congestion of the head, in fevers, in 
inflammatory conditions, in coryza, and in other complaints. 

b. Coldness of the face we find in chills, in spasms, exhaustion, in sick- 
ness of the stomach, in syncope. 

A deadly coldness in cholera; also in violent hysterical paroxysms. 
In inflammation of the lungs, coldness of the face denotes the com- 
mencement of suppuration. 

Sudden coldness of the face in scarlet fever portends death. 

Orusta Lactea, Milk Crust, Eczema. 

This disease is an eczema of nursing infants. The eruption usually 
commences as a patch of slightly raised pimples. The patch itches, in- 



232 THERAPEUTIC HINTS TO CRUSTA LACTEA, &C. 

creases in size, and becomes more inflamed in consequence of being con- 
stantly rubbed; the cuticle is raised in more or less defined vesicles, which 
are usually broken by friction; the surface becomes excoriated, somewhat 
swollen, pouring out an ichorous secretion. 

With the increase of irritation the patch spreads. In case the eruption 
commences in several patches, they are liable to run into one. Thus the 
disease increases; the secretion, from being a transparent and colorless ichor, 
becomes opaque, milky, then yellowish, and at last purulent, while small 
pustules are developed on the red and tumefied skin around the patch. For 
this reason it has been called impetiginous eczema. The developing crusts now 
grow thicker, and have the appearance of dried honey. Not unfrequently, 
as a consequence of pressure or friction, blood is mingled with the discharges, 
and the crusts become colored of various hues, from a lightish-brown to posi- 
tive black. 

Although commencing on and being confined most frequently to the 
forehead and cheeks of the child, this obstinate disease may attack the whole 
body, being a source of great suffering to the child and annoyance to the 
mother. 

Should the eruption continue even after the milk teeth are all cut, no 
new light of prophecy need beam upon the little patient, according to Wil- 
son: " When pubert5 T arrives, then certainly the disease will go." Although 
there are cases of pretty tolerable stubbornness, I have not seen a case 
which did not yield to a judicious Homoeopathic treatment in a reasonable 
space of time. 

Therapeutic Hints. 

Arsen. Pimples and vesicles; acrid discharge; itching; burning; w r orse 
at night in cold air; better from external warmth. 

Bellad. Teething, jerking in sleep; want to sleep, yet inability to go 
to sleep. 

Calc. carb. Children fair and plump; teething; scrofulous habit; worse 
about new moon; burning after washing; perspiration after eating or 
drinking. 

Cicuta. Thick, yellowish scurf on the chin and upper lip, with oozing; 
scurf on nose. 

Crot. tig I. Itching, followed by burning; vesicles run together, ooze 
and form thick, gray-brown crusts. 

Lycop. Thick crusts, underneath cracked surface; skin dry; excoriated 
places; w 7 orse at night and in warmth. 

Merc. sol. Tendency to inflammation of the lymphatic glands; saliva- 
tion; scorbutic gums. 

Rhus tox. Acrid, inflamed look; swollen glands on neck and throat; 
stiffness of the neck. 

Sulphur. Excoriations, pimples, vesicles; violent itching, worse at 
night; bleeding from scratching; diarrhoea in the morning. 

Compare Eczema Capitis. 



COMEDO, ACNE PUNCTATA AND ROSACEA. 233 

Comedo, Acne Punctata and Rosacea. 

"Comedo is a distended, sebaceous follicle, whose contents, projecting 
above the surface of the skin, becomes black from dirt, and when pressed 
out assumes the shape of a worm. When an irritative process is set up 
around a hair follicle by the retention of the secretion, and assumes a true 
inflammatory character, we have Acne punctata." 

"Acne rosacea is a chronic inflammation of the face, made up of acne 
spots, periglandular inflammation, erythema and new growth of connective 
tissue, growing independently of the glands." (L,ilienthal, pp. 126 and 127.) 

Therapeutic Hints. 

Comedo and Acne punctata I have seen disappear after Bellad. or Pulsat. 
Compare also Arsen., Card, veg., Hepar, Kali bro?n., Kali hy dr., Lac/i7ianth., 
Silic, Sulphur. If in connection with sexual excesses: Calc. carb., Phosph. 
ac, or Sulphur. 

Acne rosacea is much more difficult to manage. 

Alum., when the redness is livid and the veins varicose. 

Arsen., when there is great burning. 

Calc. carb., when there are menstrual disorders and congestion to the 
head. 

Calc. sulf. is very important. 

Carb. veg., varicose veins on nose. 

Laches., bluish redness. 

Petrol., more at the commencement, when the vessels are not yet in- 
jected. 

Sulphur, great itchiness and bluish color of the face. 

Besides, compare: Ant. crud., Capsic, Carb. an., Canthar., Caustic, 
Conium, Dulcam., Ledum, Mezer., Natr. mur., Nitr. ac, Nux vom., Rhus 
tox., Ruta, Sepia. 

Lupus. 

Lupus is a neoplasm consisting of cell proliferation, excited by the 
bacillus tuberculosis . This large accumulation of proliferating cells, pressing 
away and destroying the layers of the cutis, and often also the deeper-lying 
tissues, is characteristic of lupus. We meet it in different stages: 1, there 
are only brownish-red spots — Lupus maculosus; 2, there are papules or 
nodules elevated above the skin, also of brownish-red color and in size from 
that of a pea to a hazel-nut — Lupus tuberculosus; 3, there is infiltration; the 
skin appears of a similar color and is covered with lamellae of the epider- 
mis — Lupus exfoliaticus; 4, there are atonic ulcers, which result from the 
softening of the infiltrations — Lupus exulcerans; 5, there are new formations 
rising above the skin which frequently involve large portions — Lupus hyper- 
trophicus; and 6, there are large ulcers extending peripherically — Lupus ser- 
piginosus. The first four stages are also known under the name of Lupus 



234 ULCUS RODENS AND EPITHELIOMA. 

nonexedens, and the latter two Lupus exedens. The favorite seat of lupus 
are the nose and cheeks; from lupus exedens great disfiguration of the face 
may result. 

All authors agree that lupus has nothing to do with syphilis, either ac- 
quired or congenital. (Iyilienthal, Skin Diseases.) 

Therapeutic Hints. 

Aur. viur., when starting from the mucous membrane of nose and 
spreading to the cartilages, bones and skin. 

Graphit., lupus of nose, with deep ulceration. 

Lycop., superficial ulceration in pale, sallow patients. 

Besides, compare: Arsen., Bar. card., Card. an. and veg. , Caustic, 
Cicuta, Hydrocotyle asiatica, Kali dic/ir., Phosphor., Silic, Staphis., Sul- 
phur, Thuja. 

Ulcus Rodens and Epithelioma. 

The Rodent ulcer has hard sinuous edges, is of several or perhaps of 
many years duration, almost painless, and occurs in middle-aged or elderly 
persons of fair health and without enlarged glands. It attacks by preference 
the eyelids and the adjacent portions of the cheek, the nose, or the cheeks. 
It is as rare on the lower as epithelioma is on the upper lip. 

Epithelioma is the common form of so-called cancer of the lip or tongue 
(also of vulva, clitoris, penis and rectum). It is essentially an infiltrating 
disease, beginning, as a rule, as a little wart or tubercle, and then gradually 
spreading, it may crack, fissure and ulcerate, and when at this stage we 
easily recognize its malignant character by the infiltration with the cancerous 
material, and the integument then presents the well known indurated and 
everted edges. The base of the ulcer is dirty or grayish, more or less papil- 
lated; it ma}' be reddish and discharge a thin fluid or be disposed to scab 
over. (Lilienthal's Skin Diseases.) 

Therapeutic Hints. 

For Rodent ulcer compare: Arse?i., Bellad., Cicuta, Hepar, Hydrocotyle, 
Hydrast., Mercur., Nitr.ac, Silic, Staphis., Sulphur, Uran. 

For Epithelioma of lip compare: Acet. ac, Arg. nitr., Arsen., Ars. jod., 
Aurum, Bellad., Carb. an., Chelid., Clemat., Conium, Hydrast., Kreos., 
Laches., Pulsat., Silic, Siilphur, Thuja. 



MOUTH 



1. Its external parts. 

The lips we have had to notice on several occasions, as parts of the face. 

Their paleness denotes poverty of blood; a transient paleness, however, 
is found in chills, spasms, fainting fits and frights. 

Their redness is a healthy condition; but an increased deeper, or brighter 
redness is found in feverish conditions. A higher redness of the lower lip, 
without apparent fever, indicates Sulphur. 

Blnish lips are seen in all such conditions, where a free circulation of 
blood is interfered with. 

Dry lips are found in all acute, feverish or inflammatory conditions. 

Brownish or even blackish crusts form in typhoid states. 

Fever-blisters, hydroa, are found on the lips very often in intermittent 
fevers and pneumonia, scarcely ever, however, in typhus; and lastly, the 
cancer of the lip, a malignant growth, appears mostly at the prolabium, rarely 
at the adjoining integument of the lip. 

The mouth is kept open in stoppage of the nose, difficulty of breathing, 
great interior heat, hardness of hearing. In fevers it is a sign of great ex- 
haustion — the lower jaw falling down, especially during slumber. This 
symptom very frequently indicates Lycop. 

The mouth is spasmodically closed in lock-jaw and other spasmodic 
affections. 

2. The interior cavity of the mouth. — We shall examine it under the 
following heads: Gums, teeth, tongue, salivary glands and their ducts, 
tonsils, uvula, soft palate, fauces and mucous membrane of the mouth and 
fauces. 

The Gums 

Present different aspects. They are pale in anaemia, from the abuse of iron 
and mercury, and in spasmodic conditions; blue in cyanosis and scurvy; 
brown and blackish, coated with tough mucus, in typhoid conditions; a bluish, 
grayish, slate-colored stripe or line on the gums is a sign of lead poisoning; a 
purple line is found in old age, and a pink line, especially on the gums of the 
lower jaw by paleness of the remaining gums, is often met within phthisical 
persons. 

Swelling of the gums is either of a congestive and inflammatory nature — 
in toothache, parulis — or of an cedematous and spongy nature (in scurvy, 
mercurial affections, noma, stomatitis. ) In such conditions the gums gener- 
ally bleed easily when being cleansed, or only slightly touched. 



236 PARULIS, GUMBOIL, &C. 

Bleeding gums are said to have been observed also from suppressed 
menstrual or hemorrhoidal bleedings — vicarious bleeding. 

Ulcerated gums may originate from diseased states of the teeth, from 
general maladies or from constitutional maladies, such as scurvy, syphilis, 
mercurial poisoning, noma, stomatitis. 

The special diseases of the gums are: 

Parulis, Gumboil, Inflammatory Swelling of the Gums. 

This generally takes its origin in a diseased tooth, but may appear with- 
out any known cause. Its seat is almost always on the gums, covering the 
external side of the alveolar processes, and may reach to such a height as to 
swell up the cheek and corresponding side of the face, making chewing and 
talking a very difficult operation. It almost always ends in the formation 
of an abscess, which breaks and discharges. 

Therapeutic Hints. 
Arjiica, Hepar, Mercur., Silic. 

Epulis, a kind of Fungoid Growth on the Gums. 

This originates either in the gums, periosteum, or on the maxillary 
bone. When it begins in the gums or periosteum, there is a reddish or 
bluish-red, hard and painless swelling of a roundish or oval shape, growing 
out of the alveolar process or between the teeth. It is somewhat movable if 
it rests upon a broad pedicle; general^, however, it has none, and shows no 
distinct boundaries. In its further progress it assumes the form of an irregu- 
lar, fleshy lump, which, growing larger, overlaps one or more teeth; the 
adjoining teeth are pressed out of their position, and grow crooked or fall 
out. The swelling soon bursts through the mucous membrane, by which it 
has been covered, and presents a tuberous, grayish-red mass, which is either 
an entire mass or is split into different, irregular lobes by deep crevices. It 
bleeds easily, and, by sloughing, pieces of it fall off, forming cavities, which 
secrete a most offensive ichorous discharge. 

When it starts from the maxillary bone, we observe at first a swelling 
of the bone, then the teeth fall out, and at last the morbid growth bursts 
forth. 

In some cases it has its seat in the antrum Highmorianum. 

Therapeutic Hints. 
Calc. card., C/iamom., Natr. miir., Thuja. 

Fistula of the Teeth. 

In consequence of inflammation of the periosteum lining the root of the 
teeth, and its consequent suppuration, or caries of the root and alveolar 
processes, a channel is gradually formed, which opens either on the inside of 



THE TKETH. 237 

the mouth or outside of the face, where it discharges a morbid secretion, and 
forms hard, callous edges on its outlet. This is called a Fistula dentalis. 

Therapeutic Hints. 
Compare Askalabotes, Calc. carb. y Caustic, Ratau., Stlic, Sulphur. 

The Teeth. 

The ossification of the dental sacks of the twenty milk-teeth takes place 
in the fifth month of pregnancy. Their eruption, as a general rule, not 
however without many exceptions, takes place in the following groups: 




1. The lower two incisors between the fourth and seventh months, fol- 
lowed by a pause of from three to nine weeks; 

2. The four upper incisors — at first the two central, then the two lat- 
eral — between the eighth and tenth months, followed by a pause of from six 
to twelve weeks; 

3. The first two molars of the upper, then the lower incisors, and lastly 
the molars of the lower jaw, between the twelfth and fifteenth months, fol- 
lowed by a pause until the eighteenth month; 

4. The canine teeth (eyes and stomach teeth) between the eighteenth 
and twenty-fourth months, followed by a pause of from two to three months. 

5. The four second molars between the twentieth and thirtieth months. 
This period of first dentition is often attended with serious ailments of 

the child. We find it complicated frequently with ulcers on tip of tongue or 
other portions of the mouth; with abnormally increased secretion of the 
fluids of the mouth, slobbering; with conjunctival blennorrhcea, especially 
during the eruption of the eye-teeth and upper molars; with catarrhal affec- 
tions of the alimentary canal — diarrhoea and vomiting, and of the respiratory 
organs — catarrh on the chest; with cutaneous eruptions, such as: urticaria, 
pomphi, lichen, prurigo, eczema and impetigo (crusta lactea); with disor- 
ders of the nervous system — spasms and eclampsia; and with fever, a general 
elevation of the body temperature. How is this? Can such a comparatively 
small irritation, as of necessity must be combined with the teeth piercing- 
through the gums, cause all such mischief? Or is it not rather one of those 
common mistakes, where a thing is supposed to be the cause of another thing, 
because it is found simultaneously with the same ? Ma} r not it and the other 
have both a still deeper, yet common cause? And this cause is the develop- 



238 ODONTALGIA. 

ment of the brain, which at that time is greater and more rapid than at any 
other period of life, lasting to the seventh year of life. The soft tissue of the 
brain grows denser, and the distinction between its cortical and medullary, or 
gray and white substance, becomes more marked, whilst the yellowish sub- 
stance, which had formed a line of demarkation between them gradually 
fades away. The brain of infants is, compared with the remaining body, 
very voluminous; being in the proportion of 1 : 8, whilst in adults it is in 
the proportion of 1 : 40 or 50. And still it grows on rapidly up to the sev- 
enth year, so that the brain of an infant, which weighs at its birth, say three- 
quarters of a pound, w 7 eighs in its second year nearly one pound and a half, 
until up to the seventh year it attains a weight of two pounds and a half and 
more. (Burdach.) It is clear, that such great and marked changes in the 
central organ may naturally be attended by a liability to disturbances in its 
own sphere and other peripheric organs, and this is the reason why the period 
of dentition, which is in itself only the result of this interior development of 
the brain, is attended by so manifold and serious disturbances. I hope this 
will be sufficient to prove the absurdity of the practice of lancing the gums 
during infancy. 

The teeth become loose from mercurial poisoning, in scurvy and syphi- 
litic affections. 

The decay of the teeth is ascribed to microscopic parasites, and to a want 
of silicea in the system, 

A decay near the gums of the teeth is a sign of sycosis. 

Odontalgia, Toothache. 

Toothache has many causes: decay of the teeth and exposure of the 

nerve; various affections of different organs of the body; taking cold, etc. 

The best treatise on this painful affection, the curing of which has won many 

a friend for Homoeopathy, is that of Dr. Hering in his Domestic Physician. 

With the kind permission of its author, I shall insert it here with some 

additions. 

Most in the front-teeth. — Bellad., Caustic, Card, veg., Chamom., China, 
Coffea, Ignat., Mercur., Natr. mur., Nux mosch., Nux vom., Phos- 
phor., Phosph. ac, Rhus, Silic, Staphis., Sulphur. 

Most in the eye and stomach-teeth. — Aeon., Calcar., Hyosc, Rhus, Staphis. 

Most in the molars or back-teeth. — Arnica, Bellad., Bryon., Calcar., Carb. 
veg., Caustic, Chamo?n., China, Coffea, Hyosc, Ignat., Mercur., 
Nux mosch., Nux vom., Phosphor., Phosph. ac, Pulsat., Rhus, 
Silic, Staphis., Sulphur. 

Most in the upper-teeth. — Bellad., Bryon., Calcar., Carb. veg., China, Natr. 
mur., Phosphor. 

Most in the lower-teeth. — Arnica, Bellad., Bryon., Carb. veg., Caustic, 
Chamon., China, Hyosc, Ignat., Mercur., Nux vom., Phosphor., 
Pulsat., Rhus, Silic, Staphis. 

One-sided. — Aeon., Bellad., Chamom., Mercur., Nux vom., Pulsat. 



ODONTALGIA. 239 

On the left side. — Aeon., Ap. vir., Arnica, Card, veg., Caustic, Chamom., 

China, Hyosc, Mercur., Nux mosch., Phosphor., Rhus, Silic, 

Sulphur. 
On the right side. — Bellad., Bryon., Calcar., Coffea, Laches, Natr. mur., 

Nux vom., Phosph. ac, S tap his. 
A whole row of teeth. — Chamom., Mercur., Rhus, Staphis. 
In hollow teeth. — Ant. crud., Bellad., Bryon., Calcal., Carb. veg., Caustic, 

Chamom., China, Coffea, Hepar, Hyosc, Laches., Mercur., Nux. 

mosch., Nux vom., Phosphor., Phosph. ac, Pulsat., Rhus., Silic, 

Staphis., Sulphur. 
In the gums, — Ant. crud., Arnica, Bellad., Bryon., Calcar., Carb. veg., 

Chamom., China, Hepar., Hyosc, Laches., Mercur., Natr. mur., 

Nux ?nosch., Nux vom.. Phosphor., Phosph. ac, Pulsat., Rhus., 

Silic, Staphis., Sulphur. 

upper. — Bellad., Calcar., A T atr. mur. 

lower. — Caustic, Phosphor., Staphis., Sulphur. 

interior of. — Arnica, Natr. mur., Phosph. ac, Pulsat., Rhus, Staphis. 

swollen. — Aeon., Bellad., Calcar., Chamom., Carb. veg., Caustic, 

China, Hepar, Laches., Nux vom., Natr mur., Phosphor ., Pulsat. , 
Rhus, Sulphur. 

Gums painful. — Ap. vir., Arsen., Calcar., Carb. veg., Caustic, Laches., Mer- 
cur., Nux mosch., Nux vom., Phosphor., Staphis., Sulphur. 

bleeding. — Bellad., Calcar., Carb. veg., Caustic, Laches., Mercur., Nux 

mosch., Nux vom., Phosphor., Staphis., Sulphur. 

ulcerated. — Bellad., Calcar., Carb. veg., Caustic, Hepar, Laches., 

Mercur. , Natr. mur. , Nux vom. , Phosphor. , Staphis. , Silic. 

pressing. — Aeon., Arnica, Bryon., Carb. veg., Caustic, China, 

Hyosc, Ignat., Natr. mur., Nux mosch., Nix vo?n., Phosphor., 
Rhus, Silic, Staphis., Sulphur. 
inwards. — Rhus, Staphis. 

outward. — Phosphor. 

asunder. — Phosph. ac. 

as if from congestion of the blood, as if the teeth were too close. — 

Aeon., Arnica., Bellad., Chamom., Calcar., China, Coffea, Hepar, 

Hyosc, Nux vom., Pulsat. 
As if pulled out or wrenched. — Arnica, Caustic, Nux mosch., Nux vom., 

Phosph. ac, Rhus. 
Too long. — Arnica, Arsen., Bellad., Bryon., Calcar., Carb. veg., Caustic, 

Chamom., Laches., Hyosc, Natr. mur., Nux vom., Rhus, Silic, 

Sulphur. 
Loose. — Arnica, Arse?i., Bryon., Carb. veg., Caustic, Chamom., China, 

Hepar, Hyosc, Ignat., Mercur., Natr. mzir., Nux mosch., Nux 

vom., Phosphor., Pulsat., Rhus, Staphis., Sulphur. 
As if too loose. — Arsen., Bryon., Hyosc, Mercm ., Rhus. 



24O . ODONTALGIA. 

Blunt. — Aeon., China, Dulcam., Ignat., Laches, Mercur., Natr. mur., Nux 
moscn., Phosphor., Phosph. ac, Pulsat., Silic, Staphis., Sulphur. 

Sore, bruised. — Arnica, Arsen., Bcllad., Bryon., Calcar., Card, veg., Caus- 
tic, Ignat., Natr. mur., Nux vom., Phosphor., Pulsat., Rhus. 

Burning. — Chamom., Mer cur., Natr. mur., Nux vom., Phosphor., Pulsat., 
Rhus, Silic, Sulphur. 

Gnawing, scraping. — Chamom., Nux vom., Rhus, Staphis. 

Digging. — Ant. crud., By yon., Calcar., China, Ignat. 

Boring. — Bcllad., Calcar., Laches., Mercur., Nat. mur., Nux vom., Phos- 
phor., Phosph. ac, Silic, Sulphur. 

Jerking, twitching. — Ap. vir., Ant. crud., A?'se?i., Bryon., Bellad., Calcar., 
Caustic, Cepa, Chamom., Coffea, Hepar, Hyosc, Laches., Mer- 
cur., Nux vom., Pulsat., Rhus, Sulphur. 

Drawing, tearing. — Ant. crud., Bellad., Bryon., Card, veg., Calcar., Cepa, 
Chamom., China, Glonoin., Hyosc, Laches., Mercur., Nux vom., 
Phosph. ac, Rhus, Staphis. 

Cutting, Piercing. — Aeon., Ant. crud., Bellad., Bryon., Calcar., Caustic, 
Chamom., China, /.aches., Mercur., Nux vom., Nux mosch., 
Phosphor., Phosph. ac, Pulsat., Rhus, Silic, Staphis. 

Beating, Pulsating. — Aeon., Arnica, Arsen., Bellad.. Calcar., Caustic, 
Cha?7iom., China, Coffea, Glonoin., Hyosc, Laches., Mercur., 
Natr. mur., Phosphor., Pulsat., Rhus, Staphis., Sulphur. 

Intermittent. — Bellad., Bryon., Chamom., Coffea, Calcar., China, Mercur., 
Nix vom., Pulsat., Rhus, Silic, Staphis., Sulphur. 

Constant, day and night. — Bellad., Calcar., Caustic, Natr. mur., Silic, Sul- 
phur. 

During the day only, better in the night. — Mercur. 

, none in the night. — Bellad. , Calcar. , Mercur. , Nux 

vom. 

During the day only, worse in bed. — Ant. crud., Mercur. 

Worse in the night. — Aeon., Ant. Qud., Arsen., Bellad., Bryon., Carb. veg., 
Chamom., China, Coffea, Hepar, Hyosc, Mercur., Natr. mur., 
Nux mosch., A 7 ux vom., Phosphor., Phosph. ac, Pulsat., Rhus, 
Silic. , Staphis., Sulphur. 

By night only, not during the day. — Phosphor. 

Most before midnight. — Bryon., Chamom., China, Natr. mur., Rhus, Sul- 
phur. 

after . — Arsen., Bellad., Biy on., Carb. veg., Chamom., China, 

Mercur., Natr. mur., Pulsat., Phosphor., Rhus, Staphis., Sul- 
pliur. 

When awaking. — Bellad., Carb. veg., Laches, Nux vom. (See sleep.) 

In the morning. — Arsen., Bellad., Bryon., Caustic, Carb. veg., China, 
Hyosc, Ignat., Natr. mur. Nux vom., Phosphor., Phosph. ac, 
Pulsat., Rhus, Staphis., Sulphur. 

At noon. — Coccul, Rhus. 



ODONTALGIA. 24 1 

Afternoon. — Calcar., Caustic, Mercur., Nux vom., Phosphor., Pulsat., Sul- 
phur. 
Towards evening. — Pulsat. 
At night. — Ant. Crud., Bellad., Bryon., Calcar., Caustic, Hepar, Hyosc, 

Ignat., Mercur., Nux mosch., Nux vom., Phosphor., Pulsat., 

Rhus, Staphis., Sulphur. 
Every other day. — China, Natr. mur. 
Every seventh day. — Arsen., Phosphor., Sulphur. 
In spring. — Aeon., Bellad., Bryon., Calcar., Carb. veg., Dulcam., Laches., 

Natr. 7nur., Nux vom., Pulsat., Rhus, Silic, Sulphur. 
In summer. — A?it. cried., Bellad., Bryon., Calcar., Carb. veg., Chamom., 

Laches., Natr. mur., Nux vom., Pulsat. 
In autumn. — Bryon., China, Mercur., Nux vom., Nux mosch., Rhus. 
In winter. — Aeon., Arsen., Bellad., Bryon., Calcar., Carb. veg., Caustic, 

Chamom., Dulcam., Hepar, Hyosc, Ignat., Mercur., Nux mosch., 

Nux vom., Phosphor., Phosph. ac, Pulsat., Rhus, Silic, Sulphur. 
Caused by damp night-air. — Nux mosch. 

damp air. — Mercur. 

cold damp weather. — Nux mosch., Cepa, Rhus, Natr. sulph. 

wind. — Aeon., Pulsat., Rims, Silic. 

draught. — Bellad. , Calcar. , China, Sulphur. 

Taking cold. — Aeon., Bellad., Bryon., Calcar., Caustic, Chamom., China, 

Coffea, Dulcam., Ignat., Hyosc, Mercur., Nux vom., Nux mosch., 

Phosphor., Pulsat., Rhus, Staphis., Sulphur. 

, when overheated. — Glonoi?i., Rhus. 

, by getting wet. — Bellad., Calcar., Caustic, Hepar, Laches., Nux 

mosch., Phosphor., Pulsat., Rhus, Sulphtir. 
Suppressed perspiration — Chamom., Rhus. 
Getting worse from cold air. — Bellad., Calcar., Hyosc, Mercur., Nix mosch., 

Nux vom., Sabad., bilic, Staphis., Sulphur. 

in the mouth. — Aeon., Bellad.. Bryon., Calcar., Caustic, Hyosc, 

Mercur., Nux mosch., Nux vom., Phosphor., Pulsat., Silic, Sta- 
phis, Szdphur. 

opening of the mouth. — Bryon., Chamom., Caustic, Hepar., Nux 

vom., Phosphor., Pulsat. 
breathing. — Pulsat. 

drawing air into the mouth. — Ant. crud., Bellad., Bryon., Calcar. , 

Caustic, Hepar, Mercur., Natr. mur., Nux mosch., Phosphor., 

Silic, Staphis., Sulphur. 
cold washing. — A?it. crud., Bryon., Calcar., Chamom., Mercur., Nux 

mosch., Nux vom., Pulsat., Rhus, Silic, Staphis., Sulphur. 
eating cold things. — Bryon., Calcaj., Chamom., Nux vom., Pulsat., 

Rhus, Sabad., Staphis., Sulphur. 
drinking cold things. — Bryon., Calcar., Chamom., Caustic, Hepar., 

16 



242 ODONTALGIA. 

Laches., Mercur., Natr. mur., Nux mosch., Nux vom., Pulsat., 

Sabad., Silic, S tap his, Sulphur. 

rinsing of the mouth with cold water. — Sulphur. 

cold in general. — Arsen., Ant. crud., Calcar., Card, veg., Mercur., 

Natr. mur., Nux mosch., Nux vom., Pulsat., Phosphor., Rhus, 

Silic, St aphis., Sulphur. 
In the open air. — Bellad., Calcar., Caustic, Chamom., China, Hyosc, Mer- 

cur., Nux mosch., Nux vom., Phosphor., Pulsat., Rhus, Staphis., 

Sulphur. 
, staying. — Bellad., Bry on., Chamom., Hyosc, Mercur., Nux vom., 

Phosphor., Staphis., Sulphur. 
In the open air, walking. — Nux vom., Phosphor., Staphis. 
In a room. — Ap. vir., A?it. crud., Chamom., Hepar, Nux vom., Pulsat., 

Sulphur. 

after coming out of the open air. — Phosphor. 

In a warm room. — Bryon., Cepa, Chamom., Hepar., Nux vom., Pulsat., 

Phosphor. 
Warm stove. — Arsen., Pulsat. 
External warmth. — Bryon., Chamom., Hepar, Mercur., Nux mosch., Nux 

vom., Phosphor., Phosph. ac, Pulsat., Rhus, Staphis., Sulphur. 
Something warm. — Bryon. > Calcar., Card, veg., Chamom., Coffea, Laches., 

Mercur., Natr. mur., Nux vom., Phosph. ac, Pulsat., Silic, Sul- 
phur. 
Eating warm things. — Bryon., Calcar., Chainom., Nux vom., Phosphor., 

Pulsat., Silic. 
Something hot. — Bellad., Calcar., Phosph. ac. 
Drinking warm things. — Bryon., Chamon., Laches, Mercur., A T ux mosch., 

Nux vom., Pulsat., Rims, Silic. 
Warm bed. — Bellad., Bryon., Chamom., Mercur., Nux vom., Phosphor. 

Phosph. ac, Pulsat., Rhus. 
Getting warm in bed. — Chamom., Mercur., Phosph. ac, Phosphor., Pulsat. 
Drinking. — Chamom., Calcar., Caustic, Laches., Mercur., Pulsat., Rhus, 

Silic. 

cold or warm. — Laches., Natr. sulph. 

water. — Bryon., Calcar., Card, veg., Chamom., Mercur., Nix vom., 

Pulsat., Silic, Staphis , Sulphur. 

wine. — Aeon., /gnat., [Nux vom. after wine.] 

malt liquors. — Nux vom., Rhus. 

coffee. — Bellad., Card., veg., Chamojn., Coccul., Ignat., Mercur., 

Natr. sulph., Ntix vom., Pulsat., Rhus. 

tea. — China, Coffea, Ignat.. Laches. 

Smoking tobacco. — Bryon., Chamom., China, Ignat., Mercur., Nux vom. 

Salty things. — Card. veg. 

Eating. — Ant. crud., Arnica., Bellad., B?yon., Calca?., Carb. veg., Caustic, 

Chamom., Coccul., Hepar, Hyosc, Laches., Mercur., Nux mosch., 



ODONTALGIA. 243 

Nux vom., Phosphor., Phosph. ac, Pulsat., Rhus, Silic, Staphis., 

Sulphur. 
Only while eating. — Coccul. 
After eating. — Ant. crud., Bellad., Bryon., Calcar., C/iamom., China, Coffea, 

Ignat., Laches., Mercur., Natr. mur., Nux vom., Rhus, Staphis., 

Sulphur. 
Chewing. — Arnica, Arsen., Bellad., Bryon., Card, veg., Caustic, China, 

Coccul., Coffea, Hyosc, Ignat., Mercur., Natr. mur., Nux vom.. 

Phosphor., Phosph. ac, Pulsat., Silic, Staphis., Sulphur.. 
Only while chewing. — China. 
Swallowing. — Staphis. 
Biting. — Arsen., Bellad., Bryon., Calcar., Card, veg., Caustic, China, Coffea, 

Hepar, Hyosc, Laches., Mercur., Nux vom., Phosphor., Phosph. 

ac, Pulsat., Rhus, Silic, Staphis., Sulphur. 

something soft. — Veratr. 

soft food — Coccul. 

hard food. — Mercur. • 

Touched by the food. — Bellad., Ignat., Nux vom., Phosphor., Staphis. 

Picking. — Pulsat. 

Cleaning. — Carb. veg., Laches., Phosph. ac, Staphis. 

Touching. — Ant. crud., Arnica, Arsen., Bellad., Bryon., Calcar., Carb. veg., 

Caustic. , China, Coffea, Hepar, Ignat., Mercur., Natr. mur., Nux 

mosch., Nux vom., Phosphor., Pulsat, Rhus, Staphis., Sulphur. 
with the tongue. — Carb. veg., China, Ignat., Mercur., Phosphor., 

Rhus. 

even very softly. — Bellad., Igyiat., Nux vom., Stapis. 

Pressing on the teeth. — Caustic, Chi?ia, Hyosc, Natr. mur., Staphis., 

Sulphur. 
Sucking the gums. — Bellad., Carb. veg., Nux mosch., Nux vom., Silic. 
Rising. — Ignat., Mercur., Platina. 
Moving the body. — Arnica, Bellad., Bryon., China, Mercur., Nux vom., 

Phosphor. , Staphis. 

the mouth. — Caustic, Chamom., Mercur., Nux vom. 

Talking. — Nux mosch. 

Deep breathing. — Nux vom. 

Being at rest. — Arsen., Bryon., Chamom., Pulsat., Rhus, Staphis., Sulphur. 

Sitting. — Ant. crud., Mercur., Pulsat., Rhus. 

too much. — Aeon. 

While lying down. — Arsen., Bellad., Bryon., Chamom., Hyosc, Ignat., 

Mercur., Nux vom., Phosphor., Pulsat., Rhus., Staphis., Sulphur. 

on the painful side. — Arsen., Nux vom. 

on the painless side. — Bryon., Chamom., Ignat., Pulsat. 

in bed. — Bryon., Chamom., Nux vom., Pulsat. 

In bed. — Ant. crud., Bellad., Bryon., Chamom., Mercur., Nux vom., Phos- 
phor., Pulsat. 



244 ODONTALGIA. 

Sleep with yawning. — Staphis. 

When going to sleep. — Ant. crud., Arsen., Mercur., Sulphur. 

While asleep. — Mercur. 

When awaking. — Be/lad., Bryon., Calcac, Carb. veg., Laches., Nux vom. y 

Pnosphor., Silic, Sulphur. 
Mental emotions. — Aeon. 
Vexation. — Aeon., Chamom., Rhus, Staphis. 
Passion. — Nux vom. 

Mental exertions. — Bellad., Ignat., Nux vom. 
Reading. — Ignat., Nux vom. 
Noise. — Calcar. 

Being talked to by others. — Arsen., Bryon. 
For women. — Aeon., Ap. vir., Be/lad., Calcar., Chamon., China, Coffea, 

Hyosc., Ignat., Nux mosch., Pulsat. 
Menstruation, before. — Arsen. 

, during. — Calcar., Carb. veg., Chamon., Natr. mur., Laches., Phos- 
phor. 

, after. — Bryon., Calcar., Chamom., Phosphor. 

During pregnancy. — Ap. vir., Bellad., Bryon, Calcar., Hyosc., Mercur. „ 

Nux mosch., Nux vom., Pulsat., Rhus, Staphis. 
While nursing. — Aeon., Arsen., Bellad., Calcar., China, Dulcam., Mercur., 

Nux vom., Phosphor., Staphis., Sulphur. 
For children. — Aeon., Ant. crud., Bellad., Calcar., Chamom., Coffea, Ignat. , 

Mercur., Nux mosch., Pulsat., Silic. 
For irritable, nervous persons. — Aeon., Bellad., Chamom., Coffea, China, 

Hyosc, Nux mosch. 
For persons who have taken much mercury. — Carb. veg., Bellad., Hepar, 

Laches., Staphis. 
who drink much coffee. — Bellad., Carb. veg., Chamom., Coccul. y 

Mercur., Nux vom., Pulsat., Silic. 
Getting better from: 
Cold air. — Nix vom. , Pulsat. 
Wind. — Calcar. 
Uncovering. — Pulsat. 

Drawing air into the mouth. — Nux vom., Pulsat. 
Cold washing. — Bellad., Bryon., Chamom., Pulsat. 
External cold. — Bellad., Bryon., Chamom., China, Mercur., Nux vom., 

Phosphor., Pulsat., Staphis., Sulphur. 
Cold hand. — Rhus. 

Finger wet with cold water. — Chamom. 
Holding cold water in the mouth. — Bryon., Cepa, Coffea, Cle?nat., Natr^ 

sulph . 
Cold drinking. — Bellad., Bryon., Chamom., Mercur., Nux vom., Phosphor. , 

Pulsat., Rhus, Sulphur. 
In the open air. — Ant. crud., Bryon., Cepa, Hepar, Nux vom., Pulsat. 



ODONTALGIA. 245 

In the room. — Nux vom. , Phosphor. , Sulphur. 

External warmth. — Arsen., Bellad., Calcar., Chamom., China, Hyosc, 

Laches., Mercur., Nux mosch., Nux vom,, Pulsat., Rhus, Staphis., 

Sulphur. 
Wrapping up the head. — Nux vom., Phosphor., Silic. 
Eating something warm. — Arsen., Bryon., Nux mosch., Nux vom., Rhus, 

Sulphur. 

Drinking . — Nux mosch., Nux vom., Pulsat., Rhus, Sulphur. 

Getting warm in hed. — Bryon., Nux vom. 

Drinking. — Bellad. 

Smoking tobacco. — Mercur. 

When eating. — Bellad., Bryon., Chamom., Phosph. ac, Silic. 

After . — Arnica, Calcar., Chamom., Phosph. ac, Rhus, Silic. 

When chewing. — Bryon., China., Coffea. 
Biting. — Arsen., Bryon., China, Coffea. 
Picking the teeth, so that they bleed. — Bellad. 
Picking the teeth. — Phosph. ac. 

Rubbing . — Mercur. , Phosphor. 

Touching the teeth. — Bryon., Nux vom. 

Sucking the gums. — Caustic. 

Pressing upon the teeth. — Bellad., China, Bryon., /gnat., Natr. mm., 

Pulsat., Phosphor., Rhus. 
Moving. — Pulsat., Rhus. 
When walking. — Pulsat. , Rhus. 
When at rest. — Bryon., Nux vom., Staphis. 
Sitting up in bed. — Arsen., Mercur., Rhus. 
Getting up. — Phosphor., Nux vom. 
When lying down. — Bryon., Mercur., Nux vom. 

on the painful side. — Bryon., Ignat., Pulsat. 

painless . — Nux vom. 

lying down in bed. — Mercur., Pulsat. 

In bed. — Sulphur. 
When going to sleep. — Mercur. 
After sleep. — Nux vom., Pulsat. 
The pains extend 

to the jawbones and face. — Hyosc, Laches., Mercur., Nux vom., 
Rhus, Sulphur. 

to the cheeks. — Bryon., Chamom., Caustic, Mercur., Silic, Sta- 
phis., Sulphur. 

into the ears. — Arsen., Bryon., Calcar., Chamom., Hepar., 
Laches., Mercur., Staphis., Sulphur. 
The pains extend 

into the eyes. — Caustic., Chamom., Mercur., Pulsat., Staphis., 
Sulphur. 

into the head. — Ant. crud., Arsen., Chamom., Hyosc, Mercur., 
Nix vom. , Rhus, Staphis. , Sulphur. 



246 ODONTALGIA. 

With headache. — Ap. vir., Ghnoin., Laches. 

rush of blood to the head. — Aeon., Calcar., China, Hyosc, Laches. , 

Pulsat. 

swollen veins of the forehead and hands. — China. 

heat in the head. — Aeon., Hyosc., Pulsat. 

burning of the eyes. — Bellad. 

flushed cheeks. — Aeon., Arnica, Bellad., Chamom., Mercur., Nux 

mosch., Nux vom., Phosphor., Pulsat., Rhus tox., Sulphur. 

pale face. — Aeon., Arsen., Ignat., Pulsat., staphis., Sulphur. 

swelling of the cheek. — Arnica, Arsen., Bellad., Bryon., Chamom., 

Laches., Mercur., Natr. mur., Nux vom., Phosphor., Pulsat. , 

Phosph. ac, S tap his., Sulphur. 

salivation. — Bellad., Dulcam., Mercur. 

dry mouth and thirst. — China. 

without thirst. — Pulsat. 

dry throat and thirst. — Bellad. 

chilliness. — Pulsat., Rhus. 

heat. — Hyosc. , Rhus. 

warm perspiration. — Hyosc. 

chilliness, heat, thirst. — Laches. 

diarrhoea. — Chamom., Coffea, Dulcam., Rhus. 

constipation. — Bryon., Mercur., Nux vom., Staphis. 

1. Arnica. After extraction of a tooth; it will stop the bleeding and 
accelerate the healing of the gums. After the insertion of artificial teeth, it 
relieves the pain in the swelling; after filing out carious teeth — which is 
sometimes a very useful operation — mix a few globules of it in a teaspoonful 
of water, and put some of it on the parts which have been filed. In very 
intense pain, occurring after the tooth has been drawn, sometimes Hyosc. is 
of use. Arnica is sometimes good for throbbing toothache, w 7 ith a sensation 
as if the tooth were being forced out from its socket by the blood; hard 
swelling of the cheeks. 

2. Coffea. Will remove the severest pains, wdiich drive the patients 
almost frantic; the} 7 cry, tremble and do not know w 7 hat they do; the pain 
is indescribable; it is momentarily relieved by holding cold water in the mouth. 
For stinging, jerking pain, or intermitting aching and pain when chewing, 
it is to be preferred to all other remedies. 

3. Aeon. Must be given in all those cases where the patients are almost 
frantic with pain, which is indescribable, and which Coffea has failed to re- 
lieve; also for throbbing pains, occasioned by taking cold, with determina- 
tion of blood to the head; burning in the face; it is particularly suitable for 
children; when it is no longer efficacious, give Chamom. or Bellad. 

4. Glonoin. For toothache from taking cold, after having been over- 
heated, if the beating of the pulse is felt in all the teeth, or a drawing in all 
the teeth; pain extending to whole right side of face, having waves of spon- 
taneous exacerbation, without being influenced by anything specially. 



ODONTALGIA. 247 

5. Chamom. Particularly in children — and in persons who are fre- 
quently vexed, and who drink much coffee — also in females before menstrua- 
tion; pain in hollow teeth, after taking cold when in perspiration, or when 
the patient is very irritable afid inclined to cry; when the pain is insupport- 
able, and aggravated periodically, worse during the night; when no particu- 
lar tooth can be pointed out as the painful one; or when the tooth is hollow 
and loose, and feels as if too long; or when the pain extends through the 
whole set, and every tooth feels too long; also when it extends through the 
jaws into the ear, and through the temples into the eyes; when there is 
crawling continually, or scraping sensation in the nerve of the hollow tooth, 
after which the pain increases; drawing and tearing, or boring and throbbing 
pain; when at its height, the pain is stinging and jerking, and extends to the 
ear; the patient cannot bear the warmth of the bed, and the pain generally 
commences^oon after meals, particularly after eating or drinking anything 
warm; when it grows much worse after drinking cold water — also after 
coffee; cannot be relieved by anything but dipping a finger into cold water 
and applying it to the tooth; when, while the pain lasts, the cheek is red 
and hot, or the cheek and gums are swollen and of a painful red color; 
when the glands under the chin are painful and swollen, accompanied with 
great weakness, particularly in the joints; with pain in the articulation of 
the jaw on opening the mouth, extending to the teeth. 

6. Nux mo sch. Suits children, women — particularly during preg- 
nancy — and all people with a cool, dry skin, who never perspire; for pains 
from taking cold in damp, cold weather, or from the night-air; for pains 
which get worse if air, particularly cold, damp air, is drawn into the mouth; 
if warm water or warm applications ease the pain; for toothache which is 
increased by the shaking of the body in going up or down stairs; if the 
pain commences on the right side and goes to the left; for pains as if a tooth 
were wrenched out; worse from much talking; the teeth become easily blunt. 
Frequent yawning, sleepiness and swooning; profuse menstruation. 

7. Nux vom. For toothache in persons of a hasty temper, with ruddy 
complexion, who love coffee and ardent spirits — have little out-door exercise, 
or who have taken cold; when a healthy tooth is painful and feels loose, or 
the teeth seem too long, with jerking, shooting pains in the lower jaw; a 
drawing pain extending into the temple, or a pain from a hollow tooth, 
affecting the whole face and even the bones, or extending over the whole 
side; or for drawing and burning pains in the nerves of a tooth, as if it were 
wrenched out, accompanied by violent stitches, which affect the whole body, 
particularly on inspiration'; when a dull pain in the bones changes to a tear- 
ing pain, which passes through the teeth and jaws, or where there is a bor- 
ing, gnawing, tearing pain on one side; sometimes jerking or rheumatic 
pains, attended with a prickling sensation; when they chiefly commence in 
bed or in the evening, preventing chewing, grow worse or return as soon as 
the mouth is opened in the cold air; or when reading or thinking; or when 
the tearing pains become worse from drinking anything cold and better from 



248 ODONTALGIA. 

external warmth; in general the pains are worse after eating and exercise; 
when along with the tearing pains the glands beneath the lower jaw are 
painful and particularly when a swelling appears on the gums, which seems 
about to burst. 

8. Pulsat. For persons of a mild, quiet, timid disposition, or for women 
and children of a fretful temper; when the pain is only on one side; for 
toothache which is prevalent in the spring, accompanied by earache and 
headache, confined chiefly to one side; when there is a stinging pain in the 
decayed tooth, accompanied by great sensitiveness of the left side of the 
face, extending to the ear, with heat in the head and chills over the whole 
body; but particularly when there is a gnawing pain in the gums, and 
pricking as of pins, with tearing and jerking in the tooth itself, as if the 
nerve were stretched and then suddenly relaxed; or for jerking or tearing in 
the tooth as if it would start from the jaw, and aggravated by cold water, 
the heat of the bed, a warm room, or by taking anything warm into the 
mouth; cold air relieves it — the toothache always ceases in the open air, but 
returns in the warm room and gets worse; worse when sitting, better w T hen 
walking about — w T orse from picking the teeth, better from pressure — chew- 
ing does not make it worse; it comes on mostly towards evening, rarely 
before, and is accompanied by chilliness and pale face, or with congestion of 
blood to the head; or with heat without thirst; especially for toothache 
caused by drinking chamomile tea. 

9. Ignai. In cases where the foregoing remedies appear to be indicated, 
but are insufficient, and the patient is of a more tender and sensitive dispo- 
sition, sometimes cheerful, at other times inclined to tears; particularly for 
persons who grieve much; when the jaw-teeth feel as if crushed; when there 
is a boring pain in the front teeth, and a soreness in all the teeth; worse after 
drinking coffee, after smoking, after dinner, in the evening, after lying down, 
and in the morning on waking. 

10. Hyosc. In very sensitive, nervous, excitable persons; the pain 
almost drives the patient mad — it is a tearing or throbbing, extending to the 
cheeks and along the lower jaw; or there is a tearing, raging pain in the 
gums, with a buzzing sensation in the tooth, which is loose, and feels, when 
chewing, as if it were coming out; or jerking, throbbing, drawing, tearing, 
which extends to the forehead; violent tearing pains in different teeth, as if 
the blood were pressed into them, occasionally accompanied by flushes of 
heat, with determination of blood to the head; it is aggravated b5 T cold 
air; generally comes on in the morning, and is sometimes accompanied by 
jerking in the fingers and arms, especially in persons who are subject to 
convulsions. 

11. Bellad. Is frequently best adapted to females or children, particu- 
larly when the pain and anguish cause great restlessness, running about, or 
where there is depression, and a disposition to cry; when the teeth and gums 
are painfully sensitive; when biting produces a feeling as if there were ulcers 
at the roots, with stinging, cutting, jerking, tearing pain; and more especi- 



ODONTALGIA. 249 

all}' for a drawing pain, which is worse after going to bed, and during the 
night; or for pricking pains in a hollow tooth, day and night; or pain in a 
hollow jaw-tooth, as if too much blood were forced into it, with heat in the 
gums and throbbing in the cheeks — nothing mitigates the pain but picking 
the gum until it bleeds; or the gums are swelled, with burning and stinging 
pains, discharge of much saliva, the cheek swelled, sometimes the eyes hot 
and the throat dry, with great thirst — frequently the pain returns in the 
morning on awaking, or recommences some time after dinner; the teeth ache 
when exposed to the open air, when touched, from biting, when food or 
hot liquids come in contact with them — pressing hard upon the cheeks some- 
times gives relief. 

12. China. For mothers who are nursing — or persons, who, otherwise 
cheerful, become cross and irritable; the teeth are covered with dark sordes; 
the pain comes on periodically, and is throbbing, tearing, jerking or drawing, 
wdth great pressure, as if the blood were forced into the teeth, or boring and 
numbness about the teeth — worse on motion or when touched, and returning 
on exposure to a draught — the gums swell, the mouth is dry, there is thirst, 
the blood rises to the head, veins of the forehead and hands swell, and the 
sleep during the night is uneasy, although the pain is not so great. 

13. Mercur. For children; in general when there are tearing pains in 
several teeth at once, in hollow ones and those adjoining them — the pain 
affects the whole side of the face, or drawing and stinging pains extend to 
the ear; it is particularly troublesome during the night; or for excruciating 
jumping pains in the teeth, especially at night, with stitches extending to the 
ear and the head, which drive the patient out of bed; also for stinging pains 
in a decayed tooth, worse after eating or drinking anything cold or warm; 
the pain is generally increased by cold, and particularly by damp air, is less 
severe when in a warm place, or when the cheek is rubbed — sometimes the 
air, when rushing in, causes pain in the front teeth; or the toothache is only 
felt during the day and ceases during the night, and is followed by perspira- 
tion, and in the morning the same pains return again, in paroxysms, with 
longer or shorter intervals, alternating with giddiness or tearing in the limbs; 
the teeth are almost always loosened, the gums swell or become white and 
ulcerated, are detached from the teeth, burn and ache when touched; or they 
begin to itch, to bleed and to suppurate, with tearing through the roots of 
the teeth, or with painful swelling of the cheeks. 

14. Hepar, after Mercur. or Bellad. When the painful swelling of 
the gums continues, or for a throbbing pain as if blood were entering the 
tooth, or a drawing pain; the pains worse after eating, and in a warm room, 
or at night. 

15. Card. veg. When Mercur. or Arsen. gives some relief, without 
effecting a perfect cure; also in persons who have taken much calomel, par- 
ticularly when the gums bleed, and are detached from the teeth; the teeth 
are loosened, become ulcerated, and ache when touched by the tongue; worse 
after eating, with drawing and tearing pains in the incisors. 



25O ODONTALGIA. 

16. Sulphur. Is most suitable for jumping pain in hollow teeth — ex- 
tending to the upper and lower jaw, or to the ear; for swelling of the gums, 
attended with throbbing pain, bleeding of the gums and swelling around old 
stumps; for toothache in the evening, or in the air, from draught, worse 
when rinsing the mouth with cold water. 

17. Phosphor. For toothache from washing or from having had the 
hands in cold or warm water. 

18. Cepa. For toothache with cold in the head, which gets better when 
the catarrh becomes worse, and which gets worse when the catarrh ceases; 
from damp, cold weather, and wind; it commences on the left and goes to 
the right side; is worse in the warm room; throbbing, drawing, pressing 
pains, with swelling of the cheek; worse when chewing; better from cold 
water; the teeth become yellow; for people who have an offensive breath, or 
who are fond of being in the open air and like to wash themselves fre- 
quently. 

19. Arsenic. When the teeth are loose and elongated, with constant 
jerking or burning, and tearing in the gums, worse when touched, when ly- 
ing on the affected side, and when at rest, and also from cold; the pains are 
mitigated by the heat of the stove, by hot applications, or by sitting up in 
bed; it is particularly indicated when the pains are very debilitating. 

20. Ant. crud. Is the principal remedy for pains in hollow teeth, of a 
boring, digging, tearing, jerking character, which sometimes penetrate into 
the head; the pains are aggravated in the evening in bed, after eating, by 
cold water; and better when walking in the open air. 

21. Bryon. For passionate, irritable, cross, obstinate people; pain oc- 
casionally in hollow, but more frequently in healthy teeth; shooting pains 
with twitching towards the ear; tearing pain extending to the cheek, and 
acute pains as if caused by an exposed nerve ; sensitiveness and pain in the 
decayed teeth from contact with the air; the teeth feel as if too long and 
loose, and when chewing the}' feel as if they would fall out. The pains are 
aggravated by smoking or chewing tobacco; from the introduction of any 
thing warm into the mouth — better in open air — sometimes relieved by cold 
water, but only momentarily, and also when lying on the affected cheek, 
but worse when lying on the other. Likewise when the pain shoots from 
one tooth into the other, and also into the head and cheeks. 

22. Rhus. For the same painful sensation of elongation and looseness 
of the teeth, as Bryon., and also when they feel as if they were asleep (Chi?ia, 
Dulcam.), and hollow, or sensitive to the air; the gums are swollen, burn, 
and itch like an ulcer, or they are sore and detached from the teeth; for 
jumping, shooting, or drawing pain, as if the teeth were being torn out 
(Put sat.), or pressed into their sockets (Staphis.), or for slow pricking or 
throbbing or tearing in all the teeth, extending into the jaws and temporal 
bones, with a painful soreness of one side of the face, from taking cold, or 
from vexation; worse in the air; insufferable during the night and mitigated 
by heat; sometimes accompanied by an offensive smell from the carious 



ODONTALGIA. 25 1 

teeth. It suits best for quiet persons (unlike Bryon.), who are disposed to 
sadness and melancholy, or are easily agitated and frightened (similar to 
Bellad.). 

23. Staphis. When the teeth become black and hollow, the gums pale, 
white, ulcerated and swollen — aching when being touched; intense gnawing, 
drawing or tearing pains in decayed teeth, particularly in the roots, or ex- 
tending through a whole row, or when the pain shoots from a hollow tooth 
into the ear, with throbbing in the temple — worse in the open air, from 
drinking anything cold, from eating, and particularly during the night or 
toward morning. 

24. Laches. Pain in all the decayed teeth during rush of the blood to 
the head; drawing, tearing, throbbing, boring pain in the jawbones; hollow 
teeth feel too long; pain extending down the throat; better when pus is 
discharged; gums swollen, bleeding easily, or they are bluish-red, beating 
and burning, worse from anything warm; toothache worse after warm and 
cold drinks, after eating and awaking; with headache, beating over the eyes, 
stitches in the ears, swelling of the cheek; pains in the limbs of the opposite 
side, chills, fever and thirst. It is particularly suited for colds in damp, 
warm, spring weather; during menstruation, the smaller the discharge the 
greater the pain, at the cessation of the menstruation; for melancholic and 
choleric persons, for persons of vivid imagination; after long-continued grief, 
and after the abuse of mercury. 

25. Phosph. ac. Is suitable for bleeding and swollen gums; tearing 
pains, which are worse when warm in bed, and also from heat and from cold; 
burning in the front teeth during the night; pains from hollow teeth, ex- 
tending into the head. 

26. Ap. vir. For the most violent pains in the gums, also for jerks and 
throbbing in the molars, with involuntary, sudden biting together of the 
teeth, headache and bleeding of the gums. 

27. Silic. For tedious, boring, tearing pains, day and night, worse 
during the night, spreading over the whole cheek, also into the bones of 
the face; discharge of offensive matter from openings near the roots of the 
teeth or from the gums; swelling of the jaw. 

28. Dulcam. Is sometimes useful for toothache proceeding from cold, 
particularly when accompanied by diarrhoea, and when Chamom. does not 
answer; also when there is at the same time confusion of the head, or when 
the toothache is accompanied by profuse salivation (similar in this to Bellad. 
and Mercur. ) and the teeth feel blunt. 

29. Calcar. For toothache in pregnant females; pains in hollow teeth, 
especially around loose stumps; pressing, drawing, jerking soreness; draw- 
ing, pricking, rooting, gnawing, grubbing, throbbing pains, with swelled 
gums, which are sore, bleed easily, throb and pain; it is only suitable when 
there is determination of blood toward the head, particularly during the 
night; when the pains are caused by taking cold, or are aggravated by cold 
or a draugh of air; the patient can neither bear warm nor cold drinks — even 
noise makes it worse. Fistula dentalis. 



252 SWELLED FACE. 

30. Caustic. For toothache arising from breathing in the open air, 
generally attended with stinging, throbbing pain, and a feeling of soreness; 
or the teeth feel painfull}' loose and lengthened, as if forced out of their 
sockets {Arnica, PJwsph. ac); when there are ulcers at the roots of the 
teeth, the gums suppurating are swollen and very tender. The pain fre- 
quently affects the whole of the left side of the face, especially at night when 
the patient lies on it, and is equally sensitive to heat and cold; in long-con- 
tinued or often-returning colds. After grief; melanchol}- mood; profuse, 
badly-smelling sweat at night. 

31. Clemat. Drawing, stitching, worse at night; better for a short 
time by holding cold water in the mouth or sucking at the tooth, and in the 
open air. 

32. Kali birchr. Pain in molar bones, worse from coughing. 

33. Kali carb. Stitch pain and tearing up into the head and eye, with 
dizziness; chilliness, dry skin and bad alkaline smell from mouth; worse 
from chewing. 

34. Mag. carb. and Phosph. Pain is worse at night, drives out of 
bed. 

35. Natr. sidph. Pain is better from holding cold water in mouth, and 
is brought on again by taking hot water or hot coffee in the mouth. 

36. Petrol. Abscess at root of tooth, with swelling of left lower jaw, 
painful to touch and on stooping. 

37. Plant, maj. Aching in decayed teeth, or shooting up left side of 
face; face red. Is a popular remedy. 

38. Sabad. Hot or cold food or drink, also cold air produce or increase 
the pain. 

39. Sepia. Chronic cases; caries; waterbrash during pain ; meclimaxis; 
leucorrhoea. 

40. Spigel. Pain leaves during eating and reappears afterwards, with 
palpitation of the heart. 

41. Sulph. ac. Pain begins slowly to increase, growing to an almost 
unbearable degree when it suddenly ceases. 

42. Thuja. With decay of teeth commencing close to the gums. 

Swelled Face. 

When the cheek remains swollen after the toothache has ceased, it may 

be removed by giving Pulsat., if Mercur. or Chamom. have been previously 
taken for the pain; or Mercur. after Pulsat. or Bellad.; or Bellad. after 
Mercur.; or Sulphur, after Bellad., Bryon., Arsen., etc. If the swelling is 
red, as in erysipelas, Mercur. should be given; if less red, but hard and stiff, 
Arnica. Hcpar, when the swelling begins to soften, and appears as if about 
to suppurate, followed by a dose or two of Laches. , if Hepar does not affect a 
speedy abatement of the swelling, and then by Hepar again or by Mercur. , 
if the latter have not been taken before. 



THE TONGUE. 253 

THE TONGUE. 

To this remarkable piece of furniture of the human economy great atten- 
tion has been paid by physicians of all shades and in all times. And, indeed, 
it often presents quite characteristic diagnostic as well as therapeutic hints. 
The most important of these features are the following: 

1. Its Color. 

It is either too red all over, as in scarlet fever, with considerably raised 
papillae — whence the name strawberry tongue — or red and dry, as in inflam- 
mations of the brain and its membranes; in inflammation of the thoracic 
viscera and mucous membranes of the stomach and intestines; or red on the 
edges and on the tip, or a red, dry streak in the middle of the tongue in 
typhoid fevers, or red, clean and glossy, indicating great fever heat, conges- 
tion to the head, impending delirium, and in gastric fevers, the transition 
into the typhoid state; and if, at the same time, cracked, ulceration of the 
bowels; or red, moist and smooth, in chronic affections of the stomach. 

A pale tongue is found in chills; in spasms; after loss of vital fluids; in 
chlorosis, dropsy and general exhaustion. When it sets in in exanthematic, 
gastric or bilious fevers, it denotes a fatal issue. 

A lead-colored tongue is found in cholera, in mortification of the lungs 
and stomach, in scirrhus of the tongue. 

A lead-colored tongue, with thrush, denotes impending death, under all 
circumstances. 

A bluish tongue is a sign of impeded circulation of the blood, and, there- 
fore, it may be found in paroxysms of asthma, whooping-cough, croup, 
bronchitis, pneumonia, heart disease, dropsy of the chest and cyanosis. 
Scurvy and mercurial inflammation of the tongue have also a bluish hue. 

2. Its Humectation. 

A moist tongue is, in general, a favorable sign. But in putrid fevers, 
with exhausting perspiration, it has no such favorable meaning. 

A constantly moist tongue in soporous conditions denotes great exhaus- 
tion. % 

A dry tongue is found in a great many different morbid conditions, espe- 
cially in feverish affections, particularly in such as have a tendency to senso- 
rial disturbances. 

Great dryness of the tongue in typhus cerebralis is, according to Schoen- 
lein, an unfavorable sign. 

Dryness of the tongue in infants is a forerunner of thrush or internal in- 
flammation. 

3. Its Temperature. 

A hot tongue is found in congestive and inflammatory states of different 
parts of the body; in infants before thrush appears. 

A cold tongue is found in chills, violent spasms, after great loss of blood. 



254 IT S COVERING OR COATING. 

internal mortification, apoplexy, cholera. In fevers it denotes greatest pros- 
tration and impending death. 

4. Its Covering or Coating. 

We must bear in mind that the tongue is coated or furred without indi- 
cating any disordered state of the system — in the morning by an empty 
stomach; after siesta; after night-watching, and with habitual smokers of 
tobacco. 

A coating of the root of the tongue does not mean much; in a slight de- 
gree every one has it, even in the best of health. 

A coating on the tip of the tongue is said to be found in phthisical per- 
sons. 

One-sided coating is said to be found in one-sided complaints, as proso- 
palgia, paralysis; in one-sided lung diseases; in affections of the liver and 
spleen. 

A patchy or map tongue, the so-called pityriasis linguae, is produced 
merely by a stouter layer of epithelium around the places of thinner cover- 
ing. A systematic cause for this affection is not known, although it may 
possibly be connected with some abnormal states of the stomach. 

A thick, white coating occurs most extensively in affections of the fauces; 
but also in gastric derangements. 

The yellow-coating is generally believed to be bilious; single yellow 
streaks on a white-coated tongue indicate obstinacy of the disease. 

A peculiar buff leather appearace is presented in cases of enteritis and 
hepatitis; also in tonsillitis. 

A dark brown coating exists in malignant fevers, and in haemorrhages 
from the mouth. 

A black coating, in dysentery, indicates exhaustion — mortification — 
death. In jaundice it denotes organic diseases of the liver, spleen, such as 
induration, tubercles, abscesses. In small-pox it is quite an unfavorable 
sign. 

5. Its Form and Size. 

We find a large, long tongue most conspicuously in chronic hydrocepha- 
lus and cretins. 

A small tongue, if not congenital, in atrophy, consumptive diseases, and 
long-standing paralysis of the tongue; especially if caused from an irritation 
of the brain or spinal marrow. 

A sudden dimunition in size denotes, in inflammatory diseases of the 
lungs and liver, formation of abscesses; also general exhaustion; especially 
in putrid and typhoid fevers. 

A gradual decrease, in acute diseases, denotes gravity and obstinacy of 
such diseases, and is a sign of a dangerous affection of the brain. 
(Sprengel. ) 



ITS CONSISTENCY. 255 

A broad tongue is found in rachitis, scrofula, inclination to abdominal 
affections and in intermittent fevers. 

A narrow, pointed tongue is said to be found in persons who are subject 
to spitting of blood, tuberculosis, and internal inflammations. 

A thick, swollen tongue is found in rachitis, cretins, chronic dropsy of 
the head, in obstinate dyspnoea and chronic inflammation of the mucous 
membrane of the stomach; also in intermittent fevers, catarrhal affections, 
mercurial salivation, inflammation of the tongue, in old drunkards; after 
death b}^ strangulation or suffocation. 

A swollen and heavy tongue in old age is the forerunner of apoplexy; the 
same in drunkards. In fevers, if associated with dryness and stammering 
speech, it denotes congestion of the brain. In croup, pleurisy and pneu- 
monia, it is a bad sign, just as bad as its sudden dimunition, without improve- 
ment of the other symptoms. (Hippocrates.) 

A thin, like a small, tongue is found in atrophy, consumptive diseases. 

Tumors on the tongue, if hard, brownish-red, with bluish blood-vessels 
interwoven, are of a scirrhous nature. 

Single lumps and fleshy excrescences on the tongue are found in elephan- 
tiasis. 

6. Its Consistency. 

We find a hard tongue associated with great dryness of the tongue in 
congestion, inflammation, in fevers, in tonic spasms, in scirrhus and other 
degenerations of the substance of the tongue. 

A soft tongue we find in catarrhal affections, in chronic mucous diar- 
'rhoea, gastric derangements and in paralysis of the tongue. When soft, the 
teeth generally show their imprints on its sides — often found after mercurial 
poisoning. In brain diseases a soft tongue is a bad sign. 

7. Cracks and Fissures 

On the dry tongue, sometimes deep, bleeding and suppurating, are found in 
typhoid fever, in small-pox, dysentery. 

8. Paralysis 

Of the tongue, which manifests itself by an imperfect, stammering speech, 
is often the consequence of apoplexy, softening or other affections of the 
brain. 

Its immobility and its trembling are signs of torpor of the brain, espe- 
cially in consequence of typhoid conditions, puerperal fever and septicaemia. 

Therapeutic Hints. 

A red tongue all over with considerable raised papillae. Arum, triph., 
Bel/ad., Hyosc, Merc, corr., Tart. emet. 

Red, glistening tongue: Kali bichr., Laches. 
Red tip: Arg. nitr., Morphium. 



256 THERAPEUTIC HINTS TO THE TONGUE. 

Red tip in the shape of a triangle: Rhus tox. 

Red tip, undefined and red borders: Sulphur. 

Red borders: Bellad., Bryon., Morphium, A T ux vom., Sulphur. 

Red streak in the middle of a yellowish-coated tongue: Ver. vir. 

Lead-colored tongue: Arsen. 

Bluish tongue: Arsen., JJigit., Mur. ac, Thuja. 

White thick coating: Ant. crud., Arsen., Bryon. and many others. 

Whole tongue as if painted white : Glonoin. 

White coating and cracks across the middle: Kobalt. 

White coating only on one side: Rhus tox. 

A white streak on both sides: Caustic. 

In the middle only: Bryon., Phosphor. 

On the root only, strongly marked: Sepia. 

Map tongue: Arsen., Lac. vac, Laches., Natr. mur., Nitr. ac, Tarax. 

Yellow coating : Many remedies. 

Brown coating: Arsen., Bellad., Cactus, Coccul., Kali bichr., Merc, prot., 
Plumbum, Secale, Silic, Spongia, Sulphur. 

A dry, white tongue, without thirst: Bryon., Pulsat. 

Dry, white, without thirst and paralyzed : Nux mosch. 

Dry, white, and feeling as if burnt or scalded: Psorin., Pulsat., Sepia. 

Diy and cracked: Arsen., Bellad., Chamom., Kali bichr., Rhus tox. , 
Ver. alb. 

Dry and red; Arg. nitr., Bellad., Chamom., Hyosc, Laches., Lycop., 
Morphium. 

Dry, red and cracked at the tip: Kali bichr., Laches., Rhus tox., 
Sulphur. 

A black coating: Arsen., China, Elaps, Laches., Mercur., Opium, 
Secale, Ver. alb. 

A soft tongue, with imprints of teeth: Mercur., Rhus tox., Stramon. 

A clean tongue, with gastric and other derangements: Cina, Digit. 

Trembling and inability to protrude the tongue in typhoid conditions: 
Laches. 

Heavy, trembling tongue, with falling of lower jaw in typhoid conditions: 
Lycop. 

Spasmodic darting of the tongue out of mouth in typhoid conditions: 
Lycop. 

Protruding of tongue, with silly expression in diphtheria : Lycop. 

Protruding, cold and lame : Hydr. ac 

Paralysis of tongue: Aeon., Arsen., Bar. carb., Bellad., Caustic, Dul- 
cam., Graphit., Hyosc, Laches., Nux mosch., Opium, Plumbum., Stramon. 

Difficulty of moving the tongue: Anac, Bellad., Calc carb., Lycop. 

Heavy tongue: Anac, Bellad., Carb. vcg., Colchic, Lycop., Mur. ac, 
Natr. mur., Plumbum. 

Stiffness of tongue: Borax., Colchic, Euphras., Laches., Natr. mur. 



GLOSSITIS. 257 

Glossitis, Inflammation of the Tongue. 

We understand by this name an infiltration of the parenchyma of the 
tongue, which is either confined to only- a portion of the tongue, Partial 
glossitis, or pervades the entire organ, Glossitis diffusa universalis. A mere 
superficial inflammation of the mucous membrane of the tongue belongs as 
part to inflammatory processes of the general mucous membrane of the 
mouth. 

The most important symptom of an Universal glossitis is the rapid 
swelling of the tongue, which in a day or two may acquire such dimensions 
as to prevent by its pressure upon the pharynx and epiglottis not only swal- 
lowing, but also breathing and to cause death by suffocation in a few hours. 
The patient is seized with paroxysms of asphyxia, as in croup, becomes 
cyanotic and suffocates, if breathing is not restored. The tongue, not hav- 
ing room in the mouth, also protrudes and presses sideways between the 
back teeth, causing deep indentations, with immediate disposition to the 
formation of ulcers. The neighboring lymphatic and salivary glands also 
become swollen. The pain is severe, and extends to the ears and throat. 
Its course is rapid, terminating either, as before stated, in death by suffoca- 
tion, or in a gradual subsidence of the swelling, or in the formation of an 
abscess, which mostly breaks through the surface of the tongue. Even 
gangrenous destruction of large portions of the tongue has been observed 
as a result of mercurial glossitis, and at times there remain circumscribed 
indurations, with a disposition to renewed attacks. 

Partial glossitis usually commences as a painful tumor, from the size of 
a pea to that of a bean, on the back part of the tongue, which gradually 
suppurates, finally breaks and discharges. It is not attended with any 
special disturbance of the general health. 

The Causes of a genuine parenchymal glossitis are not clear by any 
means. Some have recorded epidemics of this disease; others have observed 
it as a consequence of anthrax poison ; others as a result of mercurial poison- 
ing, and still others as the effect of the sting of a wasp, bee, or hornet. 
Sporadic cases of glossitis have in nowise been etiologically explained. The 
most fatal are those caused by the poison of anthrax — Grlossanthrax — or car- 
buncle of the tongue. 

Therapeutic Hints. 

If anthrax, bee, wasp and hornet-stings, and mercurial poisoning are set 
down as causes of glossitis, we naturally will find powerful remedies for this 
disease in: 

Anthrac. Especially when there is great burning and a disposition to 
gangrene; after A rsen. 

Apis. When there is a stinging and burning pain, with blisters on the 
tongue. 

17 



258 CANCER OF THE TONGUE. 

Merc. sol. When there is ulceration, and great fiabbiness of the tongue, 
with salivation. 

Besides compare: Plumbum, Ran. seel., Sepia, and 

Arse?i. Great burning and tendency to gangrene. 

Laches. Blisters which change into ulcers. 

Petrol. Fetid salivation. 

Sulphur. Ulcerated tongue. 

Camphora, or Natr. mur. When caused by an insect sting. 

Cupr. ac, Calc. Carb., Hepar, Nitr. ac, Sulphur. After abuse of 
mercury. 

Canthar. After scalding the tongue. 

Calc. carb., Carb. veg., Conium, Hepar, Lycop., Mezer., Silic, Sulphur . 
When indurations remain and the case becomes chronic. 

Arnica, Hypericum. Traumatic origin. 

Asaf. , Hepar, Nitr. ac. , Staphis. Mercurial poisoning. 

Cancer of the Tongue 

Is of the epithelial kind and commences usually at the edge, near the tip of 
the tongue, as a small, hard lump, which after awhile forms an ulcer of a 
roundish shape, with raised edges and uneven bottom. It distinguishes itself 
from every other ulcer by its continuous encroachments, by its hard, larda- 
ceous bottom, by the visid, milky juice which can be squeezed out by press- 
ure upon its edges, and by the lancinating, boring, burning pains, with 
which it is attended, robbing the patient of rest at night, and not unfre- 
quently leading him to suicide. By-and-by the adjacent parts of the tongue 
begin to swell, and the cancer itself spreads either upon the superior or 
inferior surface of the tongue. In its further progress the motion of the 
tongue becomes impeded, and the swallowing of solid food impossible. A 
great deal of saliva is secreted, and as the swallowing is painful and difficult, 
the patient spits all the. time. The glands under the tongue, and also the 
lymphatic glands of the neck become affected; they swell and harden; the 
tongue becomes firmly attached to the bottom of the mouth, so that its 
motion is almost destroyed; it gradually is transformed into a thick, short- 
ened, misshapen lump, with round protuberances upon it, which break and 
emit a terrible smell. Sometimes the glands of the neck and the region of 
the parotid glands swell to such an extent that it is impossible for the 
patient to open the mouth, and he gradually sinks under excruciating suf- 
fering, starvation and exhaustion. The disease is slow, lasting from one to 
three years. 

Therapeutics Hints. 

Compare Arsen., Caustic, Carb. an. and veg., Conium, Hydrast., 
Laches., Nitr. ac, Phytol., Sepia, Silic, Sulphur. Galium ap. (Clifton and 
Bailey), Mur. ac. (Cooper). 

Sedum acre, sempervivum tectorum. 



THE SAXIVARY GEANDS AND THEIR DUCTS. 259 

THE SALIVARY GLANDS AND THEIR DUCTS. 

There are three pairs of such glands: the parotid, which is situated near 
the ear on each side; the submaxillary, lying in the posterior angle of the 
submaxillary triangle of the neck on each side; and the sublingual, which is 
imbedded beneath the mucous membrane of the floor of the mouth on each 
side of the fraenum linguae. The excretory ducts of the parotid, called 
Stenon's ducts, open at the internal surface of the cheeks, opposite the second 
molar tooth of the upper jaw; those of the submaxillary, called Wharton's 
ducts, open by the side of the fraenum linguae; and those of the sublingual, 
w T hich are seven or eight in number, also open in this same locality. The 
product which they pour forth into the mouth is the saliva. This very im- 
portant fluid is greatly altered by disease; but still, all the microscopical 
and chemical researches have failed to reveal any facts which can be con- 
sidered of diagnostic value. 

The saliva varies in Quantity. 

There is normally less secretion in the first four months of infancy, and 
also in the last years of old age. But its secretion may be abnormally les- 
sened by deficiency of beverage, or by different pathological conditions, 
wmich induce copious secretions of fluids, either through the skin, or kidneys, 
or serous membranes. 

An increase of saliva (salivation, ptyalism) may be caused by various 
drugs, as our Materia Medica shows; but the most known and the most 
virulent is that caused by mercury, being accompanied by a most sickening, 
penetrating smell from the mouth, swelling and inflammation of the gums, 
loosening and falling out of the teeth, stomatitis, and ulceration of the 
mucous membrane. We find an increase of saliva also in many diseases of 
the cavity of the mouth, of the tongue, in caries of the teeth, in necrosis of 
the jaw, during the eruption of the milk teeth, in acute and chronic irrita- 
tions of the parotid and submaxillary glands, during the eruption of small- 
pox in the mouth; sometimes at the commencement of typhus; in conse- 
quence of irritation of the trifacial, the facial and the glosso-pharyngeal 
nerves; in consequence of diseases of the stomach, of the pancreas and spleen; 
in intermittents; during pregnancy, menstrual disturbances, climaxis and in 
many hysterical conditions. 

The color of the saliva may also be changed. 

A blue color has been observed in slow poisoning cases by lead. 

Yellow, even greenish saliva has been found in liver complaints and 
jaundice. 

A red, bloody saliva in different morbid conditions, when it becomes 
mixed with blood, as in haemorrhage from the mouth or nose, inflamed and 
bleeding gums, etc. But has also been found in suppression of haemorrhoidal 
discharges. After external injury of the head, bloody saliva is, like bleed- 
ing from the ears, a sign of fracture of the skull bones. 

Its Chemical reaction in a healthy state is slightly alkaline ; if it be acid, 



260 THE TONSILS. 

it indicates a disturbance in the digestive organs. It may also become acid 
in diseases of the intestines, in rachitis, gout and in scrofulous conditions. 
In a normal state saliva contains more or less sulphocyanide of potash or 
soda, which can be easily detected by adding a drop of sesquioxide of iron 
to some saliva, which changes it to a deep red color. During smallpox this 
substance seems to be wanting in the saliva, and be present in the contents 
of the pustules. 

Ranula, Frog. 

It consists of a swelling on the floor of the mouth under the tongue, 
either in the middle or on one side of the fraenum linguae, caused by a widen- 
ing of Wharton's duct in consequence of obstruction by minute foreign 
bodies which have become lodged there and incrustated. It presents itself 
on inspection as a soft, elastic, fluctuating and transparent kind of blister or 
bag, whose sheath is similar to a fine serous membrane, and the contents of 
which consists of a gluey, transparent, pale-yellowish or brownish fluid, of 
alkaline reaction, and without microscopic elements. It varies considerably 
in size and form, the latter depending somewhat on the former. When 
small it is globular; but as it increases its shape is modified by the surround- 
ing tissues. C} r sts and abscesses are also formed in this locality, with which 
ranula must not be confounded. 

Therapeutic Hints. 

Compare Apis, Be/lad., Calc. carb., Fluor, ac, Mcrcur., Mezer., Nitr. 
ac, TJutja. 

Ambra grisea, "excoriating feeling in mouth, preventing eating, with 
an insipid, rancid taste." (Gilchrist.) 

THE TONSILS 

Lie between the two palatine arches and generally project distinctly be} T ond 
them, though in a variable degree. Their form is that of an oval disc, 
sometimes of a flattened globe. Their size varies much, so that no positive 
volume can be determined on. Their free superior surface, being moderately 
red, presents from ten to sixteen round or linear openings, which are barely 
visible; sometimes they are wider and more like fissures. They lead into 
longer or shorter fissures (lacunae, sinuses), running perpendicularly or 
obliquely in various directions, and sometimes giving off branches. The 
lacunae are lined with a thin but uniform layer of epithelium. The tissue 
surrounding the lacunae consists of follicles and interfollicular tissue. The 
follicles are composed of reticular tissue, with few capillaries, and of small, 
round cells imbedded in them. The interfollicular tissue is of an essentially 
similar character, only it is richer in capillaries and contains small arteries 
and veins. The framework of the tonsils consists of a fibrous connective 
tissue, by which they are also surrounded and fastened to different pharyn- 
geal muscles. 



INFLAMMATION OF THE TONSILS. 26 1 

Inflammation of the Tonsils; Amygdalitis; Tonsillitis; Angina 

Tonsillaris. 

There is a Simple catarrhal inflammation of the mucous membrane cov- 
ering the tonsils, which is in most cases only part of a general pharyngeal 
catarrh. A Lacunal or Follicular catarrh of the tonsils is deeper, produces 
a thin or thick whitish, yellowish, curdy substance, which, when thick, 
adheres tightly and consists of epithelium and pus. It may be confounded 
with herpetic angina, mild diphtheritis, or even with superficial abscess of 
the tonsil. The tonsils in such cases are always more or less swollen and 
the palatine arches inflamed. This morbid process yields mostly in a few 
days after a spontaneous evacuation of the epithelial and purulent contents; 
or the contents may dessicate, and then become foul, or calcareous. Those 
little, cheesy lumps, which at times, with some patients, when hawking for- 
cibly, fly out of the mouth, are of this origin. In still other cases it may 
give rise by extension to a Parenchymatous amygdalitis, which is character- 
ized by a high grade of congestive hyperemia and serious infiltration, in con- 
sequence of which the tonsil or tonsils — for it may be unilateral or bilateral — 
become enormously swollen. This state of things results either in a return 
to the normal form by absorption, or in an infiltration of small cells both 
in the interior of the follicles and between them, and a consequent new for- 
mation of reticulated substance giving rise to permanent hypertrophy of the 
tonsils; or in the formation of several abscesses. Sometimes an abscess 
forms in the connective tissue surrounding the tonsils — Peritonsillar or Eetro- 
tonsillar abscess — most frequently between the tonsil and the affected pala- 
tine arch, usually the anterior arch. This affection ordinarily involves but 
one tonsil, sometimes the other, several days afterwards, forms a walnut-sized 
protuberance, which usually terminates in perforation, followed by a rapid 
return to the normal condition. This formation of abscesses is commonly 
known under the name of Quinsy. 

In clinical practice we cannot always distinguish between these different 
pathologico-anatomical forms; neither does it matter. Either of them, with 
the exception of the superficial catarrhal form, may be accompanied with 
great pain, swelling of one or both tonsils, impossibility of swallowing and 
talking, of opening the mouth or moving the head. They are mostly asso- 
ciated with hyperaemia, or collateral oedema of the pharynx, extending 
sometimes into the Eustachian tubes, with pain in the ears, or to the larynx, 
with dyspnoea or paroxysms of suffocation, especially on lying down. Fever 
attends all more severe cases, especially those with suppuration; the temper- 
ature may rise to 104 F., with morning remissions and evening exacerba- 
tions. There is loss of appetite; sometimes headache, delirium, and even 
convulsions have been observed in children at the commencement. 

The duration of a superficial and lacunal tonsillitis varies between 
three and eight days, while a parenchymatous amygdalitis and a tonsillitis 
with abscess lasts at least eight days, frequently a week and a half, and even 



262 THERAPEUTIC HINTS TO INFLAMMATION OF THE TONSIES. 

as long as two or three weeks. Persons once affected by tonsillitis are liable 
to repeated attacks. Fatal terminations are exceedingly rare. 

Therapeutic Hints. 
' ' The much recommended timely opening of tonsillar abscesses is of 
little use, because it is very seldom successful, and, even when it succeeds, 
hardly ever relieves the patient. It is somewhat different in* anterior periton- 
sillar abscess; but even then the relief to the patient is seldom as great as 
after spontaneous discharge. Deep incisions are not advisable, owing to the 
contiguity of carotid artery." (Wagner, allopathic authority.) 

It is strange, that in some "homoeopathic" works we find the use of 
the Bistory still advocated. 

Amm. mur. Both tonsils swollen; can neither swallow, talk, nor open 
the mouth; after taking cold. 

Apis. Stinging, burning pain when swallowing; dryness in mouth and 
throat; red, highly inflamed tonsils; oedematous swelling of fauces and 
glottis. Fears open air, yet cannot stand the warm room; thirstlessness. 

Bar. carb. Liability to tonsillitis after slight cold, or suppressed sweat 
of feet; tonsils tend to suppurate; especially right side. 

Bellad. Especially right side; parts bright red; also swelling of the 
neck, externally, painful to touch and motion; cerebral symptoms. 

Hepar. Sticking pain as from a fishbone in the throat when swallowing ; 
tendency to suppurate; after mercury. 

Ignat. In follicular catarrh, almost specific. 
Kali hydr., or Iodium. (Kafka.) 

Laches. Especially left side; choking when drinking; fluids are driven 
out through the nose; worse in afternoon, after sleep, from slightest touch; 
can't bear bedclothes near the neck. 

Mercur. Dark redness; fetid ptyalism; very offensive smell from mouth; 
aphthae or thick coating on the tongue. 

Phytol. ' ' Pain at the root of the tongue or to the ears when swallow- 
ing, much dryness of the throat, with soreness, fauces and tonsils appear 
dark, perhaps of a bluish cast." (Win. Jeff. Guernsey.) 

Plumbum. Angina on left side, with copious flow of purplish saliva 
and spasms. 

Silic. In stubborn cases where abscesses are forming, yet don't break, 
especially left side. 

Sulphur. When, after the bursting of the abscess, the parts still remain 
irritated, and the patient does not recover as fast as he should. 
For chronic enlargement and induration: 
Bar. carb. and mur., Calc. carb. andyW. , Ignat., Lycop. 
Phosphor. Mucus in throat removed with difficulty; it is white, nearly 
transparent, in lumps and quite cold when it comes into the mouth. 

Phytol. Enlarged tonsils and uvula; tonsils of a bluish cast; harrassing, 
hawking cough, after every cold. 
Psorin. and Sulphur. 



THE UVULA AND SOFT PALATE. 263 

THE UVULA AND SOFT PALATE. 

These parts ma}^ be variously affected, being always more or less 
involved in diseases of the neighboring tissues. We have anaemia, hyper- 
emia, haemorrhage, inflammation, oedema, ulceration, phlegmon, thrush, 
diphtheritic exudations, atrophy, syphilitic affections, morbid growths and 
cancer presented to our observation, and also motor and sensory disturb- 
ances. 

Paralysis may be limited to the muscles of the soft palate, or may 
occur with paralysis of other muscles, most frequently those supplied by the 
facial nerve, or in connection with catarrh, phlegmonous inflammation, 
morbid growths, etc., and in consequence of diphtheritis, the most frequent 
form. Its various forms interfere more or less with swallowing, talking and 
breathing. 

Anesthesia of the soft palate, mostly with diminished reflex irritability, 
is found in insane patients, and also in consequence of the influence of some 
substances upon the periphery (ice bromide of potassium, morphine, lye, 
etc.). Diphtheritic paralysis is almost always combined with anaesthesia. 

Hyperesthesia occurs as w r ell with the maintenance of a normal ap- 
pearance of the parts, as in the various disturbances of circulation and the 
inflammations. 

What in common life is styled ' ' falling of the palate " is an inflamma- 
tion and oedema of the uvula, by which it becomes greatly enlarged, 
causing a constant hacking and hemming, and interfering with swallowing 
and breathing. 

Therapeutic Hints. 

The remedies which act especially upon the uvula and soft palate, are: 
Aeon., Argent., Bellad., Coffea, Crot. tigl., Gelsem., Hepar, Igyiat., Iodium, 
Kali bichr., Laches., Merc, sol., Merc, subl., Natr. mur., Nitr. ac, Nux 
vom., Phosphor., Phytol., Sulphur. 

Angina Faucium, Angina Catarrhalis, Sore Throat. 

This catarrhal affection frequently involves the mucous membrane which 
covers the soft palate, tonsils and back part of the throat (fauces). The 
parts redden and swell, are at first dry and afterwards covered with a whitish 
tough phlegm, which especially assumes on the tonsils to a certain degree an 
appearance of diphtheritis. In its acute form it is mostly attended with some 
fever, painful deglutition, a heavily coated tongue, bad taste and an increase 
of saliva. Deglutition in bad cases, where the palatine and pharyngeal mus- 
cles are involved, becomes utterly impossible, so that an attempt at swallow- 
ing causes either choking or an expulsion of the fluid through the nose. For 
this reason, also, the voice of the patient assumes a nasal twang in talking. 
Sometimes the inflammation extends higher up into the naso-pharyngeal 



264 THERAPEUTIC HINTS TO UVULA AND SOET PALATE- 

cavity, affecting the Eustachian tubes and causing hardness of hearing and 
stitch-pain in the ears. 

It is caused either by atmospheric influence and a constitutional dispo- 
sition {idiopathic form), or is part and portion of certain acute diseases, such 
.as scarlet fever, smallpox, measles, etc. {symptomatic form). At times an- 
gina faucium prevails epidemically. 

Therapeutic Hints. 

Aeon. Dryness with burning, stinging and drawing in the throat, making 
swallowing painful, feverishness, impatience and restlessness. Cold west 
and northwest winds. 

Apis. Burning, stinging pain, or pressing as from a hard body; redness 
and swelling of tonsils, uvula and tongue; abundant collection of soapy 
saliva; painful deglutition or impossibility to swallow. 

Bellad. Scarlet redness; stitches extend into the ear; painful deglu- 
tition or impossibility to swallow, the fluid escaping through the nose; swell- 
ing of cervical glands; red face; congestion to the head; headache; fever. 

Bryon. Gastric derangement; tongue heavily coated, dirty yellowish; 
insipid, pappy taste; constipation; chilliness; motion increases the pain; 
irritableness. 

Ignat. Lump in throat; pain in throat worse between the acts of swal- 
lowing; whitish tough mucus in spots on tonsils, simulating diphtheria. 

Laches. Throat feels constricted; lump in throat; constant desire to 
swallow, though difficult and painful; neck sore to touch; all symptoms 
w T orse on left side, in the morning after sleep, and in the afternoon. 

Merc. sol. Redness and swelling of the parts; whitish, smeary concre- 
tions on tonsils; tongue thickly coated, whitish; flow of slime and saliva 
from mouth; constant inclination to swallow; pain in parotid glands and 
muscles of the neck. Fever exacerbation in the evening. 

Merc. corr. snbl. When there is no swelling of the tonsils. Very 
often subdues the inflammation quickly wmen given at the commencement. 
(Bolle.) * 

Nux vo?n. Catarrh in head and throat, with a feeling of soreness, raw- 
ness, scraping and the sensation of a lump in throat on swallowing; after 
taking cold. 

Petrol. Feeling of great dryness in the throat, with abundant accumu- 
lation of mucus at the same time. Stinging, burning pain in throat during 
deglutition, extending into the ears and neck. Great thirst and costiveness. 

Pulsat. Dark, bluish redness with varicose veins, scraping rawness and 
dryness in throat, without thirst. 

Sanguin. Throat feels sore and as if scalded by hot drinks; dry and 
constricted; drinking does not relieve the dryness; mucous membrane feels 
as if it would crack, is red and inflamed. 



CHRONIC SORE THROAT. 265 

Chronic Sore Throat, Angina Granulosa or Follicularis. 

It is characterized by little, roundish, elevated spots, like peas split in 
half, which stand either singly, scattered over the pharyngeal wall of the 
fauces, or in rows or ridges extending from above downwards; or the mucous 
membrane of that locality appears smooth, but dry and glistening, or it is 
covered with a tough, whitish or yellowish-greenish mucus, or brownish and 
blood}' crusts or skinnj^ substance, which is very difficult to detach. In 
these cases the catarrhal affection extends up into the naso-pharyngeal 
cavity, and is mostly connected with chronic nasal catarrh; but it also may 
spread downwards to the larynx, where its presence causes laryngeal irrita- 
tion and cough. The color of the fauces varies from a bright redness with 
enlarged veins radiating in various directions, to a deep brown-red hue; in 
still other cases there is very little redness. Usually it is attended with very 
little pain, perhaps some raw feeling or scraping, and with scarcely any diffi- 
culty in swallowing. The great annoyance of the patient is a feeling of 
dryness and the accumulation of tough phlegm which he constantly tries to 
remove by hemming and hawking, especially in the morning. In conse- 
quence of these, sometimes very violent efforts of cleansing the throat, small 
blood-vessels burst, which may unnecessarily alarm the patient, when he 
finds himself spitting blood. It is a very stubborn complaint and exercises 
a depressing influence upon the patient, who is kept in constant fear of going 
into consumption. 

This kind of chronic catarrh is frequently found with public speakers, 
clergymen and the like, wherefore it has received the popular name of 
preacher's sore throat, an application which, like many popular definitions, 
is not altogether well defined. For although the so-called preacher's sore 
throat in many cases may be attended with a chronic catarrh of the fauces, 
the sudden giving out of the voice, or hoarseness after loud and forced 
speaking, is mainly the effect of overstraining the muscles of the soft palate 
or vocal cords. 

Therapeutic Hints. 

Alum. Soreness, rawness, hoarseness, dryness, or secretion of thick, 
tough phlegm; worse in the afternoon and evening, better from eating and 
drinking warm things. 

Aium triph. Constant hawking; profuse secretion from posterior nares 
and fauces; hoarseness, worse from talking. 

Arg. nitr. Collection of thick, tough phlegm, causing gagging; wart- 
like excrescences; feeling of a pointed body in the throat when swallowing, 
belching, breathing, or moving the neck. 

Arnica. Great hoarseness from preaching or public speaking. 

Caustic. Burning in the throat, worse on stooping; hoarseness from 
singing. 

Elaps. Sore throat, offensive discharge from the nose, occasional epis- 



266 THERAPEUTIC HINTS TO CHRONIC SORE THROAT. 

taxis. Posterior wall of throat covered with a dry, greenish-yellow mem- 
brane, wrinkled and fissured, which extends to the nares. Occasionally 
portions of it become detached and are expelled either by mouth or nose. 
Stuffiness at root of nose and dull aching from there to forehead. Smell 
gone. Catamenia generally profuse and dark. 

Kali bichr. Secretion of very ropy or stringy phlegm through the pos- 
terior nares and fauces. 

Laches. Much inclination to swallow, although it is very painful, with 
spasmodic contraction of the throat; worse on left side, and worse after 
sleep; can't bear any pressure about the neck. 

Lycop. The fauces look brown-red; worse on right side; sometimes a 
hard green-yellowish phlegm is hawked up in the morning. 

Natr. carb. Slight redness and continual sensation of rawness and 
scraping; diminished secretion, with constant desire to hawk and hem; collec- 
tion of mucus in the night; painfulness of throat on swallowing and gaping. 

Natr. mur. Always after local applications of nitrate of silver; feel- 
ing of great dryness in the throat, and yet a constant hawking up of a trans- 
parent, thin mucus. Sensation of a plug in the throat; uvula elongated; 
the action of the muscles of deglutition is diminished; the food goes the 
wrong way, or does not go down at all. 

Petrol. In dry, sore throat, with mucous secretions; stitches into the 
ears during deglutition, and burning in the neck. 

Phosphor. When the throat is very dry, fairly glistening. 

Plumbum. When the disease spreads from left to right. 

Phytol. Dryness, feeling as if a ball of red-hot iron had lodged in the 
fauces when swallowing; can't eat hot fluids; choking sensation. 

Sapo sodcE. After scalding the throat by swallowing hot things. 

The following hints in the form of a repertory have been prepared by 
Dr. F. M. Selfridge: 

Uvula and fauces dark red, Arg. nitr. 

Uvula elongated, Bromium, Vlyethia. 

Swelling and elongation of the uvula, /odium, Kali hy dr. 

Uvula relaxed, with a sense of a plug in the throat, not relieved by 
swallowing, Kali bichr., Laches. 

Uvula elongated, fauces purple and swollen, Laches. 

Thick, tenacious mucus, obliging him to hawk, Arg. nitr. and Merc, 
iod. ; mucus cannot be raised by hawking, Caustic. ; mucus in fauces and 
posterior part of the pharynx, mornings, difficult to hawk up, Kali carb. 

Rawness, soreness and scraping in the throat, Arg. nitr., Caustic. 

Wart-like excrescences in the throat, feel like pointed bodies when 
swallowing, Arg. nitr. 

Posterior wall of the pharynx dark red, glossy, puffed, showing pale 
red vessels, Kali bichr. 

Burning and dryness of fauces and pharynx, Arg. nitr., Sanguin., 
Wyethia. 



THERAPEUTIC HINTS TO CHRONIC SORE THROAT. 267 

Burning in pharynx, extending to stomach, Kali bichr., Sanguin., 
Wyethia. 

Dryness of roof pf mouth, fauces and throat, Bellad., Wyethia. 

Throat feels raw and sore, looks red and shining, Bellad., Sanguin. 

Throat feels constricted, as if tied, Laches, or Iodium. 

Dryness of the throat posteriorly, Caustic., Wyethia. 

Constant hemming to clear the throat, Wyethia; of tough phlegm, 
Iodium. 

Must swallow continually; feels as if the throat was too narrow, Caustic. 

Must swallow on account of the dryness of the throat, yet without 
affording relief, Wyethia. 

Throat dry, with frequent empty swallowing, Iodium, Mercur., 
Wyethia. 

Salivary glands much swollen, Iodium, Mercur. 

Constant urging and desire to swallow, Bellad. 

Increased flow of tough, ropy saliva, Wyethia. 

Dryness in the posterior nares, Wyethia. 

Sensation as if something was in the nasal passages; an effort to clear 
them through the throat affords no relief, Wyethia. 

Difficult deglutition, Bellad., Wyethia. 

Swelling of mucous membrane of fauces and pharynx, Bromium, 
Wyethia. 

Mucous follicles swollen, giving a granular appearance to pharynx, 
Wyeth ia. (Clinical . ) 

Tonsils swollen and inflamed, Bromium. 

Inflammation of the throat, with burning pain, Iodium. 

Ulcers on fauces, discharging cheesy lumps of offensive smell, Kali bich? . 

Hawking of mucus, with pain in throat-pit, Caustic. 

Hawks copious blue mucus in the morning, Kali bichr. 

Dry cough, with tickling in the larynx, Bellad. ; in the throat-pit, San- 
guin. ; large quantities of mucus, Iodium. 

Paroxysms of cough, brought on by phlegm in the larynx, Kali car b.\ 
by fits of passion or laughing, Arg. nitr. 

Cough, with copious green sputa, Kali hvdr. 

Cough, with involuntary discharge of urine, Caustic. 

Internal soreness of larynx and throat-pit; worse in morning, Arg. nitr. 

Internal soreness of larynx, painful to touch, Bromium. 

Hoarseness, Arg. ?iitr., Bellad., Bromium, Kali bichr. 

Hoarseness, with rawness and dryness of larynx, Laches. 

Hoarseness, worse in morning and evening, Caustic. 

Hoarseness, lasting all day, Iodium. 

Hoarseness, with pain in chest, Kali hydr. 

Chronic laryngitis of singers, raising the voice causes coughing, Arg. nitr. 

Dry hacking cough, caused by tickling of epiglottis, Wyethia anH 
Bellad. 



268 



DIGEST TO ACUTE AND CHRONIC INFLAMMATION OF THROAT. 



Digest to Acute and Chronic Inflammation of Throat. 



Dryness of fauces: Aeon., Alum., Arg. 
nitr., Caustic, Pulsat., Sanguin., 
Wyeth. 

, glistening, shining; Bel lad., Phos- 
phor., Kali bichr., Sanguin. 

and constricted: Sanguin. 

, feels as if mucous membrane would 

crack: Sanguin. 

, with burning, stinging and drawing 

in the throat, making swallowing pain- 
ful: Aeon. 

, with frequent empty swallowing: 

Iodinn, Mercur., Wyeth. 

, with abundant mucus at the same 

time: Petrol. 

, not relieved by drinking: Sanguin. 

of posterior nares: Wyeth. 

of roof of mouth and throat : Bel I ad. , 

Wyeth. 

Burning 1 : lodum. 

and stinging: Aeon., Apis. 

Soreness, rawness and scraping: 
Arg. nitr., Bellad., Caustic., 
Natr. carb., Nux vom., Sanguin. 

, without thirst: Pulsat. 

and red: Bellad., Natr. carb , 

guin. 

Redness, dark: Arg. nitr. 

and bluish with varicose 

Pulsat. 

, puffed, pale red vessels: Kali 

Redness, brownish: Lycop. 

, purple and swollen: Laches. 

, scarlet: Bellad. 

and inflamed: Sanguin. 

, with burning: lodum. 

and swelling: Mercur. 

without swelling of tonsils: Merc. 

corr. subl. 

Swelling of mucous membrane of fauces: 
Bromium, Wyeth. 

MUCOUS follicles swollen, granular ap- 
pearance: Wyeth. 

Ulcers on fauces discharging cheesy 
lumps of offensive smell: Kali bichr. 

Wart-like excrescences, feel like pointed 
bodies when swallowing: Arg. nitr. 



Alum., 
Elaps, 



S#n- 



bichr 



, thick and tough: Alum. 

, causing gagging: Arg. nitr. 

, obliging to hawk: Arg. nitr., Merc. 

sol. 

, hard and green: Lycop. 

, dry, greenish-yellow membrane, 

wrinkled and fissured, extending to 

nares: Elaps. 
Secretion in fauces and posterior nares, 

ropy, stringy, Kali bichr. 

, difficult to hawk up: Kali carb. 

, profuse: Arum triph. 

of soapy saliva: Apis. 

, tough, ropy saliva: Wyeth. 

, slime and saliva flowing from mouth: 

Merc. sol. 
Uvula elongated and swollen: Bromium, 

Lodum, Kali hydr., Wyeth. 

and fauces purple: Laches. 

, dark red: Arg. nitr. 

, with a sense of a plug, not relieved 

by swallowing: Kali bichr., Laches. 
Redness and swelling of uvula, tonsils 

and tongue: Apis. 
Tonsils swollen and inflamed: Bromium. 
with a smeary concretion on them: 

Merc. sol. 
, with whitish, tough mucus on them 

in spots, simulating diphtheria: Lgnat. 
Salivary glands swollen: Lodum, Mercur. 



Secretion in fauces of mucus, in the 
night: Natr. carb. 

, large quantities: lodum. 

, copious, blue: Kali bichr. 



Throat feels constricted: Laches. 

, as if tied; Lodum, Laches. 

, sore to touch, can't bear any pressure 

about neck: Laches. 
Choking sensation: Phytol. 
Lump, plug, hard body, as of a: Apis, 

Lgnat., Laches., Natr. mur. 

, when swallowing: Nux vom. 

Pointed body when swallowing, belching, 

breathing or moving head: Arg. nitr. 
Ball of red-hot iron, as of a, when 

swallowing: Phytol. 
Hoarseness : Alum., Arg. nitr., Bellad., 

Bromium, Kali bichr. 

, < morning: Caustic. 

, < evening: Carb. veg. 

, all day: Lodum. 

, from public speaking, talking: 

Arnica, Arum triph. 
, sinsrinsr: Caustic. 



DIGEST TO ACUTE AND CHRONIC INFLAMMATION OF THROAT. 



269 



, with rawness and dryness of larynx: 

Laches. 
, with pain in chest: Kali hydr. 



Constant urging to swallow: Bellad., 
Laches., Mercur. 

Constant desire to swallow, though diffi- 
cult and painful, with spasmodic con- 
traction of throat: Laches. 

Must swallow, feel as if throat were too 
narrow: Caustic. 

, on account of dryness of throat, 

affording no relief: Wyeth. 

Deglutition painful: Apis., Bellad., 
Natr. card. 

, cannot eat hot fluids: Phytol. 

, with dryness and a feeling as if a 

ball of red-hot iron had lodged in 
throat: Phytol. 

, as if a pointed body in the throat: 

Agr. nitr. 

Throat painful on swallowing and gap- 
ing: Natr. card. 

, and belching, breathing and moving 

the neck: Arg. nitr. 

Deglutition difficult: Bellad., Wyeth. 

, the food goes the wrong way, or 

does not go down at all: Natr. mur. 

impossible: Apis. 

, fluid escaping through nose: Bellad. 

Pain in throat, worse between the acts of 
swallowing: Capsic, Ignat. 

Hawking" and hemming constant: Arum 
triph., Natr. card., Wyeth. 

of tough phlegm: Loduni. 

, with pain in throat -pit: Caustic. 

of transparent, thin mucus with great 

dryness in throat: Natr. mur. 

, caused by a feeling as if something 

were in the nasal passages, which is not, 
relieved by hawking: Wyeth. 

, does not raise the mucus: Caustic. 



Irritable: Bryon. 

Impatient and restless: Aeon. 

Headache, and congestion to head: 
Bellad. 

Stitches extend to ears: Bellad. 

Red face : Bellad. 

Stuffiness at root of nose and dull ach- 
ing from there to forehead: Elaps. 



Offensive discharge from nose, occasional 

epistaxis: Elaps. 
Pain in parotid glands and muscles of 

neck: Mercur. 
Swelling of cervical glands: Bellad. 
Tongue heavily coated, whitish: Merc. 

sol. 

, dirty, yellowish: Bryon. 

Insipid, pappy taste: Bryon. 
Great thirst and costiveness: Petrol. 
Gastric derangement and costiveness: 

Bryon. 
Catamenia generally profuse and dark: 

Elaps. 
Cough, dry, hacking from tickling of 

epiglottis: Bellad., Wyeth. 

, with tickling in larynx: Bellad. 

in throat-pit: Sanguin. 

in paroxysms from phlegm in larynx : 

Kali carb. 

from fits of passion or laughing: 

Arg. nitr. 

, with copious green sputa: Kali 

hydr. 
, with involuntary discharge of urine: 

Caustic. 
Internal soreness of larynx and throat- 
pit, better in morning: Arg. nitr. 

, painful to touch: Bromium. 

Chronic laryngitis of singers, raising the 

voice causes coughing: Arg. nitr. 
Fever: Aeon., Bellad. 

, better in evening: Merc. sol. 

Throat symptoms worse on left side: 

Laches. 

, right side: Lycop. 

, spread from left to right: Laches. 

Plumbum. 

, right to left: Lycop. 

, worse in afternoon: Laches. 

, and evening: Alum. 

, in morning after sleep: Laches. 

, from motion: Bryon. 

Better from eating and drinking warm 

things: Alum. 
Brought on by taking cold: Nux vom. 

cold west and northwest winds: 

Aeon., Hepar. 

swallowing hot things: Sapo sod. 

After local applications of Nitrate of 
silver: Natr. mur. 



2JO ULCERS IN THE FAUCES. 

Ulcers in the Fauces, Ulcerated Sore Throat. 

Chronic catarrh may terminate in ulceration; or the ulcers may be the 
consequence of a scrofulous diathesis; or they may have a syphilitic origin. 
The diagnosis of these different conditions might be accurately determined 
by a correct history. Besides, the diagnosis will be facilitated by considering 
that catarrhal ulcers are superficial; the scrofulous ulcer is deep, but has 
flabby, perhaps jagged edges, which do not project, the syphilitic ulcer, 
however, is deep and rounded, with elevated serpiginous and defined bor- 
ders. 

Therapeutic Hints. 

Compare Angina Faucium. 

Alum. The inflamed parts are spongy; the ulcerated surface secretes a 
yellow-brownish, badly-smelling pus; a boring pain from the fauces to the 
right temple and head. 

Aiirum. Putrid, cheese-like smell from the mouth; deep ulcers affect- 
ing the bones; after the abuse of mercury. 

Baptis. Putrid, dark-looking ulcers; fetid breath; great prostration. 

Hepar. After the abuse of mercury in syphilis. 

Hydrast. Extensively used by western Homoeopathic physicians for 
ulcerated sore throat; no characteristics given. 

Kali bichr. Deep ulcers, eating even through the velum palati; 
bones of the nose affected ; fetid discharge from the nose; sypihlitic origin. 

Kali hydr. Syphilitic and mercurial cachexia combined. 

Laches. Spasmodic contraction of the fauces when swallowing, etc. 
Compare Inflammation of Fauces. 

Mercur. Ptyalism, fetid smell; secondary syphilis. 

Nitr. ac. After the abuse of mercury ; syphilis. 

Sanguin. Rush of blood to the head; flying heat; throbbing in the 
head, from the nape upwards; distended veins in the temples. 

Retro-pharyngeal Abscess. 

This affection is either an acute suppuration of the connective tissue 
between the posterior wall of the fauces and the vertebrae, occurring not 
unfrequently in children up to the tenth year of age, or it is the consequence 
of diseases of the cervical vertebrge, such as caries, fracture, especially of 
the atlas and axis. Acute suppuration of the retro-pharyngeal connective 
tissue usually takes a rapid course and develops symptoms like phlegmonous 
sore throat, in varying degrees of intensity, such as fever, sleeplessness, 
dyspnoea, difficulty in deglutition, pain increased on motion of the head, 
stiffness in holding the head, spasms in young children, and convulsive par- 
oxysms. 

Suppuration from vertebral affections is much slower in its course and 
its symptoms are less prominent, with the exception of an inability to turn 
the head and the difficulty of swallowing. 



DEEP INFLAMMATION OF CONNECTIVE TISSUE OF THROAT. 27 1 

The abscess, left to itself, opens spontaneously and discharges its contents 
into the lower pharynx; or fistulous tracks are formed towards the thoracic 
cavity, or towards the skin of the neck. 

A fatal termination may ensue by suffocation from the discharge into 
the larynx, especially during sleep; or from compression of the larynx by 
the enormous size of the tumor; or from secondary disease of the larynx or 
thoracic organs caused by descent of pus in the thorax. These various 
possibilities determine our prognosis. 

Its Diagnosis we can make out by inspection and palpation, as its 
location (posterior wall of fauces) distinguishes it from amygdalitis; or the 
symptoms of vertebral affections render it at once distinguishable from other 
complaints. 

Therapeutic Hints. 

Main remedies: Hepar., Silic. 

Acute suppuration of the connective tissue: Apis, Bellad., Bryon., 
Laches., Mercur., Pulsat., Rhus tox. 

Affection of cervical vertebrae: Arnica, Asa/., Calc. carb., Hepar., 
Lycop., Mercur., Mezer., Phosphor., Silic, Sulphur. 

Impossibility to swallow; fluids regurgitate through the nose: Aurum, 
Bellad., Laches., Lycop., Mercur., Nitr. ac, Phosphor. 

Deep Inflammation of the Connective Tissue of the Throat; 

Angina Ludovici. 

" It is a very acute inflammation and suppuration of the cellular tissue 
beneath the chin, in the environs of the submaxillary glands, which has 
been named after its earliest describer, 'Ludwig,' and which has appeared 
epidemically at various times." 

The inflammation generally begins on one or the other side of the 
hyoid bone, rarely in the middle, just over the bone. There is extensive 
infiltration, with disposition to undergo purulent or even ichorous degenera- 
tion. Post-mortems have shown the connective tissue and muscles of the 
entire submental region transformed into a semi-fluid, brownish mass, mixed 
with necrotic shreds of connective tissue; the submaxillary and parotid 
glands destroyed by gangrene; the neighboring parts intensely infiltrated, 
even as far as the pharynx and larynx; and the periosteum of the lower jaw 
loosened. m , 

The swelling in the hyoid region sets in with lighter or severer, or 
even complete typhus symptoms; it grows rapidly, gets harder and larger 
until it covers the entire anterior half of the throat as far down as the 
sternum. 

The skin over it is tightly stretched and reddened; the lower jaw be- 
comes immovable and deglutition impossible. Respiration and circulation 
are greatly interfered with by compression of the laVynx, trachea and the 



272 THE MUCOUS MEMBRANE OF THE MOUTH. 

main internal jugular vein, and speech is made difficult or impossible by the 
pressure of the tumor under the tongue, which pushes it to the roof of the 
mouth and renders it immovable. It is attended with headache, vertigo, 
delirium. 

In some cases the swelling may entirely subside without suppuration, 
although absorption goes on but slowly ; in most cases suppuration sets in 
and the result is a shreddy pus, or gangrenous ichor, with subsequent gan- 
grenous destruction, septicaemia, embolism in various organs, death; or in 
more favorable cases fistulous ulcerations, strongly contracting cicatrices, 
which produce torticollis and impeded mobility of the neck, as also caries 
and necrosis of the jaw-bones. 

Its Causes are said to be: topical irritations, catching cold, especially 
during times of prevalent rheumatism and erysipelas; and exanthematic, 
typhoid and puerperal conditions. Of late no epidemics of this kind have 
been observed. 

Therapeutic Hints. 

I find only one case mentioned in our literature, by Dr. J. C. Burnett, 
which was cured by Aeon, and Iodic m, and later Nux vom. and Iodum, in 
alternation. Compare Raue's Annual Record, 1874, page 108. 

I should suppose that Anthrac. and Laches, might be of great service 
in this destructive disease. 

THE MUCOUS MEMBRANE OF THE MOUTH IN GENERAL. 

This is a continuous membrane covering the inside of the cheeks and all 
the organs within the cavity of the mouth except the teeth, lining the fauces, 
and extending thence upwards into the nose and downwards into the 
oesophagus, stomach, and intestines, and by way of the larynx and trachea 
into the finest bronchial tubes. 

Stomatitis. 

The term stomatitis designates an inflammation of the buccal cavity. It 
is most commonly met with in children suffering from gastro-intestinal dis- 
turbances induced by unfavorable hygienic surroundings, hot weather, or 
artificial feeding. It may, however, result from mechanical, thermal, or chem- 
ical irritation; certain drugs; or it may be parasitic in origin. Again it is 
found in certain dyscrasiae such as syphilis, scorbutus, etc. 

Catarrhal Stomatitis, 



Is the simple acute variety characterized by a diffuse swelling of the buccal 
mucous membrane, and does not terminate in ulceration. Slight constitu- 
tional disturbance generally co-exists. 

Parasitic Stomatitis ; Thrush. 

This affection is produced by a parasitic fungus, the oidium albicans, 
and is characterized by the formation of numerous, milk-white patches or 



PARASITIC STOMATITIS. 273 

elevations which are difficult to remove. They are not the result of an 
exudative inflammation, but due to the extensive development of the above 
named fungus within the mucous membrane. 

We may frequently foretell its coming, when we observe that the mouth 
of the infant is getting dry, hot, red and sticky and its secretion gives an 
acid reaction. Then after a few hours white points of the size of a pin's head 
appear mostly at first on the inner surface of the cheeks, quickly spreading 
over various other places and soon covering in some cases the entire buccal 
cavity, and even the pharynx and oesophagus with a white membrane. 
After a while its white color turns yellowish or brown if bleeding occurs from 
rough handling. The first few days this membrane adheres firmly to the 
mucous membrane; later, on about the third or fourth day, it becomes loose 
and can easily be wiped away. 

According to Reubold this fungus confines itself to the squamous epi- 
thelium solely, and therefore the larynx, trachea, and the nasal cavities, the 
stomach and intestines remain free from it. It has been found, however, on 
the lowest portions of the rectum, upon the female genitals, and excoriations 
of the external skin, especially in the vicinity of the mouth, on the chin and 
neck. 

During the continuance of this fungous growth the mouth of the nurs- 
ling is hot, has an acid reaction and is sensitive to touch in a degree that 
even nursing sometimes is painful to the child. But as long as the affection 
is not complicated with intestinal catarrh, its course is quite mild and short, 
and passes away in a few days if proper attention is paid to cleanliness. 
Even if a reproduction should occur, it offers no special difficulty to cleans- 
ing and leaves the substance of the mucous membrane intact. 

It is different with artificially fed children when an intestinal catarrh 
is superadded to the trouble. Under it the child may sink with signs of a 
follicular enteritis. 

Causes. — The formation of this fungus is favored by acid fermentation. 
The secretion of the mouth is a mixture of saliva and mucus. The saliva is 
of alkaline reaction, more so after a meal, less so on an empty stomach. The 
buccal mucus, however, has an acid action, which is visibly increased on con- 
tact with atmospheric air, when acid fermentation at once begins. In young 
infants the secretion of mucus is in preponderance over the secretion of saliva; 
there is therefore a physiological tendency to acidity in a young child, and if, 
in addition to it. the child is nourished artificially and improperly by sub- 
stances which easily undergo acid fermentation (sucking-bags, poor milk from 
badly cleansed bottles, etc.,) an outbreak of thrush is sure to follow. We 
find, therefore, that thrush attacks more frequently children artificially fed 
than those who suck their mothers' breast, and for this additional reason that 
the latter in sucking draw the saliva out of their salivary glands, while the 
easy flow from the bottle requires nothing but swallowing. I would rather 
have the baby fed by the spoon, as in this way chewing motions are induced 
and a more thorough mixture of the food with saliva is insured. 
18 



274 STOMATITIS ULCEROSA. 

We find thrush also in adults, but it is of rare occurrence, and then 
always in consequence of protracted and exhausting diseases, such as phthisis, 
diabetes, cancer, etc. — setting in shortly before death. Its pathological 
character is identical with that described above, and its causes are the same 
— anomalies in the chemical composition of the fluids of the mouth, accele- 
rated acid fermentation and absence of the movements of chewing. 

Therapeutic Hints. 

The remedy must be chosen according to existing symptoms which ac- 
company this affection. 

Wash the mouth always after nursing with a rag dipped in water or a 
mixture of wine and water. 

sEthusa. Vomiting of milk in lumps; diarrhoea. 

Arsen. In adults and children; great burning, exhaustion, deep illness. 

Baptis. Last stage of consumption. 

Borax. Great heat and dryness in the mouth. 

Chamom. Child is fretful, wants to be carried about all the time; has 
colic, and green, sour stools. 

Hepar. When worse on inside of lower lip. * 

Mercur. Confluent thrush, changing into cankers; ptyalism; bad smell 
from the mouth; feverishness; green slimy stools. 

Staphis. Thrush changing into canker-sores with a bluish-red or yel- 
lowish bottom; more or less flow of saliva and bad smell. 

Sulphur. Sour smell from the mouth; stools slim}' with much straining, 
or painless; worse in the morning. 

Sulph. ac. After borax, increased flow of saliva, yellowish color of the 
skin. 

Stomatitis Ulcerosa ; Formation of Ulcers in the Cavity of 

the Mouth. 

Aphthae, or Cankers of the mouth. They are either the consequence 
of Catarrhal erosions, forming ulcers of a superficial nature; or of Follicu- 
lar inflammation, producing ulcers of greater depth; or in connection with 
Labial herpes or Hydroa, when they evidently have the same etiological 
significance. Aphthae occur chief!}' in children. The follicular form is fre- 
quently found in women during menstruation, pregnane}* or lactation. 
Often a few 7 hours are sufficient to bring about aphthous ulcers. They are 
chiefly situated on the mucous membrane of the lips and cheeks, especially 
where it is reflected on the gums, less frequently on the gums themselves, 
on the palate, or on the tongue. Their floor is whitish, yellow, their edges 
are reddened, somewhat raised, on account of the adjoining catarrhal stom- 
atitis; they are of an oval form and may attain the size of a bean. The 
follicular ulcers are small, circular and excavated. All cause great sensi- 
tiveness of the mouth, interfere materially with speaking and chewing, and 
are attended with an increased secretion of mucus and saliva, which, how- 



THERAPEUTIC HINTS TO STOMATITIS ULCEROSA. 275 

ever, is not marked by any great intensity of nauseous odor, as we always 
find in Stomacace, or Putrid sore mouth, which is a destructive ulceration of 
the border of the gums, producing extensive swelling of the entire mouth 
and a cadaveric breath. It is mainly a disease of children, after their first 
dentition has been completed, but not found very frequent in private prac- 
tice. Apart from children it has appeared epidemically among soldiers. 
Very often, when it appears sporadically, its cause can be traced to the abuse 
of mercury, or an enfeebled state of the S3^stem, uncleanliness, poor food, 
and atmospheric influences. The morbid process usually begins at the mar- 
gin of the gums of the lower jaw, creeps gradually backwards, and attacks 
somewhat later those portions of the mucous membrane of the lips, cheeks, 
and tongue, which are in direct contact with the affected gums. The surface 
of the tongue, the hard and soft palate, as well as the pharynx, remain free 
from it. It is characteristically marked by great fetor, and a profuse, dis- 
tinctly acrid secretion, flowing constantly from the mouth. On pressure the 
gums bleed easily, or bleed spontaneously, coloring the saliva brownish-red. 
The tongue is thickly coated and swollen, showing distinct impressions of 
the teeth. The adjacent lymphatic glands are also tumefied. The fever 
attending it is ordinarily but slight. 

Ulcers dependent on some dyscrasia, such as syphilis, scrobutus, etc., 
will be spoken of in their respective places. 

Therapeutic Hints. 

Aphthae. Cleanliness and attention to the general hygiene of the 
patient is of great importance in treating these affections. The indicated 
remedies are: 

Arum triph. Superficial ulceration; tumefaction of lips; catarrhal 
burning and biting sensation in mouth and throat. 

Calc. catb. During dentition. 

Hydrast. Follicular and catarrhal ulcers with exceedingly tenacious 
mucus in the mouth. 

Laches. Canker sores on tip of tongue. 

Lycop. Under the tongue near the fraenulum. 

Mercur. On the gums, with ptyalism. 

Natr. mur. On tongue, gums and cheeks with great burning and im- 
peded speech. 

Nux vom. Gums inflamed, putrid smell from mouth; constipation. 

Sulphur. After Nux vom., or Mercur. ; bloody saliva; disturbed sleep. 

Sulph. ac. On gums which bleed readily; ptyalism; great weakness; 
ecchymosed spots on skin. 

Stomacace. 

Arsen. Edges of tongue ulcerated with great burning and pain; diar- 
rhoea and great prostration. 

Baptis. Gums ulcerated, loose, dark red or purple; intolerable fetid 
breath; can swallow only liquids; loose, offensive stools; after abuse of 
mercury. 



276 NOMA. 

Hcllcb. Sores flat, yellowish, with raised edges upon an inflamed basis; 
ptyalism; fetid smell from the mouth; glands swollen on neck and under 
the jaw. 

Hepar. After abuse of mercury. 

Kali mur. Main remedy of the old school. 

Mercur. Ulcerated gums, tongue and cheeks; loose teeth; fetid smell. 
Burning pain, worse at night; diarrhoea with tenesmus. In fact it is proven 
to have produced this disease in its worse forms; it must, therefore, in many 
idiopathic cases, be almost specifically indicated. 

Nitr. ac. After the abuse of mercur}' with fetid and acrid saliva, 
which causes sores on lips, chin and cheeks. Pustules with red circumfer- 
ence, here and there on body. 

Nux vom. Ulcerated gums, foul and painful swelling of gums; pim- 
ples and painful blisters in the mouth; ptyalism at night, bloody saliva; 
fetid odor from mouth; constipation. 

Phytol. Edges of tongue ulcerated, tip very red; secretion of mouth 
very thick and tenacious. Mercurial ptyalism. 

Rhus tox. Great restlessness, especially in the night; bloody saliva 
runs out of the mouth. 

Rhus venenata. The mucus membrane of cheeks, tongue and fauces is 
reddened, and feels as if it had been scalded, with stinging pains. 

Staphis. Ulcers with a bluish-red or yellowish bottom; gums swollen, 
painful, spongy, bleeding readily; increased bloody saliva; fetid breath. 

Sulphur. Gums ulcerated, swollen, receding and readily bleeding; 
bloody saliva; fetor; diarrhoea; sleeplessness. Frequently indicated after 
Nux vom. 

Noma, Gangrene of the Cheeks. 

The first symptom of this malignant but rare disease is a small blister, 
situated in the middle of the cheek or toward the corner of the mouth on the 
inside of the cheek. It is filled with a pale reddish or turbid grayish or 
brownish fluid. It bursts so soon that its formation is mostly overlooked, 
and appears afterwards as a superficial ulcer with an unclean basis, soon 
assuming a gangrenous character. Simultaneous^ 7 with this blister, under- 
neath it, a small lump is found, which may be felt even outside on the cheek, 
which consists of infiltrated cellular and adipose tissue. Now the gangre- 
nous destruction goes on rapidly, and on the outside appears an cedematous 
swelling of the diseased cheek, often shining, fatty or oily, or appearing 
livid, pale or marbled. By and by there is also formed outside, mostly on 
the middle of the cheek, an inflamed spot or blister upon a hard basis, which 
soon covers itself with a dark crust. This crust being removed, gangrenous 
ulceration appears under it, like that on the inside of the cheek, which 
spreads with the same rapidity, destroying in a short time the greater part of 
the affected side of the face. 

The general and concomitant symptoms seem at first to indicate nothing 



NOMA. 277 

alarming. Generally the glands of the neck swell and the face has a pale, 
cachectic aspect. Eventually, however, there is a general sinking of 
strength, diarrhoea sets in, and death may ensue from exhaustion, before the 
gangrenous destruction extends over the whole cheek. 

This disease is mostly found in childhood, and always in sickly chil- 
dren, or after scarlet fever, measles, typhus, and sometimes after smallpox. 
Adults are ver} T seldom attacked by it, and then it appears only after typhus 
or puerperal fever, and especially after the abuse of mercury. 

Therapeutic Hints. 

The main remedies recommended are: Arsen., Helleb., Secale, China, 
Card, veg., Kali phosph. (Schiissler.) 



NECK 



General Observations. 

Ocular inspection of the neck externally, as a whole, presents various 
noticeable features. 

A short and thick neck, in consequence of hypertrophy of its muscles, is 
found in emphysema of the lungs. 

A long thin neck mostly accompanies tuberculosis. 

A spasmodic contraction of the neck backwards denotes meningitis, with 
exudation on the base of the brain. 

The external jugular vein puffs out in the triangular space, which is 
called the interstitium intersterno-cleido-mastoideale, in all cases where the 
free circulation of the blood through the thoracic cavity is interfered with, as 
in diseases of the heart, and in consequence of continued violent coughing, 
screaming, singing and the like. A pulsation of this vein is observed in 
insufficiency of the tricuspid valve. 

The carotid artery is seen to pulsate more strongly in feverish condi- 
tions, and where there is obstruction in the circulation within the brain; its 
jumping pulsation is a sign of insufficiency of the valves of the aorta; 

The Acromial and suprasternal regions sink in when the upper parts of 
the lungs shrink; and 

These regions become inflated during inspiration or expiration, when 
emphysema or caverns exist in the upper parts of the lungs; also during 
capillary bronchitis of infants. 

Swellings of the neck are of various nature: 

They are emphysematous when, in consequence of internal or external 
injuries of the larynx or trachea, air penetrates into the subcutaneous cellular 
tissue; or when, in consequence of a rupture or laceration of the lungs, the 
air is forced through the mediastinum into the cellular tissue of the neck. 

They are oedematous in case of general dropsy, or when, by tubercular 
or scirrhous tumefaction of the lymphatic glands, the vena jugularis or 
anonyma becomes compressed; this causes at the same time an oedema of 
the face, or of the arm. 

There is a swelling of the lymphatic glands, either by infiltration with 
tubercular or scirrhous masses, or by becoming involved, secondarily, in 
inflammatory processes of the mouth, throat, face or scalp, of which we have 
spoken. 

Parotitis or mumps appear on the upper part of the neck in front and 
below the ear, while 



BRONCHOCKIvK. 279 

Bronchocele, Struma or Goitre, 

Which is an enlargement of the thyroid gland, appears lower, sometimes on 
one, sometimes on both sides of the neck. Simple enlargement or hyper- 
trophy of this gland is, according to Porta, found only in children and young 
persons, while in older persons struma is always a degeneration of this 
gland, consisting in formations of cysts, which contain a thick, gummy, 
jelly-like substance, of a yellow or brownish color, and which are known 
under the name of colloids. According to Schuh, these colloids are either 
interspersed between the substance of the gland, or they form separate round 
or oval appendages upon the gland, without involving the gland itself into 
the morbid process. 

The struma of new-born children consists, as above mentioned, in a sim- 
ple enlargement of either the entire gland or of one of its lobes, and inter- 
feres, sometimes seriously, by its pressure upon the trachea, with the child's 
respiration. In severe cases it may produce death in a day or two, or even 
a few hours after birth. This is especially the case should the swelling 
extend under the sternum, or the sternal portion of the clavicle, or in case 
the muscles underneath the hyoid bone prevent its extension exteriorly. 

In regard to the combination of struma with tubercolosis we may say 
that, where struma is developed, there tubercular affection of the lungs may 
be found, but they do not reach the stage of softening or phthisis, so that 
struma excludes tubercular phthisis. 

Basedow's or Graves' disease has been treated of, under the chapter on 
the eyes. 

Therapeutic Hints. 

Bellad. Heat and rush of blood to the head; pain in swallowing; gland 
painful to touch. 

Bromium. In juvenile subjects, with light hair, blue eyes, fair skin. 

Calc. carb. In scrofulous persons, worse towards new moon. 

Egg shell, divested of its inner coating, finely triturated, has been used 
successfully. 

Fitcus vesiculosus. (R. N. Foster. ) 

Iodium. Inveterate cases; the harder they feel, and the more other 
symptoms are wanting, the more Iodium is indicated; dark hair, dark eyes, 
dark skin. 

Natr. carb. Pressing pain; round, hard swelling on the upper right 
part of the gland. 

Natr. mur., and also Natr. sulph. have been given with success. 

Spongia. Is recommended by Hahnemann for goitre in persons who live 
in valleys. Besides compare: Ambra, Amm. card., Badzaga, Calc. flour,, 
Calc. Jod., Caustic, Hepar, Kali, jod., Laches., left side; Lycop., right side; 
Rhiis tox., after hard straining; Sulphur. 



28o OESOPHAGUS. 



(ESOPHAGUS. 



The lower part of the pharynx narrows back of the laryngeal entrance 
into a tube through which the food in the act of swallowing is carried into 
the stomach. This tube is called oesophagus. Its inner wall lies entirely 
out of the reach of ocular inspection; and we must infer from other symptoms 
what its conditions are. The introduction of the probe, or bougie, teaches 
by mediate palpation merely, whether the passage is open or closed, and if 
closed, at what point; and if it brings up in its fenestra some morbid prod- 
ucts encountered during its passage, it may also aid us in our diagnosis. 
Auscultation, first practiced by Hamburger, has thus far had no great prac- 
tical results. 

(Esophagitis, Dysphagia Inflarnmatoria. 

The mucous membrane of the oesophagus, although a continuation of the 
mucous lining of the fauces, is little disposed to inflammation, because of its 
thick epithelial covering. Still inflammation may set in even here from 
thermal influences (taking cold), from mechanical irritation (by the lodg- 
ment of foreign bodies), and from chemical causes (the destructive action of 
corrosive substances swallowed by accident or design). It may also be in- 
duced by spreading from continuous parts of its mucous membrane (of the 
pharynx or the stomach), or from inflamed parts outside of it, such as the 
vertebrae, the mediastinal connective tissue, or the lymphatic glands. And 
lastly it is found sometimes in cholera, typhus, pyaemia, variola, and scarla- 
tina. All these different forms of inflammation may produce ulcers of the 
oesophagus; the catarrhal form, although the most favorable in this respect, 
may in its protracted chronic form produce dilatation of this organ. Worse 
are the forms produced by corrosion, scalding, foreign bodies, etc., especially 
if they extend to the deeper layers, when danger of stricture from cicatricial 
contraction of the ulcers is always at hand. One of the most constant symp- 
toms of inflammation of the oesophagus in any of its forms is painful deglu- 
tition or even entire impossibility of swallowing with regurgitation of food 
or drink, hence the name Dysphagia inflammatoria. 

Therapeutic Hints. 

Aeon. Violent pain in the middle of the chest through into the back, 
worse from motion. When swallowing, it feels as if the food remained 
lodged in the region of the heart; lying on back impossible. After mechanical 
injury. 

Arg. nitr. After burning with caustic ammonia; fauces red and 
swollen; pain under the manubrium sterni; face red and pupils contracted. 

Arnica. After mechanical injury. 

Arsen. Cramp in oesophagus; burning when swallowing; food ejected 
as soon as it reaches the region of larynx. Chronic form with burning sore- 



STENOSIS CESOPHAGI. 28 1 

ness behind lower end of sternum, worse when swallowing food; can't bear 
closure of dress. 

Baptis. Inability to swallow anything but liquids; great aversion to 
the open air. Oesophagus feels constricted from above down to stomach. 

Bcllad. Pressing pain, like contraction, and a feeling as though a 
foreign body had lodged fast in the oesophagus. 

Canthar. If caused by a burn. 

Capsic. Has caused a dysphagia inflammatoria. 

Kali bichr. Burning in the entire oesophagus; solid food is painful and 
difficult to swallow, leaving a sensation as though something remained there. 

Kali carb. liquids, still less solids, do not descend further than half 
way of the oesophagus, with pressure, stinging and burning in the middle of 
the chest and opposite vertebrae ; gulping and coughing up of watery phlegm ; 
chilliness, dry mouth, nausea. 

Laches. An attempt to swallow solids causes a feeling as though some- 
thing had gone the wrong way, bringing on violent gagging. 

Mezer. Violent burning and soreness in the upper half of the oesoph- 
agus; deglutition painful and difficult, especially after the abuse of mercury. 

Natr. mitr. Only fluids can be swallowed; solid food reaches only a 
certain place, whence it is ejected with fearful gagging and suffocation; 
hawking up of phlegm in the morning; obstinate constipation. 

Nitr. ac. In syphilitic persons. 

Phosphor. Inability of swallowing nourishment; weak and empty 
feeling across the abdomen with occational shooting pain in that region; sen- 
sation of heat extending up the back; great nervous irritability. 

Plumbum. Fluids can be swallowed without difficulty; solids come 
back into the mouth again; some hours after eating, burning in stomach and 
oesophagus; constipation; prostration; emaciation. 

Rhus tox. If caused by corrosive substances. 

Stramon. Constriction and spasm of the muscles of the throat on each 
attempt to swallow; also paralysis of the muscles of the pharynx. 

Stenosis CEsophagi, Narrowing of the (Esophagus. 

This state of things may be congenital (a very rare occurrence) or the 
consequence of compression from morbid changes of neighboring organs, 
such as the glands of the neck and mediastinum, or large strumous masses 
when they extend far back so as to surround the tube; or be caused by 
foreign bodies of various kinds which in the act of swallowing have stuck 
fast, or have gradually grown there, to which latter class belong all fungoid, 
polypous and carcinomous growths; or it may be the consequence of previous 
inflammation and its consequent contracting cicatrices, causing True stric- 
ture of the oesophagus; or it is a mere transient contraction of the muscular 
layer of the oesophagus, chiefly observed in hysterical or hypochondrical 
patients, constituting Spastic stenosis. In all these cases the characteristic 
symptom is difficulty of deglutition. Where the occlusion forms gradually, 



282 DILATATION OF THE OESOPHAGUS. 

the patient at first merely feels some obstruction to the free passage of the 
food, especially if solid, which, however, is overcome by drinking a little 
water or other fluid; gradually, however, when the stricture becomes greater, 
the food does not go down by these means and it is either kept in that 
region of the oesophagus until it gradually works its way through the nar- 
rowed space, or it is ejected. The higher the stricture, the sooner will re- 
gurgitation follow. 

, Therapeutic Hints. 

Bellad. When too large a morsel or a bone incites contraction of the 
oesophagus and holds it fast, Bellad. generally relieves this spasm and lets 
the incarcerated body down. 

Bryon. The patient feels the swallowed food remaining about the 
middle of the chest, in the region of the upper third of the sternum, with 
choking sensation. Solid food must be washed down with water. 

Cicuta. When, after swallowing a sharp piece of bone, the cesephagus 
closes and there is danger of suffocation. 

Cundurango. First dilution; true stricture; burning at the spot where 
the food is arrested in its downward course; the obstruction is constant; lips 
very pale and tongue exsanguine. (J. Compton Burnett.) 

Fluor, ac. The impediment to the swallowed food appears to be in the 
region of the cardia. The swallowed morsel seems to touch a sore spot, 
causing considerable pain. 

Gelsem. Warm fluids, spirituous fluids can partially be swallowed; 
cold drinks come up immediately. (Dr. Erwein.) 

Hydroph. Periodical spasms of the oesophagus, with constant painful 
urging to swallow, but impossibility of doing it; abhorrence of fluids, espe- 
cially of water; burning, stinging in the throat; cough; gagging; difficult and 
incorrect speech. 

Hyosc. Spasmodic contraction after a previous injury of the oesopha- 
gus; solid and warm food can be swallowed best; fluids cause spasms in the 
throat, stop respiration and talking; hiccough, nausea, spasmodic cough, and 
stiffness of the muscles of the neck. 

Naja trip. Spasmodic contraction of the oesophagus. 

Oxal. ac. When there is a great deal of burning in the oesophagus. 

Ver. alb. Spasmodic contraction with suffocation. 

Compare also the remedies under the foregoing chapter. 

Dilatation of the CEsophagus. 

Where there is stricture, the parts of the oesophagus above sometimes 
become dilated from the lodgment of food in that locality; but not always, 
because the muscular layers eject again what cannot pass down. But when 
these muscles lose their contractile power, a dilatation of the tube above the 
stricture is unavoidable. It is greatest just about and above the stenosis and 



DILATATION OF THB (ESOPHAGUS. 283 

diminishes as it ascends. These dilatations of the oesophagus have been 
called Stagnation aktesice. 

Then again dilatations of the oesophagus have been observed without 
any stenosis, either of the whole canal or of only a portion of the same; they 
are usually widest near the middle of the tube. The wall of the oesophagus 
is in some cases thinned, in others thickened by muscular hypertrophy and 
the course of the tube is crooked, its lining membrane at times affected with 
erosions and ulcers, and its inner space filled with a brownish, pulpy mass, 
or small particles of food. " The greater number of these patients had suf- 
fered for many years from severe dysphagia, vomiting, regurgitation of food 
shortly after eating, and repeatedly from actual rumination." (Zenker and 
Von Ziemssen.) Of their remote cause nothing is known. 

A last variety of oesophageal dilatation are the Diverticula, which con- 
sist of protrusions or bulgings of a limited portion of the oesophageal wall, 
forming blind appendages to the normal canal. They are of two kinds: 
first, those which arise from pressure within the canal outward (Pressure 
diverticula,) and secondly, those in which the wall of the oesophagus is 
pulled out by something exercising traction from without (Traction diver- 
ticula.) The first are very rare and almost exclusively situated at the 
lowest part of the pharynx, just at the upper boundary of the oesophagus, 
and on the posterior wall, sometimes exactly in the median line, and some- 
times somewhat laterally. Here the arrangement of the muscular fibres 
greatly favors a separation between their bundles, as they run in parallel 
lines in a very thin layer, transversely, from one side to the other, without 
being interlaced by oblique as above, or by longitudinal fibres as below this 
spot. Here foreign bodies are easily lodged, the continuous pressure from 
swallowing does satisfactorily explain the widening out of this portion of the 
oesophagus. It is an affection of advanced age, and causes great difficulty 
in swallowing, regurgitation of food, and the consequent symptoms of star- 
vation. 

The Traction diverticula are of more frequent occurrence and always 
found at the anterior wall of the oesophagus, mostly at a point corresponding 
to the bifurcation of the trachea, or else close by, above or below it, but 
sometimes also higher up or lower down. The}^ are mostly funnel-shaped 
and of only a moderate depth. Their outside apex is grown to a firm, con- 
tracted tissue by which traction is exercised as from a cicatrix. The start- 
ing point has been an inflammatory swelling of the parts immediately ad- 
joining the oesophagus, leading at first to adhesion with a limited portion of 
the oesophageal wall and afterwards by shrinkage to a pulling out of that 
portion of the oesophagus. It is in fact a disease of the tracheal and bron- 
chial glands, especially those at the bifurcation, incidental even to childhood. 
They do not cause dysphagia, but their ulceration and perforation at the 
apex, which may be set up by irritating substances, pieces of bones, etc., 
collected therein, causes a destructive process in the mediastinum and in its 
further progress may perforate the bronchi, and cause bronchitis, gangrene 



2S4 LARYNX AXD TRACHEA. 

of the lungs, ichorous pleuritis, pericarditis or even perforation of arterial 
trunks. 

The existence of these traction diverticula is in most cases not even 
suspected during life. However a frequent detention of food at a fixed spot, 
pretty low down, particularly the slight delay of granular food, like barley 
or rice, should at least direct the attention of the careful practitioner in that 
direction, notwithstanding such sj'mptoms may have several other explana- 
tions, and be sufficient reason to enjoin upon the patient the use of soft food 
and the habit of drinking after eating in order to wash out any remains of 
food from the diverticulum. 

Therapeutic Hints. 

As dilatations are frequently associated with loss of muscular contractile 
power, the following remedies which have proved beneficial in paralysis of 
the throat, should be consulted: Arsen., Bar. carb., Caustic, Conium, Calc. 
carb., Hepar, Iodium, Mur. ac, Stramon., Ver. alb. 

LARYNX AND TRACHEA. 
Auscultation. 

On putting the ear to the stethoscope, which must be evenly placed 
upon the larynx, we hear the rushing in and out of the air during the act of 
respiration much louder than on an}- other place. It may be imitated by 
blowing with compressed lips through the bore of the stethoscope, and is 
called laryngeal or tracheal respiration, for at the trachea too, it is heard in 
the same degree. 

Some authors lay great stress upon the necessity of auscultating these 
organs. I cannot attach such great importance to it, either diagnostically, 
or still less therapeutically. The only benefit afforded by auscultation in 
diseases of the larynx and trachea, properly so called, is the possibility of 
localizing by it the source of obstruction, if there be any; but whether that 
obstruction arise " from inflammaton' engorgement of the lining membrane, 
from solid effusion upon the internal surface, or from fluid effusion beneath 
it, or in consequence of preceding ulceration any contraction exist, either 
in the rima glottidis, or in the course of the trachea, which gives rise to con- 
striction of the tube, and thereby impedes the free ingress and egress of air, 
or whether a foreign bod}', fixed in the oesophagus and pressing upon the 
trachea, or situated in the trunk itself of the air-passages, or a tumor, or a 
mere spasmodic action, be the cause of this constriction — auscultation telleth 
not. In each of these cases the noise is usually sufficiently obvious, and the 
evidence of obstruction is sufficiently clear, independently of auscultation. 
By the stethoscope we are enabled merely to say that obstruction exists and 
to indicate its seat; but the nature of that obstruction is not revealed by it." 
(H. M. Hughes.) 

Inspection, Laryngoscopy, is of much greater importance. We need 



LARYNX AND TRACHEA. 285 

for its execution a throat mirror and suitable illumination. The throat mirror 
is round and consists of white glass thoroughly polished and well silvered, 
and securely fastened at an angle of 45 ° to a strong rod, one-sixteenth of an 
inch thick and six inches long, which terminates in a suitable handle, five or 
six inches long. The size of the mirror must be suited to the capacity of 
the patient's throat, from four-tenths of an inch to one and a quarter inches 
in diameter is its boundary; the intermediate sizes, say seven-eighths of an 
inch in diameter, are probably the most convenient for general use. 

The illumination may be secured from the direct rays of the sun, from 
diffused daylight, or from artificial light (oil lamp, candle or gaslight). 

The direct rays of the sun and diffused daylight, the best of which comes 
from a window facing the north, thus being reflected from the northern sky 
need no reflectors. With artificial light, reflectors are necessary. They 
are either held with one hand, which scarcely ever is practiced on account 
of its inconvenience, or the}' are fastened upon the forehead of the examiner 
(compare the examination of the nose), or they are screwed, movable in 
ever\- direction, on the handle of the throat mirror (an invention of Dr. Els- 
berg, Clinical Professor of Diseases of the Throat in the University of New 
York), or they are added in different ways to the illuminating apparatus, 
generally complicated and expensive contrivances. 

Of all these means, Dr. Klsberg's seems the simplest and the one most 
easily applied. His directions for the employment of this apparatus, which 
he calls the pocket laryngoscope, are the following: 

" I will first suppose the examination is to be made in the daytime, in 
the absence of direct sunlight. Seat the patient with his back to the window, 
let him open his mouth and protrude his tongue by a strong effort of his will, 
and let him hold the tongue out with his index-finger and thumb of his right 
hand, covered by a handkerchief. As I want to give minute practical direc- 
tions, I must say here that a great deal of awkwardness is prevented by 
placing the handkerchief between the middle and index-fingers, turning it 
over so as to cover the index-finger and thumb spread far apart, and closing 
the little and ring finger upon the handkerchief; the thumb and index-finger 
then taking hold of the tip of the tongue, the thumb should rest against the 
chin, and by an outward and downward movement arch out the tongue. 
When the patient does not succeed in properly holding out his tongue, the 
examiner must hold it with his left hand. The little mirror is warmed until 
the film of condensation which settles upon it passes off; its temperature may 
be ascertained by bringing its metallic back into contact with the examiner's 
cheek or the back of his hand; it is then, without touching the tongue, intro- 
duced into the mouth, taking the uvula upon its back. Keeping the parts well 
illuminated by means of the reflector, on depressing the handle a little, 
the epiglottis will be seen in the mirror; and getting the patient to breathe 
deeply, say "a," laugh " hah, hah, hah! " as heartily as possible, etc., and 
very slightly moving the handle, the various parts of the interior of the 
larynx and neighboring organs will be brought into view. 



286 ACUTE CATARRHAL LARYNGITIS. 

11 When artificial light has to be employed, the patient should sit so that 
it is a little back of him, and on his right side. In all other respects the 
mode of examination is unchanged. The pocket laryngoscope may be used 
with sunlight, or diffuse daylight, or oil lamp, candle or gaslight; and in the 
latter case the ordinary high gas fixture answers the purpose almost as well 
as a drop light or stand. Ten minutes practice familiarizes anyone with its 
use. 

" For auto-laryngoscopy an extra looking-glass is necessary which, when 
the mouth can be illuminated by direct sun or artificial light, may be in the 
handle instead of the reflector; otherwise it must be placed in any convenient 
manner in front of the examiner." 

It will be well to commence practicing this little art either on one's selt 
or another health}* subject, in order not only to aquire the skill of intro- 
ducing the throat mirror and holding it in a suitable position for a full 
illumination of the larynx, but also on account of acquiring a thorough 
knowledge of the parts, their color and movements when in a healthy con- 
dition; abnormal condition will then at once spring into notice. 

Acute Catarrhal Laryngitis, Catarrh of the Mucous Lining of the 

Larynx. 

It ma}* not amount to much more than a rosy injection of the posterior 
ends of the vocal cords and some of the parts adjoining; it may extend to 
the ventricular bands (false vocal cords),- to the arytenoid cartilages, upon 
the epiglottis and into the trachea, causing swelling, redness and ecchymotic 
spots of these parts; it may even terminate in oedema of the larynx and 
hemorrhagic extravasation upon its free surface, or h senior rhagic infiltration 
of the mucous membrane and the submucous connective tissue. These dif- 
ferent states naturally produce different symptoms of the disease. From a 
mere slight huskiness of voice the hoarseness may increase to aphonia, in 
consequence of the greater or less swelling of the vocal cords and the parts 
around them, and the innervation or alteration of the laryngeal muscles. 

The difficulty of breathing, which in adults rarely attains to any great 
degree, may in children increase to gasping and struggling for breath, sim- 
ulating croup, wherefore the name of Pseudo-croup has been adopted by 
most recent writers for this state of affairs. These attacks of stenosis are due 
partly to the relatively great amount of swelling of the mucous membrane in 
comparison with the narrowness of the true and false glottis, and partly to 
the secretion, which dries upon the parts during sleep and increases the 
obstruction. The child then awakens suddenly in the middle of the night 
with a harsh, croupy cough and struggling respiration; the stridor, however, 
is solely inspiratory, and the expiration takes place noiselessly. After the 
secretion is liquified, these symptoms abate. 

The cough, too, varies in its character. We observe paroxysmal, spas- 
modic attacks, resembling whooping-cough, followed by a drawn inspiration, 



THERAPEUTIC HINTS TO ACUTE CATARRHAL LARYNGITIS. 287 

also cough of various sounds and timbre, or without tone, in consequence of 
the greater or less swelling of the vocal cords and their adjoinings. At first 
it always sounds dry but becomes looser as the secretion of the inflamed parts 
increases. In the beginning it is very scanty, clear and transparent, some- 
times mixed with blood in the form of fine streaks, later it becomes more 
abundant and consistent, changing to yellow from the increased number of 
pus-cells. 

There is always more or less pain in the larynx, a disagreeable feeling 
of dryness or irritation, as if from a foreign body. Its severity does not 
always correspond to the amount of the inflammation; the latter may be 
trifling and yet its annoyance great. 

Difficulty in swallowing occurs only when the epiglottis and the pos- 
terior surfaces of the arytenoid cartilages and ary-epiglottidean folds are con- 
siderably implicated in the inflammation. 

Such an acute attack lasts in some cases from five to nine days, in 
others weeks, and in still others it becomes chronic. 

Its Causes are very numerous. A predisposition to it seems to exist in 
persons who perspire easily, who are weakly, cachectic, and who keep them- 
selves too warmly clad, or too much housed up. 

Exciting causes are all irritating agents, such as breathing of cold air, 
dust, acrid vapors, screaming, singing, etc.; taking cold; getting the feet 
cold; sudden exposure of the neck to cold air, etc.; catarrhs, colds in the 
head, influenza, pharyngitis after drinking strong drinks; persons get hoarse 
after debauchery, all showing a spreading from contiguous parts; and some 
constitutional diseases, as measles, exanthematic typhus, syphilis, and 
especially tuberculosis, which latter generally causes a constant disposition 
to "catch cold in the throat." 

Therapeutic Hints. 

Aeon. In the beginning, after exposure to cold west winds ; fever, with 
hot, dry skin, great restlessness and impatience. Waking up in middle of 
the night with croupy cough and breathing, pain in the larynx and great 
anxiety. Also after straining the voice in singing. 

Bellad. Spasmodic barking cough, waking suddenly about midnight; 
pain in larynx, headache, fever, drowsiness; sudden loss of voice. 

Bromium. Rough, scraping feeling in the throat, with oppression of 
breathing; husky, hoarse voice; croupy cough; fair skin. 

Bryon. Cough worse from motion, from entering a warm room, and 
with pain in pit of the stomach. From changes in the weather, either to 
warm or cold. 

Calc. carb. Teething infants; rachitic children. Cough during sleep. 

Carb. veg. Hoarseness worse in the evening; cough coining in spells, 
usually far apart. 

Caustic. Entire loss of voice, or great hoarseness, worse in the morn- 
ing, with rawness and burning in the throat. 



288 LARYNGITIS CATARRHALIS CHRONICA. 

CJiamom. Continued dry cough from tickling in the larynx, worse at 
night; cough during sleep; feverishness; restlessness; impatience; irritable- 
ness. One or both cheeks flushed; hot perspiration about the head. 

Droscra. Constant tickling in the larynx, causing cough and prevent- 
ing sleep at night, ist dil. in water. ( Baumann.) 

Dulcam. When the trouble gets renewed on every sudden change of 
the weather from warm to cold. 

Hcpar. Croup}' cough, worse in the morning; hoarseness; in fall and 
winter from dry, cold west winds. 

Iodiitm. Tickling cough; husky voice; constriction of larynx; worse 
in morning. 

Ladies. Dryness in throat; sore spot on left side of larynx; feeling as 
of a lump in the throat; choking sensation in the throat; cough excited from 
talking, laughing; irritation as if in pit of stomach. 

Mercur. Chilliness during the fever whenever moving the feet to a 
cool place in bed; easily perspiring without improvement; cold in the 
head. 

Nux vom. In the commencement with chilliness, headache, stoppage 
of nose. From exposure to draughts, or sitting in a cold room. 

Phosphor. Constant tickling cough from the larynx, also with head- 
ache, as though it should burst; cough dry; worse from evening until mid- 
night, with tightness across the chest. 

Pulsat. Chilly, thirstless; worse in the evening and in a warm room. 

Rhus tox. Tickling under the middle of the sternum; worse from talk- 
ing or laughing; pain in all the bones worse when being quiet. After strain- 
ing the voice in singing or speaking. 

Rumex. Dry cough in paroxysms, induced by hurried or deep inspira- 
tions, speaking, inhaling of colder air than usual, or any pressure upon the 
trachea in the pit of the throat. 

Sanguin. Highly recommended by Dr. Nichol. 

Spongia. Fever and irritation in throat, with hoarse, croup}' cough, 
worse from evening; breathing wheezy; spells of choking in the middle of 
the night. 

Tart, enict. Rattling cough and breathing; trembling pulse; sticky 
perspiration; no thirst; pale face; peevishness; drowsiness. 

Laryngitis Catarrhalis Chronica. 

The chronic catarrh of the larynx results often from continued exposure 
and neglect of an acute attack, or from a continuous series of irritations by 
overexertion of the voice in talking and singing, or from a chronic pharyn- 
gitis in consequence of the abuse of tobacco and alcoholic stimulants. 

We find swelling and injection of the mucous membrane either limited 
to certain parts, or diffused over the whole organ, with a velvety sponginess 
of its lining membrane. The redness shows less distinctly on the vocal cords 
than upon the other portions of the mucous membrane; the swelling and 



THERAPEUTIC HINTS TO LARYNGITIS CATARRHALIS CHRONICA. 289 

thickening of the vocal cords give to their surface a granulated, and to 
their edges an uneven appearance. The tumefaction of the epiglottis or of 
the ventricular bands, or of the ary-epiglottidean folds, amounts sometimes 
to distortion of these parts. With all this the affected parts are usually 
covered with dilated veins. Ulcerations, except in follicular inflammation, 
perichondritis and oedema, are very rare results of this disease, but on the 
other hand, secondary chronic laryngitis almost always accompanies syph- 
ilis, ulcerative processes, neoplasms, traumatic irritations and perichon- 
dritis. 

This state of things necessarily causes various alterations of the voice 
from slight huskiness, to deep hoarseness and loss of tone. It is always at- 
tended with clearing, hemming and hawking, when speaking, on account of 
the collection of phlegm in the throat, and the sensation of something there 
that ought to be removed. The secretion is either clear, transparent or 
whitish -gray, frothy with minute bubbles, or viscid, ropy or yellowish from 
numerous pus-cells. There is also more or less cough excited by the laryn- 
geal irritation, which, like the voice, is hoarse and of an unusual timbre. 
The subjective sensations are mostly those of rawness, scraping, soreness and 
burning in the larynx, aggravated by use of the voice. 

Therapeutic Hints. 

Any of the remedies detailed under the foregoing chapter may be indi- 
cated here. Besides these, one or the other of the following may be re- 
quired: 

Arg. nitr. Pharyngo-laryingeal catarrh. Weakness and tremulousness; 
palpitation of the heart. 

Arsen. The lining of the larynx more or less injected, puffy or swollen; 
voice oftener husky than hoarse, or dull without resonance or timbre. Sen- 
sation of dryness, fatigue and tickling in speaking; burning in throat. 
Delicac}^ of constitution; disposition to tubercular deposits. 

Calc. carb. The lining of the buccal cavity extremely pale; soft -palate 
and pharynx covered with dilated veins, coloring the parts bluish; throat 
dry, tongue white. Speaks in a whisper; an attempt to talk loud gives a 
muffled sound and causes a short, hoarse barking cough; cough worse from 
evening till midnight. Complexion waxy; lips almost white; face puffy, 
particularly the eyelids, with dark rings around the eyes; hands and feet cold 
and moist. listless disposition; disagreeably impressed by music and noise; 
inability for mental or physical exertion, so weak, is hardly able to walk; 
exertion causes palpitation and breathlessness; night sweats. 

Carb.veg. Swelling of the vocal ligaments; the lining of the larynx, 
and particularly of the ventricular bands, of a dingy purplish tint; hoarse- 
ness w T orse in damp weather and in the evening; loss of voice; expectoration 
moderate; lumpy and easy. Reduced vitality; venous capillary dilatation 
of pharyngo-laryngeal parts, and prevailing torpor of all functions, cold 
knees in bed. 
19 



29O DIGEST TO ACUTE AND CHRONIC LARYNGITIS. 

Caustic. Loss of voice; great hoarseness, worse in the evening; as soon 
as he tries to raise his voice to a higher pitch, it gives ont, or becomes a 
squeak. Hoarseness of singers and speakers. 

Hepar. Tuberculous disposition; scanty, tenacious, mucopurulent 
secretion, with difficult expectoration. Seated pain in one spot of the larynx, 
aggravated by pressure, speech, cough and breathing. 

Iodium. Follicular catarrh, with ulceration; constant tickling cough. 
Great hunger and yet emaciation. 

Kali bichr. Pharynx bluish and with varicose veins; the vocal cords 
and the posterior parts of the larynx are red and puffy and covered with 
grayish mucus; sensation of dryness; tickling in larynx when speaking; 
voice rough and hollow; cough, with scant}-, stringy expectoration, pro- 
voked by speaking or laughing. 

Kali hydr. Arytenoids of a purplish color, tumefied and granular; fol- 
licular ulceration; voice hoarse; sounds above the middle key impossible; 
dry cough; sensation of dryness; burning and tickling in larynx. 

Mangan. Venous dilatation in the throat and pharynx; partial injec- 
tion of the ventricular bands; hoarse voice in the morning, better after clear- 
ing up lumpy mucus; weak, anaemic individuals with disposition to tuber- 
culosis. 

Natr. mur. Follicular inflammation of pharynx; after swabbing the 
throat with Nitrate of silver. 

Nitr. ac. Ulcers in the larynx; toneless voice; previous mercurial 
abuse. 

Phosphor. Lining of vocal cords highly injected with ulceration; sup- 
pressed voice; talking provokes tickling in larynx and spasmodic cough, fol- 
lowed by great dryness and burning in the throat. 

Sanguin. Sensation of dryness, soreness and swelling in the larynx, 
and expectoration of thick mucus; redness in the throat; stoppage of the 
nose, with headache across the eyebrows. 

Sulphur. Cough in the evening, before and when going to bed; catarrh 
of other mucous membranes; disposition to skin affections; suppressed 
eruptions. 

Digest to Acute and Chronic Laryngitis. 



LOCAL SYMPTOMS. , scraping, rough with oppressed 

breathing: Bromium. 

irritation: Spongia. 

red and swollen: Mercur. 



Pharynx red: Sanguin. 

, catarrh: Arg. nitr. 

. follicular inflammation: Natr. mur. 

ulceration: fodum, Kali hydr. ~? h " ° f * ^^ Ch ° king: 

, venous dilatation, bluish color: Calc. aces. 

l /- / z^ i-i;.u^ ir„.,,„„., , spell of chokinsr, in middle of nieht: 

carb., Carb. veg., Rah bichr., Mangan. c ■ 

Throat dry: Arscu., Calc. carb., Laches., tyongia ^ 

Larynx, dryness, burning and tickling: 
Kali bichr., Kali hydr. 



Phosphor. 
Throat burning: Arsen. 
and raw: Caustic. 



, soreness and swelling: Sanguin. 

, constriction: loduni. 



DIGEST TO ACUTE AND CHRONIC LARYNGITIS. 



2QI 



, pain: Aeon., Bellad. 

, seated sore spot, worse from pres- 

sive cough, speech and breathing: 
He par. 

, sore spot on left side: Laches. 

, injected, puffy: Arsen. 

, ulcers: Nitr. ac. 

Vocal cords, swelling: Card. veg. 

, injected and ulcerated: Phosphor. 

, red and puff}* and covered with 

grayish mucus: Kali bichr. 

Ventricular bands, injection: Mangan. 

and purplish: Card. veg. 

Arytenoids, purplish, tumefied, granu- 
lar: Kali hydr. 

Voice, loss of: Card, veg., Caustic. 

, sudden: Bellad. 

, toneless: Nitr. ac. 

, whisper: Calc. card. 

, rough and hollow: Kali bichr. 

, suppressed: Phosphor. 

, husky: Bromium, lodum. 

and hoarse: Bromium. 

, oftener than hoarse; Arsen. 

, dull without resonance or timbre: 

Arsen. 

, sounds above middle key, impossi- 
ble: Kali hydr. 

, raising voice to a higher pitch, it 

gives out, or becomes a squeak: Caus- 
tic. 

hoarse: Bromium, Hepar, Kali 

hydr. 

, worse in evening: Carb. veg. 

, worse in morning: Caustic. 

, worse in morning, better after clear- 
ing up lumpy mucus: Mangan. 

, worse in damp weather: Carb. veg. 

of singers and speakers: Caustic. 

Breathing", wheezy: Spo?igia. 

Cough, worse from evening till midnight: 
Calc. carb., Phosphor., Spongia. 

, barking, spasmodic, waking about 

midnight: Bellad. 

, croupy: Bromium, Spongia. 

, worse in morning: Hepar. 

, waking up in middle of night, with 

pain in larynx, anxiety, fever: Aeon. 

dry: Kali hydr., Phosphor. 

in paroxysms: Rumex. 

from tickling in larynx: Chamom. 

, tickling: lodum. 

from larynx: Dorsera, Phosphor. 

under middle of sternum: Rhus tox. 



, with headache, as though it should 

burst: Phosphor. 

, followed by great dryness and burn- 
ing in throat: Phosphor. 

, with pain in pit of stomach: Bryon. 

, with expectoration, lumpy and easy: 

Carb. veg. 

of thick mucus: Sanguin. 

scanty and stringy: Kali bichr. 

and tenacious, muco-purulent: 

Hepar. 

from irritation in pit of stomach: 

Bryon., Laches., Pulsat. 

, excited by laughing: Kali bichr., 

Laches., Rhus tox. 
, by speaking, talking: Arsen., Calc. 

carb., Kali bichr., Laches., Phosphor., 

Rhus tox., Rumex. 
, by hurried or deep inspiration, or 

inhaling colder air than usual: Rumex. 

by motion: Bryon. 

by pressure upon the trachea in pit 

of throat: Rumex. 

by entering a warm room: Bryon. 

is worse in the morning: Lodum. 

in the evening, before and when 

going to bed: Pulsat., Sulphur. 

from evening until midnight: Phos- 
phor., Spongia. 

at night: Chamom. 

during sleep: Calc. carb., Chamom. 

in spells usually far apart: Carb. 



ATTENDING SYMPTOMS. 

Inability for mental and physical exer- 
tion: Calc. carb. 

Disagreeably impressed by music and 
noise: Calc. carb. 

Irritable: Chamom. 

Impatient: Aeon., Chamom. 

Peevish: Tart. emet. 

Restless: Aeon.,, Chamom. 

Listless deposition: Calc. card. 

Headache: Bellad., Nux vom., San- 
guin. 

Cold in head: Mercur. 

Stoppage of nose: Nux vom. 

with pain across eyebrows : Sanguin. 

Face pale: Tart. emet. 

puffy, particularly eyelids, with dark 

rings around: Calc. card. 

waxy, lips almost white: Calc. card. 



292 



CROUP. 



, fair skin: Bromium. 

Cheeks, one or both flushed: Chamom. 

Teething: Bellad., Calc. card., Chamom. 

Tongue white; buccal cavity very pale: 
Calc. carb. 

No thirst: Pulsat., Tart. emet. 

Hunger and yet emaciation: Iodum. 

Tightness across the chest; Phosphor. 

Tuberculosis disposition: Arsen.,Hcpar, 
Mangan. 

Palpitation of heart: Arg. nitr. 

and breathlessness caused by exer- 
tion: Calc. carb. 

Pulse trembling: Tart, evict. 



easy without improvement: Mercur. 

sticky: Tart. emet. 

Night-sweats: Calc. Catb. 



Pain in all the bones, worse when quiet: 

Rhus to.v. 
Weakness, can hardly walk: Calc carb, 

and tremulousness: Arg. Nitr. 

and anaemic: Mangan. 

Torpor of all functions: Carb. veg. 
Vitality reduced: Carb. veg. 
Delicacy of constitution: Arsen. 



Drowsiness: Bellad., Tart. emet. 



Chilliness: Pulsat. 

in the commencement: Nux vom. 

during fever, whenever moving the 

feet to a cool place in the bed: Mer- 
cur. 

Cold knees even in bed: Carb. veg. 

Cold and moist hands and feet: Calc. 
carb. 

Fever: Bellad., Chamom., Spongia. 

, with hot and dry skin: Aeon. 

Perspiration about head: Calc. carb. 

hot: Chamom. 



Rachitic children: Calc. carb. 
Catarrh of other mucus membranes and 
disposition to skin affections: Sulphur. 

Laryngitis brought on by exposure to 

cold west winds: Aeon., Hepar. 
, draughts, as sitting in cold room: 

Nux vom. 
by any sudden change from warm to 

cold: Bryon, Dulcam. 

from cold to warm: Bryon. 

from mercurial abuse: Nitr. ac. 

, abuse of nitrate of silver: Xatr. 

mur. 

, suppressed eruptions: Sulphur. 

Feels worse in a warm room: Pulsat. 



Croup. 

The two affections belonging under this heading are Pseudo-membra- 
neous Laryngitis, or True croup, and Acute Catarrhal Laryngitis of children, 
known as False, or Spasmodic croup. 

In the first, pseudo-membranous, or croupous laryngitis, there is formed 
fibrinous exudation upon the mucous surface, which coagulates and forms a 
false membrane, loosely attached, but frequently regenerated. It is there- 
fore nearly related to diphtheria, which in some cases also extends to the 
larynx, causing all the sj'mptoms of true croup. It differs, however, from 
diphtheria, in that the exudation never leaves scars behind. In diphtheria, 
especially in severe cases, the mucus membrane as well as the submucous 
tissues are destroyed, and cicatrize on healing. Croup may commence in the 
fauces and extend downwards, or in the larynx and spread upwards. In al- 
most all cases there is a hypersemic state of the whole mucous membrane of 
the trachea and bronchial tubes, which at times terminates in a croupous ex- 
udation in these parts. 

Ocular inspection reveals the pseudo-membrane in the fauces, if it com- 
mences or extends there; laryngoscopy is in most cases impossible; ausculta- 
tion reveals nothing but what we can hear, even at a distance — labored 
breathing with a sawing sound. 



CROUP. 293 

Croup generally attacks children in early childhood, — from two to seven 
years, and seldom more than once. 

Its Premonitory Signs consist at times in peevishness, feverishness, 
soreness of the throat, inflammation of the tonsils and fauces, with patches 
of exudation, as in diphtheria. In other cases there are no such forebod- 
ings. The child is aroused suddenly from a sound sleep, generally about 
midnight, by a hoarse, dry, croupy cough. It exhibits restlessness and 
fright, and frequently puts its hands to the windpipe. Soon, however, it 
falls asleep to be again . awakened by the same dry, hoarse cough, alter- 
nating in this wa.Y until morning, when usually a remission takes place, and 
the child seems to be lively and playful. When evening approaches, the 
child becomes worse again, and, in addition to the cough, we observe that the 
breathing is becomming impeded between the coughing spells. Not only can 
we see the labored action of the respiratory muscles, but we can also plainly 
hear a sawing noise, which the ingress and egress of the air causes in the 
stuff ed-up air-passages. This difficulty increases from hour to hour. The 
child involuntarily bends its head and neck backwards, in order to free the 
windpipe as much as possible from all pressure; the alae nasi move strongly 
up and down like wings; the epigastric region does not, as is usual during 
the act of inspiration, bulge out, but is drawn in, in consequence of a defi- 
ciency of air in the lungs on account of the obstruction in the larynx. For 
the same reason we find the xiphoid process and the cartilages of the lower 
ribs during inhalation drawn strongly inwards, instead of gliding gently 
downwards, as is natural. When we find inhalation and exhalation equally 
difficult, there is surely coagulated exudation around the glottis; when, how- 
ever, as is sometimes the case, only the inspiration is difficult and expiration 
easy, it is probable that the difficulty does not lie in the presence of a pseudo- 
membrane, but in a paralytic state of the muscular structure of the glottis, 
whereby the epiglottis, during inspiration, is not lifted up from the glottis, 
thus hindering the free ingress of air; while during exhalation the paralyzed 
parts easily give way to the returning stream of air. 

Thus the child struggles terribly for air; stis up, wants to be carried 
about, until from sheer exhaustion and the carbonized state of the blood, it 
sinks into drowsiness and stupor. The face, being at first red, grows pale, 
finally cyanotic and is covered with cold sweat; the pulse, at first quick, 
hard and strong, grows very frequent, small, irregular, intermitting, until at 
last this fearful scene is closed by general paralysis or suffocation. The 
temperature may not exceed 101.3 F. in some cases, while in other, 
especially in complications with bronchitis or pneumonia, it may rise from 
104 to 105. 8°. 

In those cases in which dissolution of the false membrane, or the tear- 
ing, loosening and ejection of it, permits recovery, we frequently find a long- 
continued hoarseness, caused by catarrh of the larfnx, or bronchitis or 
pneumonia, the latter being complications which did already exist during the 
attack, and made it so much the more serious. 



294 THERAPEUTIC HINTS TO CROUP. 

Secondary croup occurs during the course of acute, infectious or gen- 
eral constitutional diseases. Of the acute exanthemata, Measles is the one 
most frequently complicated with it, and especially during the stage of 
desquamation, while false-croup occurs usually as a prodromal symptom of 
measles. Some authors have observed secondary croup during the height 
of whooping-cough, and in the course of typhoid fever, pneumonia and 
cholera. 

True croup is most readily confounded with Acute Catarrhal laryngitis 
or False-croup ; the latter, however, is frequently attended with other catar- 
rhal symptoms, such as sneezing, coryza, etc., and apt to occur frequently. 
Diphtheria is thought by some writers (Wagner and others) not to be an 
essentially different affection from croup, and that there is no sharp dividing 
line between the two. But if we take into consideration that in croup the 
exudation takes place upon the free surface of the mucous membrane, and in 
diphtheria also within it, causing necrosis and loss of substance, that diph- 
theria is contagious while croup is not, and that in many cases of diphtheria 
a peculiar penetrating smell from the mouth claims at once our attention, we 
shall hardly find an>- difficulty in distinguishing between the two, notwith- 
standing the close similarity of symptoms betweed them. 

The Prognosis of true croup is much more favorable under homoeo- 
pathic treatment than undei allopathic. ' ' While practitioners of the old 
school of known ability and honesty confess to the most dreadful losses ' ' 
(Steiner), we of the Hahnemannian school have a right to boast of brilliant 
cures, if boasting it be when physicians of ' ' known ability and honest}- ' ' 
state their successes. 

How a man like Johann Steiner can call these men swindlers and 
ignoramuses, men who at least in therapeutic science stand far above him, is 
explainable only when we understand the beclouding influence of bigotry 
over sound judgment. 

Therapeutic Hints. 

Acid. ac. Has been used succesfully by Dr. Krebs. I have found it 
curative in a case that did not yield to other remedies, and which was 
characterized by a remarkable bright redness of the face. From five to ten 
drops of acetic acid in half a tumblerful of water with some sugar make a 
pleasant acidulated drink. I gave a teaspoonful of it every two or three 
hours with speedy effect. 

Aeon. High fever, dry skin, restlessness; the child is in agony, impa- 
tient and throws itself about. 

Arsen. Worse about midnight; great restlessness, notwithstanding 
prostration; bloated face, covered with cold perspiration. 

Bellad. Sawing* whistling breathing, frequent barking, croupy cough; 
skin dry and hot; face red; pulse full and sharp; very restless; tonsils red 
and swollen; patches of exudation on the fauces; midnight attacks. 



THERAPEUTIC HINTS TO CROUP. 295 

Bromium. When after Spongia aggravation again sets in next evening; 
especially in children with blue e3 y es and light hair. 

Calc. carb. In a case of marked calcarea constitution. (H. V. Miller.) 

Cct7ithar. In cases where the voice was entirely gone, and there was 
whistling breathing and tossing about in bed with the greatest agony. 

Caustic. Sensation of rawness in the larynx. (E.C.Price.) 

Hepar. Cough worse in the morning; mucus rattling and yet no get- 
ting rid of the phlegm; hoarseness; dry, barking cough; the child cries 
when coughing; after exposure to cold west wind. 

Iodium. As Bromium follows well after Spongia, so does Iodium after 
Hepar; cough worse in the morning, rattling and not getting loose; hoarse- 
ness; especially in children with black eyes and dark hair. 

Kaolin. First recommended by Aegidi; it seems to be especially indi- 
cated where the croupous inflammation has its seat in the lower portion of 
the larynx or in the upper part of the trachea, which may be recognized by 
the much more laboring and sawing respiration. (I. I^andesmann. ) 

Kali bichr. Worse early in the morning; inflamed fauces; membranous 
deposition; hoarseness; fat, chubby children. 

Laches. The child cannot bear anything touching its throat; aggrava- 
tion in the afternoon, after and during sleep; patches of exudation in the 
fauces; commencing paralysis of the lungs. 

Lycop. Spasmodic motion of the alae nasi; crossness after sleep; can't 
bear to be covered. 

Phosphor. In combination with bronchitis; great weakness; aggrava- 
tion evening up to midnigh; lying on back provokes the cough. 

Sanguin. In a case with whistling cough, or of metallic sound, as 
though coughing through a metallic tube. 

Spoyigia. Very dry, crowing sound of cough; always commencing to 
get worse in the evening; sawing sound of respiration even during remis- 
sion. 

Tart. emet. Face cold, bluish, covered with cold perspiration; pulse 
very frequent; rattling as if the chest and trachea were full of mucus with- 
out expectoration; great sinking of strength; commencing paralysis of the 
lungs. 

Von Grauvogl advises: 

Cuprum. When spasmodic affections, such as asthma spasmodicum, 
whooping-cough, chorea, or cholerine, etc., are prevalent (epidemic) at the 
time with other people. 

Ipec, Iodium or Bromium, when intermittent affections prevail. 

Hepa? . When panaritise, anginse, urticaria or erysipelas are the pre- 
vailing diseases. 

Schussler advises: 

Kali mur. At first, or 

Fer?. phosph. When there is violent fever. 

Calc. sulph. I^ater, if required. 



296 CEDEMA GLOTTIDIS. 

Kali phosph. In cases coming too late under treatment, with great 
weakness, pale bluish face, etc. 

Tracheotomy. — "Out of quite a large number of cases occurring in my 
practice, before I had adopted the operation of tracheotomy, I saw but three 
recoveries; since 1863, however, this discouraging rate has been so much 
improved by the employment of tracheotomy that the mortality has at dif- 
ferent times amounted only to sixty, sixty-five and seventy per cent. 
Bricheteau states it at sixty-nine, Franque at sixty-eight. Trousseau at fifty, 
and Greve in Sweden at twenty-three per cent." (Steiner. I >c Among the 
1,698 cases of tracheotomy collected by Ducheck, a favorable result occurred 
in 428 operations, a proportion of 1 to 3.9 (25.2 per cent.;, which is probably 
the correct average." (Steiner.) 

" In fatal cases of croup, where the symptoms consist of great dyspnoea, 
pallid face and lips, cold extremities and very feeble pulse, post-mortem 
examination will disclose fibrous deposits in the heart, and such cases, if 
operated upon, are sure to die; while if there be turgescence and lividity of 
the face, with blueness of the lips, accompanied with extreme dyspnoea, the 
obstruction is evidently in the trachea, and the case, therefore, offers much 
greater hope of recovery by operation." (Dr. Richardson, of London.) 

" Tracheotomy is no more curative of croup than are emetics; it cannot 
even arrest the croupous process; its only office is to establish a new provi- 
sional air-passage, while the danger of death from laryngeal stenosis lasts, 
and to assist Nature in her efforts to cure; and no other means fulfil these 
indications so certainly and so directly." (Steiner.) 

In short, although tracheotomy is not a sure cure for croup, it may in 
violent cases procure time for the selection and action of the medicine which 
finally will subdue the croupous process and thus be a means of saving the 
child. This is applicable even to Homoeopathic treatment. 

(Edema Glottidis, CEderaa Laryngis 

Consists of a serous or sero-purulent infiltration of the submucosa, following 
either inflammatory or non-inflammatory processes. 

The inflammatory form has been designated as Laryngitis phlegmonosa. 
embracing all such inflammations of the larynx which have their seat princi- 
pally in the submucous connective tissue. It is always of a secondary 
nature, and may be the consequence of a catarrhal laryngitis when renewed 
attacks or new injuries spread the inflammation in depth to the submucous 
connective tissue, or it is connected with laryngeal diphtheria, or the conse- 
quence of chemical or thermal irritants or mechanical irritations by foreign 
bodies; or it is an extension of inflammatory processes from neighboring 
parts, such as wounds of the larynx and its vicinity, or retro-pharyngitis, 
tonsillitis, pharyngeal diphtheria, angina Ludovici and parotitis. The most 
frequent cause is inflammation of the perichondrium of the laryngeal car- 
tilages, in consequence of tuberculosis, syphilitic, typhous and carcinomatous 
ulcerations. At last we find it in connection with pyaemia and septicaemia, 



THERAPEUTIC HINTS TO (EDEMA GEOTTIDIS. 297 

with ulcerative endocarditis, typhus, variola, scarlatina, measles and ery- 
sipelas. 

The inflammatory process may be diffuse, or limited to the aryteno- 
epiglottideau folds, and is then more marked on one side than on the other; 
it affects the submucous tissue of the vocal cords alone only rarely, and 
exists below the cords still more rarely. 

The non-inflammatory form, a simple, serous infiltration of the submu- 
cosa, or dropsy, is either apart of general dropsy, in consequence of nephritis, 
malarial cachexia, amyloid degeneration of the kidneys, etc. ; or a dropsical 
manifestation from diseases of the heart, emphysema and cirrhosis of the 
lungs; or the result of compression of the superior and inferior thyroid, or 
facial, or internal jugular and the innominate veins by enlargement of the 
thyroid gland, or the swelling of the lymphatic and salivary glands, or by 
new formations about the neck, aneurism of the aorta, etc. The oedema will 
be unilateral or bialateral, according to the site and extent of the hindrances 
to the circulation. The cedematus parts appear pale or pale red, translucent 
and flabby; the mucus membrane is neither injected nor swollen. By 
means of the laryngoscope, we can best decide the nature of the affection. 

The most prominent symptom of either form is Laryngeal dyspnoea, 
which at first is only inspiratory, while the expiratory stream of air passes 
the larynx without any difficulty. The reason of this is, that during inspi- 
ration, the air presses the swollen parts around the introitus laryngis together, 
thus closing its aperture, while during expiration the out-rushing air pushes 
them asunder. However, this difference ceases when the infiltration spreads 
to the aryteno-epiglottidean folds, to the epiglottis and the superior cords. 
There is also hoarseness and barking cough. The intensity of the laryngeal 
stridor depends always on the grade of swelling of the soft parts, and it ter- 
minates in suffocation if the obstruction can not be relieved. The inflamma- 
tory form may result in abscesses or ichorization. 

Therapeutic Hints. 

In general I must refer to the various causes of this affection above de- 
tailed. In special compare: 

Aeon. 

Apis. When it occurs in connection with erysipelas or eruptive fevers. 

Arse?i. When in connection with general dropsy, following kidney dis- 
eases, etc., with great restlessness and prostration. 

Arum triph. When in combination with diphtheria or scarlet fever. 

Bellad. Sudden attack; fauces deep purple; all the parts of the larynx 
cedematously swollen; pain deep in throat; stiff neck; wild expression of 
eyes; great prostration. One drop of tincture in pint of water, by teaspoon - 
fill. (P. J. Valentine.) 

Canthar. When in consequence of burns. 

China. When in connection with drops}-; inspiration short and difficult , 
expiration easy. 



298 PERICHONDRITIS LARYNGEA. 

Laches. When in connection with albuminuria; dark, almost black 
urine, like coffee-grounds. 

Phosphor. In connection with heart disease. 

Sanguin. Tonsils and pharynx swollen; sawing, rasping respiration; 
expiration easier than inspiration; cough dry and harsh, relieved by sitting, 
aggravated by eating or lying down; difficult expiration of tough, glairy 
mucus; inflammation of cervical glands. 1st trit. (Th. Nichol.) 

Swallowing of small pieces of ice has been found beneficial b}~ Niemeyer 
in the inflammatory form. 

If in bad cases medicine does not quickly relieve, scarification of the 
swelling must be tried, and if that does not succeed, tracheotomy is the only 
means to prevent suffocation and gain time for further medical treatment. 

Perichondritis Laryngea. 

The inflammation of the perichondrium of the laryngeal cartilages is not 
easih' recognized in the beginning, because pain, swelling, cough, hoarseness 
and laryngeal stenosis are symptoms of various laryngeal affections. When, 
however, the inflammation has reached the stage of an abscess which has 
broken, a diagnosis may be more readily formed. The cartilages most liable 
to be affected are the cricoid and the arytenoids. If it be the cricoid, the 
swelling will be found on the posterior wall of the laryngeal opening, or when 
seated in one of its lateral portions, somewhat towards the one or the other 
side of the posterior wall; if it be one of the arytenoid the swelling will be 
seen more anteriorly either on the right or the left side in the neighborhood 
of the cartilages of Santorini and Wrisberg. 

Thyroidal perichondritis may exist either on its inner surface, or pene- 
trate to its outer surface and form a larnygeal fistula. Perichondritis of the 
epiglottis is of rare occurrence, usually in connection with the same process 
in the cricoid and thyroid cartilages, or with other ulcerative processes. 

The Causes of laryngeal perichondritis are various. It may arise from 
traumatic influences, for instance from the frequent introduction of the 
oesophageal sound in old persons; from tuberculus, typhous, syphilitic or 
cancerous ulcerations; from primary laryngeal chondritis. 

Therapeutic Hints. 

All in all the disease being more of a secondary nature, the accompany- 
ing primary disease will have to be studied first; therefore a number of 
remedies will offer themselves for consideration. As acting especialry upon 
the cartilage, Yon Grauvogl designates Silk. 

In cases where the abscess closes the larynx, tracheotomy will have to 
be resorted to. 

Phthisis Laryngis, Tubercular Ulceration. 

As a rule, tubercular ulceration of the larynx is secondary to pulmonary 
tuberculosis and co-existing with it; in exceptional cases it may precede pul- 



THERAPEUTIC HINTS TO PHTHISIS EARYNGIS. 299 

monary manifestations, at least palpable ones. Commencing with slight 
hoarseness, lack of ring and easy giving way of the voice on taking a slight 
cold, which, however, gradually subsides, the trouble is often overlooked. 
The laryngoscope shows at this time partial injection and swelling of the 




vocal processes, of the inter-arytenoid region and the cartilages of Santorini. 
In other cases there is a striking anaemia of the mucous membrane and not 
seldom paresis of the muscles. Gradually by renewed colds, ulcers form on 
these places; they may be single, they may spread to the epiglottis and to 
the ventricular bands and vocal cords, and form an extensive ulceration all 
around the glottis. The hoarseness increases, often to total aphonia; the 
cough is generally without tone or power, and there is usually soreness on 
swallowing, and burning and stinging pain in the region of the larynx. 
The ulcers of phthisical subjects present no characteristic signs by which 
they could be recognized as such, we must consider the whole history of the 
case (whether there be any syphilitic taint) and its present state (co-existing 
pulmonary tuberculosis), in order to form our diagnosis. 

The Prognosis is that of tuberculosis in general, a poor one; still, if 
the course of the disease is slow, and the frequency of the pulse does not, for 
any length of time, exceed 96 to 100; if the ulceration is not too extensive 
and the co-existing tubercles in the lungs are not in an extensively softening 
process, and no new infiltrations occur, and also if the patient can and does 
implicitly follow our advice, we surely will be able by a careful study of the 
case to prolong life, at least. 

Therapeutic Hints. 

The treatment of pulmonary tuberculosis must be studied. For the 
prominent laryngeal symptoms, compare Laryngitis Chronica; besides con- 
sider: 

Arg. 7iitr. Swelling of the parts; ulcers with luxuriant granulations; 
titillation in the larynx; much hawking, or spasmodic cough, and accumu- 
lation of phlegm. 

Arsen. "Dirty red, or anaemic appearance of the laryngeal lining, 
with bluish-red patches, or general discoloration of the tissues; indolent, or 
burning extensive ulceration, with more or less sero-purulent secretion. 
Pulse small and feeble; progressive emaciation and weakness." (Meyhoffer.') 

Bellad. For intercurrent "colds," with difficult and painful degluti- 
tion; spasmodic or barking cough. 



300 SYPHILIS LARYNGIS. 

Carb. an. Greenish expectoration ; lungs affected, especially right side; 
enlarged glands; copper colored spots on face and bod}*; earthy colored face; 
great exhaustion. 

Carb.veg. Evening hoarseness; bloatedness; rancid belching; the most 
innocent food disagrees. Great tendency to perspire about the chest and to 
take cold on least change of temperature; knees always cold but especially 
at night in bed. 

Iodium and Kali hydr. In scrofulous subjects; follicular swelling of 
throat; extensive ulceration. 

Laches. Ulceration on left side of glottis; bluish inflammation of fauces; 
voice and cough without tone. 

Merc. jod. , after Be/lad. ' ' Dark red inflammation and swelling of the 
parts with much hawking, coughing and purulent expectorations worse in 
the morning." (Meyhoffer.) 

Nitr. ac. ' ' Great irritation; redness and ulceration of the epiglottis and 
larynx, with difficult and painful deglutition, violent dry cough and nocturnal 
perspiration . ' ' ( Meyhoffer . ) 

Phosphor., Sepia, Silic, Stramon., and Sulphur ought not to be over- 
looked. 

Syphilis Laryngis 

May consist of a mere Catarrh, scarcely distinguishable from an ordinary 
catarrh; or of Condylomata, which are flat wart-like papules, with a thick, 
whitish-gray, adventitious covering of epithelium; or of Gummy tumors or 
Syphilomata, consisting of little roundish swellings of the size of a pinhead to 
that of a small pea, usually of the color of the rest of the mucous membrane, 
and frequently found in rows; or of actual Ulcers of various extensions and 
depth. The diagnosis of all these must be made from the history of the 
case, from the evidence of other syphilitic affections, especially in the phar- 
ynx, on the skin and in the bones, and by the laryngoscope. Ulcers may 
lead to syphilitic perichondritis, to haemorrhages and papillomata, which 
often form in the vicinity of syphilitic cicatrices. 

Therapeutic Hints. 

Aurum. Accompanied by ulcers on the roof of the mouth; previous 
mercurial treatment; affections of the bones. 

Merc. sol. When ulcers appear also on the tonsils. 

Merc. jod. Painless ulcers. 

Kali hydr. Previous mercurial treatment. 

Kali bichr. Ulcers on the soft part of the fauces. 

Nitr. ac. Painful ulcers; abuse of mercury; condylomata. 

Thuja. Condylomata. 

Neoplasms of the Larynx. 

Of these, the Papilloma or Fibroma papillare occurs most frequently; it 
is a proliferation of the connective tissue, commencing by preference on the 



NEUROSES OF THE LARYNX. 301 

anterior extremities of the vocal cords. The Papillomata are in fact hyper- 
trophical- papillae, covered with a thick layer of epithelial cells. Their size 
and form varies, representing either little buttons or pegs, or warty forma- 
tions like a cock's comb; in some cases they attain to huge growths similar 
to a berry, grape, or cauliflower, which may partly or entirely fill the upper 
and middle laryngeal cavity. 

The Fibroma, or Fibrous polypus is also of frequent occurrence, appears 
mostly single, rarely multiple, takes its origin on the vocal cords. It pre- 
sents itself as a little, generally pedunculated, roundish or pear-shaped 
tumor, of a dirty whitish or reddish, or dark red color, sometimes with dis- 
tinctly branching vessels on its surface. Its size may attain to that of a 
hazel-nut, and its consistence is either hard or soft. Fibrous polypi usually 
are of slow growth. 

Mucous polypi and Cystic tumors are of not so frequent occurrence. 
They take root in the ventricle of Morgagni by preference, being attached to 
a broad base; they grow slowly and seldom attain an}^ considerable size. 
When incised, they slowly empty their more or less thickened contents. 

Cancinoma or Cancer occurs tolerably often within the larynx, and 
especially in its epithelial form. Its seat is almost invariably the upper and 
middle portion of the laryngeal cavity. laryngoscopy examination seldom 
shows very characteristic conditions at the beginning, especially in those 
cases in which cancerous infiltration into the submucous tissue produces a 
uniform intumescence of the soft parts, with strong vascular injection of the 
mucous membrane. I^ater, however, when the intumescence becomes con- 
siderable and extensive ulceration takes place, with enlargement of the 
lymphatic glands of the neck, and an extension of the morbid process to the 
pharynx or oesophagus, its diagnosis is easy enough. 

Therapeutic Hints. 

Usually, that is since the laryngoscope has been in use, the neoplasms 
have been treated surgically either by cauterization or by extirpation, or by 
still more complicated surgical operations. We are sadly in want of observa- 
tions gained by pure homoeopathic treatment. If it, however, is beyond 
doubt that similar morbid growths on other parts of the body have been 
removed by the administration of homoeopathic remedies alone, there is no 
reason why a similar treatment should not succeed in these cases. Compare, 
for instance, polypi in ears, nose, etc. For cancerous disorganization even 
extirpation is of no avail. 

Neuroses of the Larynx. 

These are either neuroses of sensation (anaesthesia* or hyperesthesia, 
neuralgia of the laryngeal mucous membrane), or of motion (paralyses or 
spasms of certain muscles of the larynx). 

Ansesthesia, or diminution or total extinction of sensibility in the laryn- 
geal mucous membrane, is an ordinary symptom of approaching death; it 



302 THERAPEUTIC HIXTS TO NEUROSES OF THE LARYXX. 

occurs in diphtheritic paralysis of the organs of the throat, and at times in 
hysteria. Its degree and extent vary, and can only be ascertained, by care- 
fully testing the parts by the probe under guidance of the laryngeal mirror. 

Therapeutic Hixts. — Argent., Gelsem., Kali brom. Electricity. 
Strychnine. 

Hyperesthesia and Neuralgia occur most frequently in inflamniatory 
and ulcerative conditions of these parts. When it is a symptom of general 
nervousness, as in hysteria, it is frequently attended with a spasmodic cough 
of longer or shorter duration, and at times periodically recurring at a given 
hour. Hypochondriasis, too, especially in persons suffering from seminal 
emissions, is at times attended with great sensitiveness of these parts. 

Therapeutic Hints. 

Ignat. Meets frequently the hysterical cough. Other symptoms must 
necessarily be taken into consideration. If in connection with inflammatory 
conditions compare these. 

Paralysis may be bilateral in consequence of a paralysis of the trunk of 
the recurrent of both sides. The recurrent innervates all the muscles con- 
cerned in the locomotion and tension of the vocal cords, except the crico- 
thyroid muscles. Such a paralysis is therefore characterized ' ' by absolute 
loss of voice; inability to cough or expectorate with force; undue expendi- 
ture of breath on making attempts at phonation, or at forcible expiration, 
for instance in coughing; the absence of dyspnoea during quiet breathing, at 
least in adults; laryngoscopically, the cadaveric (widely opened position) of 
both vocal cords, the edges of which still further approximate each other 
on forced inspiration." (Von Ziemssen.) It may be unilateral when the 
trunk of the recurrent of one side only is paralyzed. This causes the voice 
to lose its ring and become impure (rattling), being rendered so by tremors; 
on straining it in speaking loud, the voice readily breaks into a falsetto, and 
the patient becomes wearied. The vocal cord of the paralyzed side remains 
motionless during phonation, while the healthy cord and arytenoid cartilage 
pass over the median line. When the posterior crico-arytenoid muscles, the 
office of which is that of widening the glottis during respiration, become 
paralyzed, the inspirator}' opening of the glottis is extinguished, and true 
stenosis of the glottis of the highest grade, with danger of asphyxia, is es- 
tablished. The mirror shows the glottis transformed into a narrow slit, 
which is still further narrowed by the external atmospheric pressure during 
inspiration, while during expiration the glottis returns to its original size. 
Inspiration, therefore, causes loud sounding vibrations of the vocal cords, 
which are pushed forward to the middle, while expiration takes place un- 
hindered, is short and noiseless. The voice seldom undergoes any change. 

Still other individual muscles may be paralyzed, but they are of less 
importance. 



spasm of the glottis. 303 

Therapeutic Hints. 

Compare: Bellad. Bryon., Caustic, Coccul., Cuprum, Ignat., Plumbum, 
Zincum. China and Stramon., difficult inspiration and easy expiration. 
Electricity. 

Paralytic or Paretic Aphonia, may require: 

Amm. caust. When attended with bronchial and asthmatic symptoms, 
great general muscular debility, exhaustion and tremors. 

Ant. crud. Loss of voice from getting heated by exertion; return of 
voice by resting. 

Arg. met. Hoarseness after singing and preaching; anaesthesia of the 
fauces. 

Arum triph. Aphonia after singing or speaking; voice changes in tone 
frequently. 

Bellad. Aphonia comes on suddenly. 

Caustic. Sudden loss of voice after taking cold, often combined with 
catarrhal symptoms. 

Cina, Peculiar twitching of the right hand when coughing; right side 
of chest constricted, with difficult breathing; gurgling noise down along the 
oesophagus. (Kafka.) 

Cupr. met. Aphonia from central causes after convulsions. 

Gelsem. After diphtheria; during catamenia. 

Ignat. In hysteria. 

Laches. Paralysis of left vocal cord; worse after sleep; tenderness to 
touch. 

Nux mo sch. Aphonia from walking against the wind; hysterical, gastro- 
intestinal and cardiac derangements. 

Nux vom. Coming on suddenly and combined with catarrhal symptoms. 

Opium. Loss of voice from fright. 

Phosphor. Vocal cords broad and relaxed ; tired ; pale; chest oppressed; 
menses too often. (Welch.) 

Platina. In uterine disturbances. 

Rhus tox. After straining the voice. 

Stramon. From cerebral disease and great mental excitement. 

Sulphur. Chronic cases of all kinds. 

Spasm of the Glottis. 

In books this affection has been described under various names : Asthma 
spasmodicum or Laryngeum infantum, asthma periodicum acutum infantile, 
Laryngimus stridulus, Laryngitis stridulosa. The most prevalent, however, 
and at the same time the most inappropriate names are Asthma Millari and 
Asthma thymicum Koppii. It is quite difficult to understand haw the descrip- 
tion which Millar gives of a certain affection of children, and which he him- 
self styles Asthma acutum, could ever have been applied to spasmus glottidis, 
as it portrays quite clearly what we may express by the term of Laryngitis. 



304 THERAPEUTIC HINTS TO SPASM OF THE GLOTTIS. 

He even recognizes the "white, tough, jelly-like stuff," with which the 
windpipe was found filled after death. The term Asthma thymicum Koppii 
is likewise inadmissible; for the assumption which it implies, that these 
spasmodic fits be caused by a swelling or enlargement of the thymus glands 
has, in consequence of late pathologico-anatomical researches, become un- 
tenable. 

The Symptoms of spasmus glottidis are as follows : It commences with 
slight and short attacks of dyspnoea, attended by a wheezing noise during 
inspiration, whereby the children move uneasily and show an anxious ex- 
pression. Soon all is over; and if the attacks happen during the night they 
may be overlooked altogether. By and by, however, these spells increase in 
number, intensity and duration. The child is suddenly attacked in conse- 
quence of a little fright, or whilst crying, laughing, drinking, or especially 
in the moment of getting awake; its inspiration becomes whistling, crowing 
and so difficult that it strains all the respirator}' muscles to draw the air 
through the spasmodically closed glottis into the lungs. Expiration is quite 
impossible, and thus respiration ceases for a while altogether. The face of 
the child expresses the greatest agony and sense of suffocation, and becomes 
purple; cold perspiration appears upon the forehead; the veins of the neck 
becomes turgescent and the thorax is motionless. The pulse falls at this 
stage and is small and intermitting. This fearful condition lasts in severe 
cases a minute or two at* the utmost, general!}* only a few seconds; then with 
a loud, crowing cry the child again catches its breath, is exhausted; cries 
and sobs, but shows no signs of fever or any catarrhal affection. The num- 
ber of attacks may amount to ten, twenty, even fifty, in the course of a day; 
and if the complaint be not arrested it ma}* terminate in general convulsions 
and death. 

The age in which children are attacked by this disease lies, in most 
cases, between their fourth and fourteenth month; as they grow older and 
stronger, the spells grow* milder. In adults it is of rare occurrence, and then 
much less severe, on account of the larynx being more developed at that 
age. The female sex during the age of puberty, is the most frequently 
attacked amongst grown persons. Its pathological character is a disturbed 
action of the nervus vagus or recurrens, either from central or peripheral 
irritation. In children rachitis is the principal cause. Post-mortem ex- 
amination shows the larynx entirely free from any morbid changes. 

Therapeutic Hints. 

Bellad. Congestion to the head; throbbing of carotids; teething process; 
drinking excites the spasms. 

Bromium. Gasping and snuffing for breath. 

Chlorine (the gas in water), crowing inspiration and expiration im- 
possible (Dunham). The respiratory acts consist of a succession of crowing 
inspirations, each one followed by an ineffectual effort at expiration, the 
whole serving to inflate the chest to a most painful extent. (\V. S. Searle.) 



THERAPEUTIC HINTS TO SPASM OF THE GEOTTIS. 305 

Cuprum. Blueness of face and lips; convulsions; after fright of mother 
or child. Cold perspiration at night; cough relieved by a swallow of cold 
water. 

Gelsem. Inspirations long, with crowing sound; expirations sudden and 
forcible. 

Ignat. Difficult inspiration with easy expiration; hysteria. 

Iodium. Tightness and constriction about the larynx, with soreness, 
hoarse voice, etc. Enlargement . and induration of the glands, cervical and 
mesenteric; absence of appetite; utter indifference to food; scanty, high 
colored urine; clayey evacuations; emaciation; yellow skin; action of heart 
feeble and much increased by motion. (Dunham.). Rachitic children; 
swelling of bronchial glands; thymus gland (perhaps) enlarged. 

Ipec. Blueness of face and coldness of extremities, at the commence- 
ment. 

Laches. Sensitiveness of larynx and trachea to the touch. 

Mephit. Similar to Chlorine, has suffocating feeling with inability to 
exhale; bloated face and convulsions. (W. S. Searle.) 

Moschus. In hysterical women. 

Phytol. "Frequent spasmodic closure of the larynx; drawing of the 
thumbs into the palm; flexion of the toes; distortion of the face; muscles of 
the eyes affected so that the motions of one eye were independent of the 
other." (Kapp. ) 

Plumbum. Spasmodic closure of the rima glottidis; mucus rattling in 
throat, with sudden difficulty of breathing and asphyxia. 

Sambuc. Able to inhale but not to exhale; becomes livid in the face; 
gasps in great anguish and very slowly recovers its breath; awakes from 
sleep with suffocation. (C. Wesselhoeft. ) Burning red, hot face, hot body, 
with cold hands and feet during sleep ; on awakening, the face and body 
break out into a profuse perspiration, which continues as long as the patient 
is awake; on falling asleep again, the dry heat returns. 

Veratr. Cold perspiration on forehead, and cold extremities. 

The following remedies may also be indicated in individual cases : 
Arsen., Calc. carb. and p/wsp/i., Chamom., Coral, rubr. (Meyhoffer), Hydr. 
ac, Lauroc, Phosphor., Silic, Spio?igia, Sulphur. 

The rachitic conditions requre : Calc. carb., Hepar, Iodium, Silic, S21I- 
phur. 



20 



THORAX 



This is a chapter of great importance, and at the same time of difficulty. 
Its exploration we will have to undertake on different roads. We must 
know what is to be learned by inspection, palpation, percussion, and auscul- 
tation. 

I. Inspection — Ocular Examination. 

If we consider that the thoracic cavity holds within itself the lungs and 
heart, the organs of respiration, and of circulation, we shall understand why 
it is that the first phenomenon which strikes the eye is the continuous motion 
in which we find its walls engaged. 

This Respiratory motion of the chest in men is greatest in the region of 
the lower ribs on each side; in women, on the upper part of the chest; and 
in children, towards the abdomen. 

The number of respirations varies according to age, sex, and individu- 
ality; so that we might put down the normal number of respirations per 
minute in grown people at from twelve to twenty; in young persons, from 
fourteen to twenty-four; in children, about twenty-six, and in infants about 
forty-four. But there are other conditions which may materially modify the 
frequency of respirations — such as mental excitement, bodily exertions, di- 
gestion, temperature, and other conditions of the air. As a rule, however, if 
compared with the pulsations of the heart, it may be said, that during one 
respiratory act there are three or four beats of the heart; but these respiratory 
motions of the lungs and pulsations of the heart never correspond in rhythm, 
as you may easily ascertain by counting your pulse, and observing your 
breathing at the same time, the pulse being a little too fast or a little too 
slow to make up an even count between respiration and pulsation. This is 
a very interesting fact, which it is well to bear in mind. When respiration 
and pulsation become synchronous — that is, when upon each act of respira- 
tion for a length of time fall precisely two, three, four, five, or six pulsa- 
tions — we may be pretty sure that death is near. My attention was first 
drawn to this interesting fact by Dr. Hering. Since then I have found it 
verified many times. Its explanation is another matter. We might, per- 
haps, explain it, if we remember that the heart's action is governed mainly 
by the sympathetic nervous system, while the lungs are under the control of 
the vagus, though each of them send branches to these organs, the sympa- 
thetic to the lungs, and the vagus to the heart. The sympathetica is the 
great nerve of organic life, and under its direction all the functions of the 



THORAX. 307 

body are performed, which are entirely out of the reach of the will. It 
arises from a series of ganglia, extending along each side of the vertebral 
column from the head to the coccyx. The vagus has its origin in the brain, 
and its fibres may be traced through the fasciculi of the corpus restiforme 
into the gray substance of the floor of the fourth ventricle, and therefore the 
parts to which it is distributed are more or less under the control of the will. 
When death approaches, or, in other words, w T hen the separation of soul and 
body commences, those functions which are more or less under the control 
of the will are most probably the first to cease. The vagus losing its 
influence upon the lungs, their action is now continued under the sole direc- 
tion of the sympatheticus as long as organic or vegetative life still continues; 
thus respiration, and pulsation act in full harmony — become perfectly 
synchronous. 

" ' ' The respiratory motion of the chest itself in ordinary health is com- 
paratively slight in consequence of the thoracic cavity being enlarged in 
ever}- direction nearly simultaneously. It resembles the easy ebb and flood 
of a soft wave. When, however, a deep respiration is taken, it is observed 
that the sternum is slightly but steadily projected forward, the abdominal 
parietes gently dilated. The lower ribs are first and most considerably 
raised, and the elevation of each separate rib takes place gradually, evenly, 
and regularly upwards, notwithstanding which, each and all appear to move 
at the same time. Every part acts separately, but each in perfect harmony 
with the other." (H. M. Hughes.) 

Without any deviation in form, a remarkable stillness and w T ant of 
movement may be observed either in an entire side or only a part of it. This 
is a sign of inflammation of the pleura in its early stage. 

The thoracic breathing, when the diaphragm is not moved, is a sign or 
peritonitis; the abdominal breathing-, when the ribs are not moved, is a sign 
either of inflammation of the chest, or of paralysis of the respiratory nerves, 
except the phrenic, from injury of the upper part of the spinal cord. 

The Form of the thorax must also be taken into consideration, and this 
must always be done by comparing one side with the other. To accurately 
determine a difference which may exist in the semi-circumference of the 
thorax, as indicated by apparent bulging or retraction of a side Mensuration 
must be employed. For this purpose a tape-measure is used. 

The normal infantile chest is almost cylindrical but becomes more and 
more oval during maturity. 

In the adult the following types of abnormal development will be met 
with: 

Paralytic Chest. — In this type the antero-posterior diameter is shortened 
and the thorax is long and flat, due to a great obliquity of the ribs. 

Rachitic Chest. — This is produced by lateral compression of the costal 
cartilages when rickets exists, making the sternum stand out prominently 
(pectus carinatum.) 

Barrel chest. — The antero-posterior diameter is greatly increased, there 



308 LOCAL ABNORMALITIES. 

is very slight motion of the thorax during respiration and the intercostal 
spaces are abnormally wide. It is found in emphysema of the lungs, that 
morbid state in which the volume of the lungs is increased in consequence 
either of the dilatation of the air cells, or, what is of rarer occurrence, by 
the escape of air into the space between the lobules or beneath the pleura. 

Local Abnormalities. 

If we bear in mind the natural motion and the natural shape of the 
thorax, ocular inspection will reveal the following noticeable facts: 

i. The upper ribs sink away from the clavicle, become flattened and 
motionless, while, in man)' cases, the movement of the lower ones is not inter- 
fered with, and, as a general rule, the change is more evident on one side 
than on the other. This is a sign of advanced phthisis. (Barclay.) 

2. Only one side may bulge, the intercostal spaces are obliterated and 
the respiratory motion is annihilated. This is a sign of a collection of serum 
— hydrothorax, or of pus — pyothorax, or of gas — pneumothorax— into the 
pleural sac. A local prominence may also be indicative of an aneurism, 
tumor or compensatory emphysema. 

" But in many advanced cases of pleuritic effusion, of empyema (collec- 
tion of pus) and of pneumothorax, with effusion, not only, as before stated, 
is the side not enlarged, but it is, on the contrary, contracted; and not only 
are the intercostal spaces not widened and prominent, but the}* are actually 
much narrowed. Herein exists a notable example of that which is so neces- 
sary to bear constantly in mind, that the results of one mode should be care- 
full) 7 compared with those deduced from other modes of physical examination, 
and the whole weighed together with the observations derived from the 
history and the constitutional symptoms of the case under examination. 
Because the side is contracted, and the intercostal spaces narrowed, as 
observed upon inspection, it might be hastily assumed that there was no 
fluid in the chest, while in truth the contracted side might be actually filled 
with pus or serum, and the other, supposed from its greater size to be the 
one diseased, might be quite healthy." (H. M. Hughes.) 

3. A general fullness or roundness of the precordial region may be some- 
times observed. This is the case when the heart has been enlarged for a 
considerable time, or when fluid effusion has long existed in the pericardium. 

Nota bene : A broken rib may bulge out too! 

II. Palpation — Manual Examination. 

This is a method of using the hand with its sense of touch, for the elimi- 
nation of certain conditions of the thorax. We may merely tap with one 
finger, or lay the whole hand upon the parts to be examined, press or glide 
gently over the surface, according to the requirements of the case. In this 
way we become cognizant of temperature, form, resistance and motion of these 
parts. 

The Temperature, if raised to calor mordax, fairly burns and stings the 



II. PALPATION. 309 

examining hand, and is found on the chest in far advanced pulmonary com- 
plaints. We feel at the same time the condition of the skin, whether it be 
dry or moist, harsh or soft. 

The Form. When it is convenient to expose the chest of a patient, the 
appressed fingers of one hand placed flatly and pressed firmly upon the in- 
fraclavicular region of one side, while the other is similarly . placed and 
pressed upon the corresponding region of the other side, are often capable of 
distinctly appreciating a flatness of one side, or a difference in the pliability 
or expansibility of the two sides, even in the early stages of phthisis. 

The Resistance depends upon the character of the parietes and the con- 
tents of the thorax. The resistance of the parietes is greater, the more con- 
vex, stiff and strong the thoracic bones, and the narrower the intercostal 
spaces are. It is more yielding where the contrary conditions exist. In 
the acromial region the resistance to pressure increases when the muscles are 
put upon the stretch. The resistance of the contents of the thorax increases 
in the ratio as they are compressed. Whether there be much or little air, 
water or pus collected in the cavity, it has no influence upon its resistance to 
external pressure. But when this air, water or pus becomes compressed, and 
in consequence the walls which contain it are put upon the stretch, its resist- 
ance increases in the same ratio, and such swelling within the chest may feel 
as hard as a stone. Hepatization of the lungs gives a considerable resistance, 
but it is greater in exudations under the above-mentioned conditions. 

Palpation lastly reveals different kinds of Motions which originate within 
the cavity of the chest. The most important of these is the Vibration of 
voice, or the Vocal fremitus, of which we become cognizant by placing our 
hand upon the thorax of a person who is in the act of talking or singing. 
Its force corresponds with the power and depth of the voice, so that we feel 
it much stronger in men of a deep bass voice than in other persons, whose 
voices are of a higher pitch. Singing and screaming causes fremitus even 
in the highest-toned voice. The localities in which it is perceived, arranged 
according to the strength of the vibration, are as follows: 

1. Larynx and trachea down to the sternum in front and laterally. 

2. The last four cervical and first three dorsal vertebrae of the adjacent 
portions bet vveen the scapulae, especially in thin persons and children. 

3. The acromial and subclavian regions down to the liver and spleen, on 
the right side much stronger than on the left. 

4. The lateral regions, from the axillae down to liver and spleen ; to the 
fifth rib stronger on the right side; below the fifth rib stronger on the left 
side. 

5. The posterior inferior regions from the edges of the shoulder-blades 
downwards. 

6. The shoulder-blade region. 

7. The manubrium sterni. 

8. Where the liver or the enlarged heart or spleen lie close to the tho- 
racic wall, the fremitus is not felt at all. 



3IO II. PALPATION. 

The mammae of women decrease the vibration of the voice, but do not 
suppress it altogether. In thin persons with a long thorax, the fremitus is 
stronger than in persons with a broad but short thorax. It is felt more in 
the horizontal than in the upright position. This is its normal condition in 
health. 

In disease it may be increased or decreased. 

It is Increased when the bronchial walls become thickened by chronic 
inflammation; or when the lungs become hepatized, or infiltrated with tuber- 
cles, or indurated and consolidated. It is also increased by cavities, which 
lie near the periphery, contain air and not much fluid, and which are sur- 
rounded by walls of good conducting quality; in short, its increase depends 
npon good conductors of vibratory motions. 

The Fremitus is decreased by the presence of large abscesses or gan- 
grenous destruction or softening of the substance of the lungs; it is decreased 
or even suppressed when gas or serum fills the pleural sac; and it is de- 
creased when the bronchial tubes are filled with mucus, pus or blood; in 
short, in all cases where the vibratory undulation has to pass through differ- 
ent media, air, fluids and solids. 

For here, too, is the physical law of the conduction of sounds applicable; 
the more equal the media in respect to density and elasticity, the better do 
they conduct sounds ; the greater their inequality of substance, the less is 
their conductive power. 

Another vibratory motion within the cavity of the chest, which mani- 
fests itself to manual examination, is the Rhoncus vibration, caused by tough 
mucus lodged in the larynx, trachea or bronchial tubes, and brought into 
vibratory motion by the in-going and out-going current of air. This vibra- 
tion very often extends over the whole chest, although only a little tough 
phlegm may be the cause of it, which can be thrown off by a single cough. 

When, however, the cause of this vibration consists of phlegm* lodged in 
the bronchial tubes, the rhoncus vibration is not felt in the trachea and 
larynx, but may extend all the way down to the bronchial periphery. For 
this reason we can never judge from the extension of the vibration to the 
extension of its cause; in other words, it does not follow that because we feel 
the rhoncus fremitus all over the chest, that there should be phlegm all 
through the chest. This would be a mistake which could be made only by 
those who do not understand the propagation of rhoncus vibration. 

A third vibratory motion, recognizable by manual examination, is the 
peculiar rubbing or grating sensation which occurs when the surface of the 
pleura pulmonalis and costalis — which naturally glide smoothly over each 
other — are roughened by solid effusion between their contiguous surfaces, as 
in pleurisy. It is mostly of short duration, but may last in some cases 
months and even years. The same motion is caused by fibrous deposits 
within the pericardium, in consequence of pericarditis; it resembles very 
much the purring of a cat. 

A fourth motion which the examining hand discovers upon the thoracic 



III. PERCUSSION. 31 T 

walls is the Pulsation of the heart. "While the body is erect, the heart, 
when in a natural condition, is constantly felt to strike the parietes between 
the fourth and fifth ribs about an inch below and to the inner side of the 
nipple. While rying upon the back, its impulse is greatly decreased, and is 
usually felt somewhat nearer to the sternum. When the body is turned to 
the left side, the impulse is felt in a direct line with, or often nearly an inch 
to the outer side of a line passing vertically over the nipple; while, on the 
contrary, when the body is turned to the right side, it is felt between the 
cartilages of the ribs, close to the sternum, or sometimes cannot be felt at all. 

" When the parietes of the heart are thickened, or hypertrophied, and 
the force of its impulse is consequently increased, the hand, placed over the 
precordial region, becomes at once sensible of its abnormal force, though the 
pulse at the wrist ma}' at the very same time be small and feeble. In con- 
siderable hypertrophy of the, left ventricle the apex of the heart strikes not 
only lower, but also outside, or to the left of the nipple line. 

"When the cavities of the heart are dilated, with or without any 
increase of the thickness of their walls, the impulse is often perceptibly 
extended over a larger space than natural, and may be felt not only above, 
below, and around its ordinary site, but also in the scrobiculus cordis; and 
sometimes even on the right of the sternum. It must, however, be recol- 
lected, that in nervous and excitable persons of spare habit, the impulse of 
the heart is often very extensively diffused, even when no disease of the 
heart exists; and, therefore, that a widely extended or diffused impulse is by 
no means a proof of the existence of disease in the heart, or in any other 
organ. 

' ' When the heart is removed from its natural situation by gaseous or 
fluid effusions into the pleura, by tumors, abscesses, etc., it is by manual 
examination that the fact can generally be best determined. 

' ' When obstruction exists in the valves, a trembling motion or ' purring 
tremor ' is frequently communicated to the hand, and the tumultuous action, 
or trembling motion, existing in the more advanced stages of disease in the 
heart, can often be best appreciated by palpation." (H. M. Hughes.) 

HI. Percussion. 

A casual examination of the different works on this subject is amply 
sufficient to'cause total confusion in the mind of the beginner, and a loathing 
of the task of wading through such contradictory assertions of the different 
authors. For whilst the one pretends to hear the grass grow, and to find 
out every little nook and crook in the lungs that is abnormal, b3^ knocking, 
another asserts coolly, that such talk is a mere flatulent phraseology, refer- 
ring simply to the fact that the most skilled and experienced in this knock- 
ing art themselves confess of having made the most glorious mistakes. 

What are we to do then in such perplexity? Shall we throw the whole 
overboard, as a fashionable craziness of the profession? It would be a short 
process of getting rid of the trouble. But then, that is not the thing. There 



312 III. PERCUSSION. 

has been so much labor and ingenuity bestowed upon this subject, that there 
must be some guiding truths in this heap of collected experiments and re- 
searches, no matter how badly mixed with contradictory assertions. 

In the following pages I shall try to state the fundamental principles, 
by which we must be guided in the application of this kind of examination. 

There is an immediate and a mediate mode of percussion. It is immedi- 
ate when the finger of the examiner strikes directly upon the parietes of the 
chest. It is mediate when some solid material, such as a disc of wood or 
ivory, a piece of leather, or the finger of the left hand, is interposed between 
the parietes and the striking body. 

The striking body may be one or more fingers pressed together and bent 
slightly, or a little steel hammer, whose head or striking surface is covered 
with leather or caoutchouc. 

In regard to the merits of these different modes I have to say that much 
depends upon what we may have become accustomed to; still the one or the 
other may be preferable under certain circumstances, which practice will 
soon teach. 

What does percussion reveal? 

If we strike different objects we receive different sounds. There is, 
however, a marked difference between those bodies w T hich contain air and 
such as do not. As extreme examples of this difference we may cite the 
sounds which we obtain when we percuss the chest or stomach, and when we 
percuss the thigh. In the first case w T e obtain a sound wdiich reverberates — 
has resonance, whilst in the other case we hear a mere noise, a clap, without 
any resonance or tone w T hatever. This latter, which we may call the flat, 
dead or fleshy sound, is everywhere the same, where we strike upon an organ 
not containing air; such as the liver, the spleen, the kidneys, hepatized 
lung, or lung completely deprived of air by compression and fluids; a hard 
liver yields the same sound as a soft liver, a hard spleen as a soft spleen. 

But it is different with organs and bodies which contain air; there the 
sound varies quite considerably. Take for example an open jar or bottle, 
and percuss it at its mouth, you will hear a sound similar to that of a drum; 
this is the sound which Skoda has called the Tympanitic sound, and which 
we also might call drum sound. Its variations are as follows: 

i. If we percuss an open jar or bottle, this drum sound will be deeper, 
the higher or longer the bottle or the column of air which it contains; it will 
be higher, the shorter the column of air which is within. 

2. If we percuss an open jar or bottle, we find that the wider the mouth 
of the vessel, the higher is its tympanitic tone; and, the more we contract 
the mouth of the vessel, the deeper becomes this tone. In short, it depends 
on the volume of air which is set into vibration; a larger volume gives a 
deeper, a smaller gives a higher tone. 

3. If we, however, percuss closed cavities, there comes into consideration 
another circumstance. A drum or jar, whose mouth is closed tightly with a 
piece of bladder, can exemplify it. We perceive at once that the tenser the 



III. PERCUSSION. 313 

skin is drawn over the drum or the bladder over the jar, the higher becomes 
its tympanitic tone, and vice versa, the looser, the deeper. Here, however, 
it must be remarked, that this comes to pass only when the surrounding air, 
and the air within, is of equal density and expansion. As soon as either is 
set out of that equilibrium, just so soon the tympanitic sound is lost, because 
this diversity hinders the regular vibrations of the membrane, which are 
necessary for the tympanitic sound. 

Thus we find that the tympanitic sound varies in height and depth of 
its tone. It becomes higher in the ratio — 

1. As the column of the percussed air is shorter; 

2. As the mouth or aperture by which the percussed air stands in con- 
nection w T ith the external air is wider; and 

3. As the enclosing membrane is drawn more tense over the cavity. 
It becomes deeper in the same ratio — 

1. As the column of the percussed air is longer; 

2. As the mouth or aperture by which the percussed air is in contact 
with the external air is narrower; and 

3. As the membrane w T hich closes the vessel becomes looser. 
Applying these principles to the living organism, we come to the follow- 
ing results: 

1. The tympanitic sound is heard over the larynx. The wider the person 
under examination opens his mouth, the higher is its tone; in closing the 
mouth it becomes deeper and weaker, and when closing the nostrils also, it 
becomes still deeper and weaker. 

2. The tympanitic sound is heard where there exist superficial cavities in 
the lungs, which contain air. If it happens that such cavities are in immediate 
connection with the trachea, larynx and mouth, by means of large bronchial 
tubes, then w 7 e have the same phenomena in opening and shutting the mouth, 
as above detailed. In opening the mouth the tympanitic sound has a higher, 
and, when shutting it, a deeper tone. If the cavity is in no such connection, 
then opening or shutting the mouth does not alter the tympanitic sound. 

3. It is heard on the thorax in all those conditions of the lungs in which 
the external air presses equally strong within upon the substance of the lungs, 
by means of its air-cells and bronchial tubes, as it does from the outside upon 
the thorax; that is, where there is a perfect equilibrium between the pressure 
of the internal and external air. This, however, in a normal state is never 
the case. The inner pressure of the air minus the contractility of the pul- 
monary tissue, is like the external. But the disease may deprive the lung 
tissue of this elasticity and contractility by compressing it, whereby this 
equilibrium becomes established. This we find, for example, in partial 
emphysema, in the neighborhood of infiltration, as happens in pneumonia, 
where, not unfrequently, the tissue around the hepatized portion, and 
especially at the borders of the lung, is emphysematous, and also during 
pneumonia, as long as the air-cells are not infiltrated, but have lost their 
natural elasticity. In these conditions we hear a decidedly tympanitic 



314 in. percussion. 

sound. It is heard in pneumothorax — a collection of air or gas in the 
pleural sac. However, when the pleurae are much distended the tympanitic 
sound is lost and we get either a high-pitched flat tympany or entire flatness. 
We hear it again distinctly and invariably at the upper portion of the chest, 
when the lower portion of a lung is entirely compressed by a pleuritic effusion 
and its upper portion is reduced in volume. 

4. The tympanitic sound is heard lastly in those parts of the chest in 
whose neighborhood the stomach lies, namely, in the lower part of the left 
mammary, left lateral, and left infrascapular regions, provided the stomach 
be not too much distended with air; because otherwise a regular vibration of 
its walls, and hence the tympanitic sound, would be impossible. 

The same is true of the abdomen; and thus we come directly to the 
following result : The tympanitic sound on percussion is heard at the larynx; 
at the collapsed or compressed lungs; at the relaxed stomach, and at the com- 
pressible abdominal walls. 

Quite different from this tympanitic sound is another sound elicited by 
the percussion of bodies containing air: the Non- tympanitic sound of Skoda, 
which we might perhaps more intelligibly call the resonant sound of the lungs, 
or, by abbreviation, the lung-sound. The best example of this sound is 
obtained by percussing a health} 7 thorax; and, in doing this, we perceive at 
once that there are different degrees of resonance in it. It varies in clear- 
ness from a very resonant to a muffled sound; and, in duration, from a long 
resonance to a short snap. 

In the normal state of the lungs we find this sound very resonant in the 
superior sternal, the axillary, and the upper part of the infrascapular 
regions; resonant in the subclavian, the upper part of the mammary, and 
lateral, and interscapular regions; muffled in the acromial, and the lower 
part of the right mammary, and lateral, infrascapular regions; flat, dead, 
fleshy in the inner edge of the left mammary (where the heart lies), and in 
the regions of the liver, spleen, kidneys. 

Pathologically altered states of the lungs alter also this natural resonance 
of the percussion sound. 

It is Muffled ; dull— 

1. On an}- portion of the lung which is deprived of air, if it is, at least, 
the size of a half-dollar, and about half an inch in thickness. 

2. In the subclavian regions from tubercular infiltration. 

3. In the inferior posterior regions, as the favorite seat of pneumonic 
hepatization; other parts not excluded from the same cause. 

4. Diffused over a considerable portion of the chest in haemorrhages 
and destructive processes within the substance of the lungs. 

5. In malignant diseases of the lungs, where the pulmonary tissue is 
pushed aside and the air is excluded from the parts affected by cancerous or 
fungous growth. 

Diseases of the pleura cause a dull percussion sound — 

1. "In pleuritic effusion, no matter whether the fluid be blood, serum 



IV. AUSCULTATION. . . 315 

or pus. The dullness in either case may, and generally does, primarily, 
affect only the lower part of the serous cavity, gradually extending upwards 
as the fluid increases, and by its increment displacing the lung. But it may 
also, on the contrary, in either case, extend over only a limited space, to 
which it is confined by previously existing pleuritic adhesions. 

" When the pleura is free from such adhesions, the fluid, from whatever 
part of the membrane it proceeds, may in each case gravitate to the lowest 
part of the cavity, and its site may be changed according to the varying 
position of the patient's body. In each case, therefore, the part in which the 
dullness is observed may also vary with the change of position. The change 
in the situation of the fluid and of the consequent dullness, according to the 
position of the body, is, however, far more common in hydrothorax than in 
either simple pleuritic effusion or empyema, in which diseases the fluid is 
much more frequently confined to a limited space by surrounding adhesions, 
or gravitaties with less facility." 

2. "In malignant disease of the pleura, as in that of the lung, the pul- 
monary tissue is pushed aside, and the dullness and resistance exist on per- 
cussion commensurate with the extent of the solid deposit." (H. M. 
Hughes. ) 

Hyper-resonance is found when the air vesicles are abnormally dilated, 
the sound becoming more tympanitic in character and higher pitched. It is 
met with in such conditions as emphysema and is practically what Flint calls 
vesiculo-tympanitic resonance, on account of its mixed quality. 

The Metallic ringing percussion sound, or Amphoric Resonance. This is 
the same sound which we elicit by striking empty or nearly empty vessels. The 
presence of water is not required, but does not hinder its production. Accord- 
ing to Wintrich it originates in smooth cavities, where the vibrations of the 
sound are reflected from wall to wall in a regular manner. It is heard in pneu- 
mothorax, over large cavities, and such cavities as are connected with each 
other, whose walls must be fit for the reflection of sound; that is, they must 
be smooth and curved. 

The Cracked pot sound is similar to the metallic ringing sound, only not 
so perfect — a spoiled metallic ringing. It may be produced on any healthy 
chest by knocking forcibly with the fist during loud speaking or singing. 

Pathologically it is indicative of a cavity communicating with a bronchus. 
However, Wintrich points out how disappointing it is to have diagnosed a 
cavity by this sign and not find any existing on post mortem examination. 
There are some who consider it an infalliable sign of a cavity, but is unwise 
to put too much confidence in a single physical sign if there are not other 
signs present to verify the condition suspected. 

IV. Auscultation. 

You may auscultate a patient either by applying your ear immediately 
to his chest, or by interposing a stethoscope between it and your ear. The 
first is called immediate and the latter mediate auscultation. 



316 THE NORMAL SOUNDS OF RESPIRATION. 

Much has been said in books about the superiority of each method over 
the other; but there is no need of such long disquisitions. I hear best with 
the naked ear, and so will anyone else who faithfully tries both methods. 
But I prefer the stethoscope decidedly, if I have to examine an unclean per- 
son, or a person with skin disease, or in an}' case where great delicacy must 
be observed, or when I cannot easily apply my ear to to the parts to be ex- 
amined. 

There has also been a great talk in books about the form and material 
of the stethoscope. It is all the same, whether it be made a little shorter or 
longer, straight or bent, out of one piece or of several pieces of wood or 
metal, if only its bore be smooth and adapted to conduct and reflect the 
sound perfectly. That is all that is required. 

In order to know anything about abnormal sounds in the respiratory 
organs, we must first become acquainted with those sounds which we can 
hear in a normal state of these organs. 

The Normal Sounds of Respiration. 

They must be distinctly considered as inspiratory and expiratory sounds. 

The Inspiratory sound heard at the larynx, trachea and large bronchial 
tubes ma}' be imitated by forcing air against the hard palate, as is done in- 
voluntarily in hard breathing, or in pronouncing the guttural consonant ch. 
The height or depth of this sound (its pitch) depends upon the width of the 
opening through which the air passes. This sound is called Bronchial 
respiration or Tubular breathing, and is found in a normal state at the larynx, 
trachea, large bronchial tubes under the upper part of the sternum, the inner 
side of the subclavian, the interscapular regions, and occasionally, though 
less distinctly, in the axillary regions, especially the right one. It is loudest 
in the larynx, less loud at the trachea, and still less loud at the superficial 
bronchial tubes, sounding as if coming from a distance. If this bronchial 
or tubular breathing be heard in other localities than the above named, it 
may, with tolerable certainty, be regarded as morbid. 

An altogether different sound is heard during inspiratior, when we put 
the stethoscope upon any other part of the chest than those previously speci- 
fied. It may be imitated by narrowing the opening of the mouth and then 
drawing in the air. The consonant of this murmur is v or b, and it is called 
the Respiratory or Vesicular murmur of the air-cells and finer bronchial 
tubes. 

" It varies considerably in intensity in different regions of the chest. It 
is most distinct in the acromial, the central and lower part of the superior 
sternal, the subclavian, the axillary and the subscapular regions. It is less 
distinct in the lateral, the right mammary, the scapular regions, still less in 
the hypochondriac, and least of all in the inferior sternal and the inner part 
of the left mammary region. 

' ' Independently of the variation of the intensity of the sound in the 
different regions of the chest, whether the variation arise from the position 



THE NORMAL SOUNDS OF RESPIRATION. 317 

of the organs, the amount of pulmonary tissue beneath the ear, or the facility 
or difficult}' with which the inspired air reaches the pulmonary cells, the two 
sides of the chest frequently vary a little in respect to the loudness of the 
respiratory murmur. Thus it is rather louder in the acromial, scapular and 
infraclavicular regions of the right side, but in so slight a degree as to be 
scarcely worth}* of consideration in a practical point of view. 

' ' The respiratory murmur may, both locally and generally, be more or 
less loud than natural in persons who are quite free from any appreciable 
disease. It may also be harsh or rough, scarcely audible, or altogether absent. 
Thus in childhood and in youth, the respiratory murmur is louder than in 
adult life, and especially than in old age. From this circumstance a loud 
inspiratory murmur is called (whether normal as in childhood, or youth, or 
abnormal, from any cause, in age ) puerile or supplementary respiration : 
puerile, because it is the normal state of respiration in children, and supple- 
mentary, because it is thought that when one lung or part of a lung is disabled 
the increased activity of the other lung, or another part of the same lung, 
supplies the defective action of the diseased organ or part. 

" It is always heard when the healthy respiration is more than ordina- 
rily active, as in persons ' out of breath,' as it is called, from strong exertion, 
as running, dancing, etc., or after the respiration has been voluntarily sus- 
pended for a time, and the individual breathes quickly to restore the normal 
balance of the circulation through the pulmonary organs; we hear it, there- 
fore, also after the sudden termination of an asthmatic paroxysm. The 
strength of the inspiratory murmur, instead of being increased, may be 
diminished, though no disease exist in the chest. This imperfection of the 
respiratory murmur is usually observed either in parts of the lungs which 
have been little used, as in the lower regions of the chest of females accus- 
tomed to tight lacing, or in persons suffering from deformity, whether con- 
genital or acquired; or in the chest of persons considerably advanced in 
life, also after long illness when the patient for a long time has been obliged 
to lie on his back. In the first two and last instances the defect results from 
want of use and consequent imperfect expansion of the lung. In the case of 
deformity it proceeds from atrophy and consequent defective functional activity 
of the pulmonary tissue. It may, indeed, be regarded as the natural char- 
acter of the respiratory sound in old people, and may therefore be called 
' senile,' as that existing in children is termed ' puerile respiration." 

' ' Occasionally the inspiratory murmur is entirely absent from one or a 
part of one lung, though no disease be present in the organ itself. This 
condition, however, probably never exists without some mechanical obstruc- 
tion to the ingress of air, either in the air tubes or upon the exterior of the 
organ (spasm, foreign body, apparent death)." (H. M. Hughes.) 

The murmur of expiration in the normal state of the respiratory 
organ causes little or no sound in the air-cells and finer bronchial tubes; 
whatever sound is heard differs from the murmur of inspiration, and resem- 
bles rather a gentle aspiration or blowing. It can be imitated only bv the 



3l8 PATHOLOGICAL DEVIATIONS. 

mouth during expiration; the consonant which .represents it falls between/" 
and k. In the larynx, however, it is louder than in inspiratory murmur. 

Laennec and Skoda, attribute the sound of the vesicular breathing to 
the friction of the air against the walls of the finer bronchial tubes and the 
air-cells, the contractile power of which it has to overcome. The reason 
why the inspiratory murmur of the air-cells is much louder than the expira- 
tory is, that the air, when it enters into them, meets with resistance from 
their contracility, but does not meet with any in its passage out of them. 
It is different, however, in the large bronchial tubes, and particularly 
in the trachea and larynx; here the air, during inspiration, meets with no 
opposition; it has, indeed, rather a tendency to expansion; but during 
expiration the stream of air coming from all parts of the lung out of the 
air-cells, collecting in the trachea and larynx, becomes compressed and 
causes friction on the walls of this tube, and especially in the narrow glottis; 
hence, the expiratory murmur of the larynx, trachea and large bronchi is, as 
a rule, louder than the inspiratory. 

Pathological Deviations from the Normal Vesicular Respiration. 

1. The inspiratory murmur. The presence of the vesicular murmur 
at any part of the thorax indicates the entrance of air into the air cells of 
that part of the lung which lies beneath the spot auscultated. Its absence, 
therefore, indicates those abnormal conditions which prevent the passage of 
air into the air-cells; such are compression of the air-cells by exudations or 
tumors in the pleura, enlargement of the heart and other diseases; infiltration 
of the lung tissue by plastic or tuberculous matter, by blood, serum, pus, 
etc. ; atrophy of the air-cells and obstruction of the bronchial tubes by 
mucus, blood, or by swelling ot the mucous membrane. 

The vesicular murmur becomes harsher, when the lining membrane of 
the air-cells and finer bronchial tubes is roughened, swollen and thickened. 
The presence of a harsh vesicular respiration, which may amount sometimes 
even to a hissing sound, indicates, therefore, a swelling of the mucous mem- 
brane of the finer bronchial tubes and air-cells, as exists in catarrh; or soli- 
tary tubercles thickly scattered through the tissue of the lungs; and oedema 
of the lungs. 

2. The expiratory murmur. In a healthy condition of the lungs it is 
very soft and somewhat shorter than the inspiratory murmur, sometimes 
scarcely audible. Its abnormal conditions are, therefore, harshness and pro- 
longation. The causes hereof must be sought in a roughened and narrowed 
condition of the finer bronchial tubes and air-cells, by which greater friction 
of the egressing air is produced. 

This prolongated and harsh expiratory murmur is rarely heard extending 
all over the lungs in a uniform manner, but is mostly confined to portions of 
the lungs, and then is of the highest diagnostic importance. 

If it extends over a large surface of the lungs, it indicates a more gen- 



PATHOLOGICAL DEVIATIONS. 319 

erally swollen and uneven surface of the bronchial mucous membrane, as we 
find in acute and bronchial catarrh, with or without emphysema. If it, how- 
ever, is confined to the apex of the lungs, between the first and third ribs, 
and more in front than behind, and more on one side than on the other, it 
indicates tuberculosis. 

Dr. Jackson, of Philadelphia, was the first who, in the year 1832, drew 
attention to this prolonged, harsh, expiratory murmur, as a sign of tuber- 
cular infiltration, and it has been extensively confirmed since. Flint calls 
this broncho-vesicular, as the bronchial element is added. 

This prolonged, expirator} T murmur is sometimes broken into two or 
three jerks, and is observed in tuberculosis; also in old people and children 
w T hen frightened; also during the chilly stage of fevers. The inspiratory 
murmur also exhibits such interruptions. It is necessary to listen in such 
cases to the larynx, whether the interruption is heard there too, otherwise it 
might easily be mistaken for a friction -sound of the pleura. 

3. Bronchial respiration. When we auscultate the larynx or trachea, 
the respiratory sound is louder than in any other part of the chest, if it be in 
a healthy condition. It may be imitated, as said before, by forcing the air 
against the hard palate, so as to produce the consonant c/i, guttural. This 
respiratory sound has been termed bronchial respiration. If heard in any 
other part than that above specified, it denotes a change in structure, which 
subdues the vesicular breathing, and serves as a good conductor of sound 
from the larger bronchial tubes. Such conditions are: hepatization and 
tubercular infiltration (the most frequent); next in frequency, thickening- 
of the bronchial tubes, with atrophy of the lung tissue; pulmonary oedema 
and pleuritic effusions ; hydrothorax, and cavities freely communicating with 
a bronchus. In the latter case it is often distinguished as cavernous from its 
hollow quality and low pitch. As a general rule it may be said that bronchial 
breathing is present in such conditions of the lungs giving rise to a tympan- 
itic sound on percussion. 

4. Rhonchi or rattling noises in the respiratory organs; Rales. When 
the bronchial tubes are partly constricted, or when tough mucus exists 
therein, which is set into a vibratory motion by the rush of air during respi- 
ration, or, if sticking tightly to the walls, is suddenly torn, then we have all 
kinds of noises within the thorax. Such noises may be high, deep, clear, 
husky, harsh, or hollow; may be short like a snap, and return at intervals; 
or continuous for a longer time, like the purring of a cat. 

' ' These noises, ' ' says Dr. Wintrich, " have been called, strange enough, 
dry rattling noises, and have been divided into rhonchi sicci, graves, sonori, 
sibilantes and canori. The poetical talent of some authors has had ample 
opportunity to force them by comparison into the most singular and fanciful 
classes, of which a cool reflection has might} T little to think," and, I may 
add, by which the beginner is thrown into utter confusion. They originate 
within the respiratory tubes, exactly in the same manner as sounds originate 
in any other kind of tubes. The sound is high, shrill, when the tube is nar- 



320 PATHOLOGICAL DEVIATIONS. 

row or constricted in one or more places; it is deep, in tubes of large lumen 
and when the vibrating column of air is long, or when the vibratory undula- 
tion is low; it is loud, strong, when the stream of air is of great force; and 
vice versa, it is weak, faint when the stream of air is weak. 

These rhonchi often extend over a large portion of the chest; if deep 
they occasion a vibration of the thoracic walls, perceptible to the touch; if 
high, not. Still we cannot, as has been mentioned already under the head 
of vocal fremitus, from its extension, draw any conclusion as to the extent 
of its cause, because this sound may be propagated, like the fremitus, 
from a single point where it originates, to all parts of the chest. 

These rattling noises generally have their origin in catarrhal affections, 
and change constantly according to the location and the different nature of 
phlegm, which is shifted from one place to another by breathing and cough- 
ing. Exceptions to the above are hissing sounds, which sometimes exist con- 
tinuously for weeks, and even months. These hissing sounds, or rhonchi 
sibilautes, must have, therefore, a more persistent cause, the nature of which 
seems to be constriction in some- of the finer bronchi; and we find them in 
such a persistent manner only in tuberculosis of the apices of the lungs. 

The so-called moist sounds are thought to originate in the presence of a 
fluid, which, by the rush of air, is stirred up into large and small bubbles, 
which burst. We may distinguish the following varieties: 

i. Rhonchus crepitans, vesicular crepitation, or crepitant rale. It is 
quite similar to the noise wmich is produced when a lock of hair is tubbed 
between the fingers. It is heard only during inspiration. I^aennec and all his 
followers, even Skoda, explained it in this way: that the rush of air during 
inspiration into the finest bronchial tubes and air-cells, if the) 7 contain a fluid, 
stirs this fluid into bubbles, which burst and thus cause the crepitant rattle. 
Walshe, an English author, not being satisfied with this explanation, formu- 
lated the theory that it originated through the sudden expansion of the 
interstitial spaces around the air-cells by a full inspiratory action. He 
thought these interstitial spaces glued together by the exudation of a tough 
matter in pneumonia, so that a sudden expansion would tear them asunder 
and cause this crepitation. This opinion of Walshe w T as later refuted .by 
Davies in his lectures, who explained that in pneumonia the exudation does 
not take place outside but inside of the air-cells, as the tough sputa sufficiently 
show, and that the same crepitating sound is also found in oedema of the 
lungs. Dr. Wintrich gives, no doubt, the best explanation of this sound. 
He says: "This crepitating sound is nothing else but the noise which is 
caused by the sudden inspiratory expansion of the air-cells and finest bronchial 
tubes when their walls have become glued together by means of a stick} 7 ex- 
udation. ' ' It is therefore not heard in a sound lung, because here the air- 
cells, even during the fullest expiration, never contract to such an extent 
that their walls touch each other and stick together. Wherever it exists, 
there is a morbid swelling and tough secretion within these air-cells and finest 
bronchial tubes, which bring their w T alls during expiration in such near 



PATHOLOGICAL DEVIATIONS. 32 1 

contact that, by means of the sticky secretion within, they are glued together 
and then torn asunder by the following inspiratory act. 

The intensity of this crepitation depends upon the toughness of the 
secretion and upon the force with which inspiration tears the adhering walls 
asunder. It does not cease after coughing and expectoration, because it de- 
pends upon a swelling and a secretion of the air-cells and finest bronchial 
tubes which no cough can remove. It is heard at the commencement of 
pneumonia, just when exudation takes place, and at its resolution; in capil- 
lary bronchitis and in oedema and sometimes in emphysema of the lungs. In 
oedema the crepitant rattle is much softer and distant, because the transuda- 
tion is of a much less sticky nature than in pneumonia or bronchitis. 

It is heard, lastly, in sound lung under the following condition, as Walshe 
describes it: "If individuals whose lungs are healthy, or diseased only at the 
apices, and whose breathing is habitually calm, are made suddenly to respire 
deeply, a peculiar, fine dry crepitation, accompanying inspiration only, may 
often be detected at the basis posteriorly. But after two or three, or, at most, 
five or six acts of respiration, it totally disappears. This pseudo-rhonchal 
sound seems to depend on the sudden and forced unfolding of air-cells, which 
are unaffected by the calm breathing habitual to the individual; and its only 
importance arises from the possibility of confounding it with crepitant 
rhonchus. ' ' 

It is frequently heard in patients who have lain long on their backs, 
especially after typhoid fevers, and may be explained in the same manner. 
The pulmonary secretion collects mostly in those places which lie deepest and 
are used least. By these means the air-cells gradually collapse and stick 
together. A few deep inspirations tear them asunder and at the same time 
remove the secretion, so that, as there is no morbid swelling in these parts, 
the crepitant sound ceases after two, three, or at most, after five or six acts 
of respiration. 

2. The subcrepitant rale. This is a sound which appears to arise from 
the bursting of very small bubbles in the air-passages. It is heard most dis- 
tinctly during the act of inspiration, weaker during expiration. It denotes 
a fluid secretion in the finer bronchial tubes. 

3. The mucous rale. There is sometimes a great deal of mucus in the 
respiratory organs, and yet, on auscultation, no rattling sound is perceptible. 
It seems, then, that certain conditions must exist in order to render the 
bursting of large and small bubbles in the air-passages audible. These con- 
ditions are: that the walls, wherein the sound originates, must be good 
reflectors of sound, like the larynx, the trachea, cavities, and bronchi, if they 
are surrounded by walls which do not contain air; and also, that fluid 
(mucus, pus, blood, serum) be contained in them, which, by respiration, is 
set into bubbling motion. The mucous rattle varies much in character; is -a 
sound of large or small bubbles, high or deep in pitch; confined to a small 
spot, or extended over the whole lung. By the extension of the sound we 
can never judge of the extent of the fluid which gives rise to it; because this 

21 



32 2 PATHOLOGICAL DEVIATIONS. 

sound is propagated quite a distance from its origin, if there exist good 
reflecting media. It therefore does not indicate any particular disease, but 
only certain conditions, like consolidation of the lung tissue, either by infil- 
tration or hepatization, compression or atrophy. 

4. The metallic tinkling. " When in consequence of a communication 
with a bronchial tube, or a portion of the lung, the pleural sac contains a 
considerable portion of air, and also a small quantity of fluid, or when a 
phthisical cavity of large size is similarly circumstanced, there is every now 
and then heard a very peculiar sort of tinkling noise upon examining the 
chest. It resembles very nearly the sound caused by shaking a pin in a 
decanter. This is the metallic tinkling. It is most commonly heard only 
at intervals; that is, it may occur once in three, four or forty respirations. 
It rarely, if ever, attends the expiration. It may cease altogether and reap- 
pear after a considerable time. In this respect it seems to be influenced by 
the position of the patient's body. It is most probably produced by the con- 
tinued and rapid reverberation of a delicate sound against the firm and 
vibrating walls of a large cavity. It is in fact an echo in a small space. 
The original sound from which the echo proceeds appears most commonly 
to arise from the bursting of a bottle of air, or from a drop of liquid falling 
upon the surface of fluid in the bottom of the cavity. But it sometimes 
seems to be likewise produced by the passage of air over a loose portion of 
membrane or thick secretion situated in a tube at or near the entrance of the 
cavity. The physical conditions necessary for its production appear to be a 
large cavity with resonating walls, and containing a large portion of air, 
with a small quantity of fluid." (H. M. Hughes.) 

In pneumothorax much depends upon the position of the patient. Often, 
when nothing can be heard while the patient is lying down, the metallic 
tinkling appears at once on assuming the sitting posture. In those cases in 
which tubercular infiltration extends to the diaphragm in the left lung, it not 
unfrequently happens that sounds within the lungs are conducted into the 
cavity of the stomach, where they cause exactly the same metallic tinkling. 
Any one who is not aware of this fact, might easily diagnosticate pneumo- 
thorax where, upon post-mortem examination, none could be found. 
Another practical and interesting sound is: 

5. A sort of click, which is heard occasionally, perhaps not oftener than 
once in four or six inspirations, resembling the sticky noise produced by the 
removal of the tongue from the roof the mouth. It is generally observed at 
the apex of the lungs, when there is a deposition of tubercles, and according 
to Wintrich, especially when these tubercles commence to dissolve. Cough 
sometimes breaks it up; but often it is of a very persistent nature. 

6. Friction sound. This sound originates when both pleural surfaces 
(pleura pulmonalis and costalis) become roughened, and in the absence of 
gas, fluids or adhesions between them, rub upon each other. It generally 
accompanies both inspiration and expiration; being at one time most distinct 
during inspiration, at another during expiration. It ma}' be heard during 



AUSCULTATION OF VOICE. 323 

inspiration only, or the reverse. It resembles the creaking of leather; ap- 
pears at intervals, and in most cases it is recognizable by the finger as well 
as by the ear, and the patient generally experiences the sensation of some- 
thing rubbing within his thorax. This sound is most commonly caused by 
pleurisy and pericarditis. It is sometimes heard at the commencement of this 
disease, when fibrous deposits have settled on the surfaces of the pleura, and 
the contact of the surfaces is not prevented by serous effusions. It is also 
heard, and sometimes more distinctly, at a later period of the disease, when 
absorption of the serous effusion has taken place, and the surfaces, covered 
by a firm plastic exudation, have once more come in contact. In this case 
the friction sound continues until either the pleura has formed adhesions to 
the thoracic walls, or its surfaces have become perfectly smooth. It is also 
heard in tuberculosis; especially in the left infraclavicular region, where it 
continues to be sometimes for months, even years; because tuberculosis is 
more or less always attended by partial pleuritic inflammations. Here, how- 
ever, it must not be confounded with the above-mentioned interrupted or jerk- 
like expiration. Both may easily be distinguished, as already stated, by 
listening to the larynx. If heard there, too, it is no friction sound, but inter- 
rupted expiration. 

Auscultation of Voice. 

The voice, as heard in a normal condition of the respiratory organs. If 

the stethoscope be placed upon the larynx of a healthy person, and we listen 
through it whilst the person is talking, his voice sounds nearly as loud as 
though he were talking immediately into our ear; but the words are not so 
clearly articulated. The same is true if we place the stethoscope upon the 
trachea. This normal sound, heard at the larynx and trachea during talk- 
ing, has been called Laryngophony and Tracheophony — -laryngeal voice and 
tracheal voice. 

If the stethoscope be placed upon the upper part of the sternum, or 
upon the cartilages of the second and third ribs or upon the interscapular 
regions, we will still hear the voice when a person speaks, but not nearly so 
loud, and the words will be still less clearly articulated than over the larynx 
and trachea. This normal sound of the voice, as we perceive it over the 
larger bronchial tubes, is called Bronchophony — bronchial voice. 

If, lastly, the stethoscope be put upon any part of a healthy person's 
thorax, the voice of the person is heard simply as a buzzing or humming, or 
is not heard at all. 

Such then are laryngophony, tracheophony, bronchophony and the 
distant humming or buzzing of the voice (vocal resonance), when heard 
over the respiratory organs in a normal condition. It must not, however, be 
supposed that there exists any defined line of demarcation between each, so 
that it could be said, here ends laryngophony, and here begins broncho- 
phony. They all gradually merge into each other; they are not distinct 
species of sounds, but merely variations of intensity of the same sound. 



524 AUSCULTATION OF VOICE. 

We may convince ourselves of this gradual lessening of intensity and clear- 
ness of articulation, if we gradually move the stethoscope from above down- 
wards, and listen at the same time, whilst the person is talking. 

Further, it must be remarked and borne in mind, that the thoracic 
voice is very generally more distinct upon the right side, and particularly 
below the right clavicle and over the right scapula, then in the correspond- 
ing situations upon the left side; also, that a shrill or acute, high-toned voice, 
generally sounds clearer and more distinctly modulated than a deep bass 
voice, though not so loud and strong as this; and that the thoracic voice is 
usually more audible in thin persons than in those who thoracic walls are 
loaded with fat; and in persons with contracted chests, than in those in 
whom the thoracic cavity is largely developed; and, other things being equal, 
it is also more distinct in females than in males. 

The voice as heard in abnormal conditions of the respiratory organs. 
Pathological changes and conditions multiply these variations in intensity 
and articulation of the voice still more. We will frequently have to make 
nice distinctions, and this is only possible, if we compare constantly both 
sides and different parts with each other, for it rarely ever happens that both 
lungs are affected alike. Thus, in listening to the sound portion we obtain 
a standard by which we are enabled to judge of the corresponding portion. 
There is a threefold alternation of the thoracic voice from its normal condi- 
tion possible: it is either — 1. Decreased in its intensity or suspended alto- 
gether; or, 2. Its intensity and clearness of articulation is augmented; or, 3. 
It is changed altogether in its character. 

1. Its decrease is caused by any and all such solid, fluid or gaseous sub- 
stances as may form or collect between the lungs and the thoracic walls, and 
which interfere with the transmission of the natural humming or buzzing of 
the voice on those parts of the thorax mentioned above. This is the case in 
moderate effusion of lymph or pus into the pleural sac, and in moderate 
pneumothorax, in so far as it separates the lungs from the thoracic walls. It 
is the case in widely-extended emphysema, if the bronchial tubes are not 
widened and thus made good conductors of sound. It is the case, where 
large cavities, as it were, swallow up the sound. It is quite important that 
all this be borne in mind, lest we might make mistakes. 

The natural thoracic voice is entirely subdued, when massive exudations 
and transudations in the pleural sac cause a separation of the thoracic organs 
from the thoracic walls. The same is produced by pneumothorax, if it does 
not cause metallic tinkling. The most total suppression, however, of the 
thoracic voice is caused by the closure of the bronchial tubes, either by 
foreign bodies, tough mucus, large quantities of pus, phlegm, or serum, etc. 
The higher up towards the larger bronchi such stoppage exists, the larger is 
the circumference in which the natural thoracic voice is wanting. 

2. Its increase in intensity as well as in clearness of articulation. At 
first I have to remark, that in no case of morbid affection, and on no part of 
the thoracic cavity, does the voice sound as loud as at its origin, the mouth. 



AUSCULTATION OF VOICK. 325 

But it may sound as loud, or nearly as loud, as we hear it in a normal con- 
dition at the larynx. This increase of the thoracic voice we may call 
Laryngophony. French authors have called it Pectoriloquy, which means a 
speaking out of the chest. If it exists in a degree, as on those places where 
the larger bronchial tubes lie, near the thoracic walls, it is called Bronch- 
ophony. Neither pectoriloquy nor bronchophony are always of the same 
strength or loudness, and therefore the authors speak of a perfect and an 
imperfect pectoriloqu3 T , and of a loud and a weak bronchopony. 

The question arises, what causes this increase of the thoracic voice to 
bronchophony and pectoriloquy in places where there should naturally exist 
only a humming or buzzing of the voice. 

The answer is : This increase of the thoracic voice depends entirely upon 
a greater or le-ser degree of aptness of the bronchial tubes to reflect and con- 
duct sounds, or, as we remarked of vocal fremitus, its increase depends upon 
good conductors of vibratory motion. This aptness of the bronchial tubes 
grows in the same degree as their walls become tenser and more solidified, 
approaching the walls of the trachea and larynx; and further, when these 
tubes are surrounded by fluids or semi-solid exudations (as in pneumonia); 
or even by solid masses (as in tuberculous infiltrations); or when the sub- 
stance of the lungs around them has become compressed, and thus deprived 
of air. All these requirements for an increase of the thoracic voice we find 
more or less realized in the following pathological conditions: In tubercular 
infiltration, if it surround several bronchial tubes up to their last extremities 
(this is of the most frequent occurrence); in pneumonic infiltration, where 
the semi-fluid or coagulable exudation causes hepatization of the substance 
of the lungs; in strongly developed oedema, especially of interstitial lung 
tissue, and this only in rare cases; in dilatation of the bronchial tubes, if sur- 
rounded by indurated and shrinking, airless lung tissue; in tumors of all 
kinds, if they compress the lung tissue, or by their own nature and situation 
around the bronchial tubes become good conductors of sound; in all kinds of 
fluid exudations into the plural sac, pleuritic exudation, haemothorax, em- 
pyema, etc., when they compress the lung to such a degree that the periphe- 
ric portions of it become deprived of air — in such cases, however, the lung 
must not be pushed too far from the parietes of the thorax, as; for example, 
during the period of dilatation in pleuritis, in which, in the majority of 
cases, no sound is heard at the corresponding wall of the thorax, in cavities, 
which stand in unbroken connection with the larynx, trachea, and larger 
bronchial tubes, which have smooth walls that are good reflectors, which are 
neither too large nor too small, and which are situated so near to the 
periphery that but little previous lung tissue intervenes between them and 
the thoracic walls — the nearer they are to the periphery and the tenser and 
harder their walls, the greater is the intensity of the thoracic voice heard 
over them. 

This increase of the thoracic voice, in consequence of these pathological 
conditions over parts which, in a normal state, afford only a humming or 



326 AUSCULTATION OF COUGH. 

buzzing of the voice, has been called, as already stated, according to its 
degree, weak or loud bronchophony, and imperfect or perfect pectoriloquy. 
Bronchophony has always a kind of nasal twang, is never so clearly modu- 
lated as sounds or words which come immediately from the mouth. 

3. The thoracic voice is changed in its character. Such a peculiar 
deviation from bronchophony is the so-called oegophony, a tremulous sound, 
which resembles the bleating of a goat, and which is nothing but a modified 
bronchophony, with the nasal twang of quick, successive, tremulous inter- 
ruptions. (Wintrich.) It is heard sometimes without any pathological 
change, in old people, if their voice has become of a trembling character. 
Otherwise it is found under conditions similar to those which produce bronch- 
ophony, and does not designate any particular condition or disease. It 
corresponds to the cracked-pot sound. 

Another deviation from bronchophony is the cavernons voice, which is 
well modulated, without nasal twang or goat-bleating. It originates in 
moderately large cavities, which are situated near the thoracic wall and 
adhere to it; which have thin, smooth walls, capable of good reflection; 
which are, by the larger bronchial tubes, in uninterrupted connection with 
the larynx and trachea, and which do not contain too much fluid. 

If these cavities are large, another deviation from mere bronchophony 
is occasioned, which is spoken of under the name of amphoric echo and 
metallic tinkling. These phenomena may be imitated by a person speaking 
and directing his voice into a jug. When he does so, a peculiar humming 
is heard in addition to the voice. Besides this humming, there is also 
occasionally heard a metallic after-tone, both of which represent what 
Laennec describes under amphoric echo and metallic tinkling. It is pro- 
duced in tolerable large cavities, and also sometimes in pneumothorax. 

Auscultation of Cough. 

As cough is nothing else than a loud and forced expiration, it is clear 
that all which has been said about respiration and voice is likewise applica- 
ble to the cough. It is heard weaker or louder under the same conditions 
which decrease or increase the sound of respiration and of voice. In some 
cases it may make the auscultatory signs clearer and more distinct, and thus 
be a help to a more accurate diagnosis. 

Special Diseases of the Respiratory Organs. 

Having thus far explained, step by step, the phenomena which respira- 
tory action, in normal as well as abnormal conditions, offers to the senses of 
sight (inspection), touch (palpitation ». and hearing (percussion and auscul- 
tation), we now come to consider certain forms of abnormal conditions of the 
respirator)^ organs which occur again and again; and although varying con- 
stantly as individual cases, present, nevertheless, some common, persistent 
features by which they may be arranged, considered and recognized, as defi- 
nite and marked forms of pathological alterations and conditions in these 



AFFECTIONS OF THE BRONCHIAE TUBES. 327 

organs. What we have learned concerning the respiratory action in normal 
and abnormal conditions, we shall now have occasion to apply to certain 
diseases, and in this way demonstrate its practical use. 

a. AFFECTIONS OF THE BRONCHIAL TUBES. 

Bronchitis, Bronchial Catarrh. 

This, like all other catarrhal inflammations, is characterized by a hyper- 
aemic state of the mucous membrane in the bronchial tubes, causing abnormal 
secretions, and, if long continued, gradual changes in their texture. The 
membrane appears injected, ecchymosed, infiltrated, opaque, swollen and 
covered with secretion. In this way the finest tubes may become entirely 
closed, preventing the renewal of air in the air-cells, and causing a poisoning 
of the blood by uneliminated carbon. This generally, however, happens 
only with infants, who are not strong enough to free themselves of the 
secreted phlegm. In such cases, during post-mortem examination, the lungs 
swell out of the thorax, not having room enough inside without being com- 
pressed by the parietes of the thorax, because their alveoli remain filled 
with the inhaled air. In chronic cases the mucous membrane grows hyper- 
trophic, the muscular fibres lose their elasticity, and the tubes enlarge in 
width, either evenly throughout, or only in short tracks, sac-like, — 
Bronchiectasia. 

The inflammation may be confined to the trachea and the larger 
bronchi, or to the smaller ones, or be diffused all over. In the first case it is 
accompanied more or less by a troublesome tickling under the sternum, or a 
sore feeling or burning; while in the second no such sensations exist, as the 
finer bronchi are less liberally supplied with sensory nerves than the larynx 
and trachea. The cough is usually much more violent in the case of inflam- 
mation of the larger bronchi; it is most readily excited at the point of bifur- 
cation. If the catarrhal inflammation is located in the smaller bronchi, it is 
always attended with more or less dyspnoea, which, in an affection of the 
larger bronchi alone, is never found, and for obvious reasons: the swelling 
and phlegm, if ever so great, cannot easily occlude these large tubes, while 
in the smallest a little swelling and a small quantity of phlegm may easily 
prevent the ingress and egress of air. 

The sputum is at first viscid, mucous, transparent, poor in cells, often 
frothy, because mixed with air from the severe efforts of coughing required 
for its detachment; often it is mixed with small quantities of blood for the 
same reason; in the spit-cup it is readily confluent and corresponds to the 
sputum crudum of older writers. As the catarrh progresses, more and more 
cellular elements become freed, and this is a sign that the culmination of the 
process is passed; the sputum now is richly cellular, non-translucent, and 
consists chiefly of mucus and pus cells — it is the " sputum coctum " of older 
writers. If the disease enters the chronic stage, the sputa become more 
puriform, and appear either in greenish or yellowish clumps of muco-pus in 



328 AFFECTIONS OF THE BRONCHIAL TUBES. 

a sero-mucous fluid, of which, when poured into water, one portion remains 
floating on account of the admixture of air, while the rest sinks to the 
bottom; or the purulent masses run together in the spit-cup, of which the 
heavy portion settles to bottom, the sero-mucous part floats upon it, and 
the whole is covered by considerable froth; this sort of expectoration is often 
fetid in a high degree; or the sputa consist of roundish, coin-like masses, 
which lie separate beside each other in the spit-cup; this sort of expectora- 
tion is often the product of a cavity in the lungs, but is also observed in 
chronic bronchitis. At still other times the sputum is sero-mucous, being 
characterized by its thin, thread}* consistence, frequently copiously mixed 
with air-bubbles which cover the entire surface of the expectorated mass. 
Its quantity is often very considerable, amounting to actual bronchorrhcea, 
and is principally observed in the chronic forms of bronchitis. The ashes of 
these various kinds of sputa have been found to contain: Chlorine, sul- 
phuric acid, phosphoric acid, potassa, soda, lime and magnesia, oxide of iron 
and silicic acid. The same constituents are found in the ashes of the lungs, 
but their quantitative composition differs greatly. Phosphoric acid, for 
instance, and oxide of iron are found in much less amount in the sputa than 
in the ashes of the lungs, whereas potassa exceeds greatly in amount in the 
ashes of the sputa. 

Bronchitis, whether confined to the larger or smaller tubes, is mostly 
always attended by fever. It generally sets in with chilliness, alternating 
with a feeling of burning heat, without a corresponding rising of the mercury 
when the thermometer is applied. Thus we ma}' already in the commence- 
ment of a fever be able to distinguish a catarrhal from an inflammatory fever; 
the latter, generally commencing with only one chill, is followed by a fever- 
heat that indicates a much higher degree by the thermometer. 

Catarrhal fevers are sometimes epidemic, when they are called Influ- 
enza or La Grippe; involving the whole system and especially the* mucous 
membranes, even those of the bowels. 

In old people, or otherwise exhausted persons, catarrhal fevers take at 
times a bad turn, and assume a typhoid character. The patient becomes 
delirious and comatose, his tongue dry, pulse small and frequent, and his 
body covered with exhausting perspiration. To the comatose state is 
added at last, a rattling in the trachea from the bursting of big bubbles, 
which is caused by the inability to throw off the phlegm, in consequence of 
paralysis of the muscular fibres of the bronchi. This is the so-called death- 
rattle; after the setting in of which the scene soon closes. This form of 
bronchitis is termed by the older writers Pneumonia notha. 

Another form is the so-called Catarrh on the chest of infants, especially 
during dentition It involves the smallest branches of the bronchi, whence 
it is also called Bronchitis capillaris. Its character is the same as any 
other form of catarrh; but as the swelling attacks the finest tubes, it soon 
makes them impervious to air, and consequently prevents the expulsion of 
carbon, and the inhalation of oxygen. Such children are in great distress, 



AFFECTIONS OF THE BRONCHI AE TUBES. 329 

breathing heavily, with hissing and rattling noises in the chest. The cough- 
ing spells are painful and violent, driving the blood to the face, and when 
still further progressed, the epigastric region and lower ribs are drawn in 
during inhalation, as in croup, a sign that the air cells are no longer filled 
by the inspiratory act; so also do we find the supra-and infra- clavicular 
region bulging out, protruding, as the air contained therein is not removed 
by expiration, and there is consequently a noticeable stillness of the upper 
part of the chest during expiration. 

When such an attack befalls newborn children from their having been 
exposed to cold by washing, bathing, etc., it soon develops itself into a higher 
stage, as the child is too 3 T oung and too weak to clear away the accumulating 
secretion by its own efforts. The child turns bluish and grayish; the nose 
becomes pointed; the eyes dull; the respiration quite superficial. It is 
nothing more nor less than a clogging up of the finest bronchial tubes, and 
in consequence of that, an overcharge of the whole system with carbon. A 
superficial observer might confound it with cyanosis from some organic lesion 
of the heart. 

The chronic forms of bronchitis differ but little from the acute forms. 
A chronic bronchial catarrh aggravates usualty in spring and fall, and leaves 
the patient comparatively free through the summer. In some cases where 
the sputa are very tough, it is attended with painful straining fits of cough- 
ing, in others the cough is much lighter, as the secretion consists of a more 
fluid and yellowish substance. Very frequently bronchial catarrh is attended 
with dyspnoea on account of constrictions which, by the chronic inflamma- 
tion, have been formed within the air-tubes. So also originate by the 
gradual change of texture of the bronchi, dilatations here and there (Bron- 
chiectasias), which in most cases contain masses of puriform sputa of a very 
fetid odor. In other cases, especially where the catarrhal inflammation is 
located in the larger bronchi, the expectoration is of great abundance, and 
consists of a thin, sero-mucous substance, mixed largely with air-bubbles. 
Such abundant discharge from the air-tubes is called Blenorrhcea of the 
Bronchi, or Bronchorrhoea. In some cases there is no great dyspnoea, in 
others where the inflammation invades the finer tubes, dyspnoea will not be 
wanting. 

A long continuance of chronic catarrh often becomes associated with 
hypertrophy and dilatation of the right ventricle of the heart. A particular 
form, the so-called "Dry Catarrh" of Iyaennec, which is associated with 
severe paroxysms of cough with but a trifling amount of expectoration, is 
often combined with emphysema. 

Physical Signs. — Percussion reveals nothing in these affections; its sounds 
are everywhere the same as in a healthy condition. 

Ascultatory signs depend upon the condition of the bronchial tubes. 
As soon as their mucous lining becomes inflamed and swollen, the vesicular 
murmur is loud, harsh and coarse; the expiratory murmur, usually scarcely 
audible, also partakes of this character, and may be even louder than the in- 



330 THERAPEUTIC HINTS TO AFFECTIONS OF BRONCHIAL TUBES. 

spiratory murmur. When, however, the inflammation affects the larger 
bronchial tubes, the vesicular murmur is frequently oversounded by the loud 
bronchial breathing which originates there; but, when the breathing is slow 
and weak, there may be, at the commencement of the disease, no sound at 
all perceptible. 

As soon as the mucous membrane becomes covered with secretion, we 
hear all sorts of mucous rattling, fine bubbling, large bubbling, hissing and 
whistling sounds, according to the nature and location of the secretion. 
When the secretion is located in the larynx, trachea or larger bronchi, the 
rattling noise originating here may be heard all over the chest; hence we 
cannot, from the extent of the noise, judge of the extent of the secretion. 
On the contrary, the finer bronchi may be filled with mucus, and no rattling 
noise be perceptible when the breathing is weak and feeble. When, during 
vigorous respiration, the vesicular murmur is absent, it denotes the presence 
of a large quantity of mucus, or the closure of the finest bronchial tubes by 
swelling, which prevents the air from entering into the air-cells. We may 
also hear the sub-crepitant rale, when the inflammation invades the finest 
bronchi. 

In regard to differential diagnosis, bronchial catarrh differs from other 
acute lung diseases by the absence of acute pain — it produces only a sore, 
raw and burning sensation; by the absence of all abnormal percussion signs; 
and by its commencing with frequently repeated chills. 

Therapeutic Hints. 

Catarrh on the chest of infants, Aeon., Be/lad., Bryon., Calc. card., Ferr. 
phosph., Ipec., Laches., Opium, Phosphor., Sulphur, Tart. emet. 

Catarrh of old people or exhausted persons, Bar. carb., Bryon., Cafb. 
veg., Hydrast., Laches., Phosphor., Rhus fox., Sepia, Tart, emet., Veratr. 

Compare Catarrh 'of Nose and Larynx. 

Acute Forms. — Aeon. In the commencement, especially if brought 
about by exposure to cold west winds, or sudden suppression of perspiration, 
with high fever, dry skin, restlessness and irascibility. 

Act. rac. Cough excited by every attempt to speak, so that one is 
obliged to desist. (Guernsey.) 

Ant. crud. Especially if caused by bathing. The cough seems to 
start from the abdomen; gastric derangement. 

A£sc. hipp. When complicated with gouty diathesis, and a tendency to 
piles with constipation. 

Arnica. Cough excited in children from crying; sputa difficult to loosen, 
or bloody. 

Arse?i. Cough attended with dyspncea; worse about and after mid- 
night; from drinking cold water; from lying down; from mental excitement; 
sometimes attended with cold in the head, diarrhoea, rheumatic pains in the 
limbs, palpitation of the heart, restless anxiety in the night. When cough- 
ing a pain extends from the small of back down into the thighs. The cough 



THERAPEUTIC HINTS TO AFFECTIONS OF BRONCHIAL TUBES. 33 1 

is excited by an intense tickling in trachea and under sternum, from cold 
air: it is whizzing with difficult expectoration of frothy, tough sputa. 
lively exercise brings on the cough. 

Badiaga. Spasmodic cough, with sneezing and lachrymation; during 
the paroxysms, crying and pressing hands upon head; sometimes strangling, 
face turning dark, and thick, yellow viscid mucus flying out of mouth and 
nostrils. Cough loose A. m., tight p. m. (H. V. Miller.) 

Bellad. Barking cough; crying when coughing; hot skin, inclined to 
be moist; drowsy; sleepy, but cannot sleep; starting in sleep. 

Bryon. Crying when being moved, and when coughing; cough tight, 
sometimes with blood-streaked expectoration; worse through day, at times 
worse in the night, compelling to sit up; worse from motion; when entering 
a warm room; from sudden changes of the atmosphere, either to warm or to 
cold; from eating and smoking. Pain in the pit of stomach, and in the 
muscles under the short ribs, or in the sides of the chest, or in the head when 
coughing; spurting of urine when coughing. The cough is at times excited 
by a tickling in the pit of the stomach. 

Calc. ca?-b. Teething children; loose cough; rattling of mucus; bowels 
moved more frequent towards evening; profuse head sweat, especially during 
sleep. 

Card. veg. Evening hoarseness; burning under sternum; soreness of 
chest, and heat of body when coughing; itching from throat down to centre 
of chest when coughing. The cough comes mostly in spells far apart; is ex- 
cited by going into the cold air out of a warm room. Cold knees in the warm 
bed. Pyrosis with a great flow of water from the mouth during the day. 

Caustic. Morning hoarseness; cough worse on getting warm in bed; 
also better in bed and from a swallow of cold water; is attended with pain 
over the left hip; involuntary discharge of urine. Heartburn and acidity 
after fat, saccharine and farinaceous food; sudden cramps in heel-cords in 
the night; stiffness and lameness of jaws. 

Chamom. During teething; cough during sleep without waking; child 
wants to be carried and is very cross. Suffocative constriction of the chest 
as if the throat were throttled, with constant desire to cough. 

Cina. Dry hacking cough, especially at night, followed by swallowing, 
as if something were rising in the throat; the child becomes stiff during the 
cough, and afterwards there is a clucking noise in the throat down to the 
stomach. 

Cinchona. Tickling cough worse from talking or laughing. 

Conium. Cough worse from horizontal position, speaking or laughing. 

Cuptum. Cough better from taking a sip of cold water; trembling after 
coughing; suffocating spells. 

Drosera. The cough seems to come from the abdomen and convulses 
the muscles of the chest and abdomen; the patient tries to relieve the pain in 
chest and hypochondriac regions by holding them tightly; perspires im- 
mediately on waking from sleep. 



332 THERAPEUTIC HINTS TO AFFECTION'S OF BRONCHIAL TUBES. 

Eupat. per/. Rough, scraping cough; violent cough with soreness in 
the chest; the patient supports the chest with his hands; cough before and 
after meals; pain in all the limbs and back; palpitation of the heart. 

Euphras. Dry, tickling cough only in daytime, better from eating and 
drinking small quantities of beer or water. After the cessation of haemor- 
rhoidal flow. 

Ferr. met. Cough better while eating, especially during supper. 

Ferr. phos. Often relieves the catarrh on the chest of children; similar 
to Aeon. 

Hepar. Cough tight or loose, worse in the morning; from uncovering 
any part of the bod}*; better from wrapping up and keeping warm. Re- 
pelled eruptions. 

Hyosc. Nightly, dry, spasmodic titillating cough, worse in lying. 

Ipec. Titillating cough with dyspnoea, nausea and vomiting, diarrhoea; 
face pale, even bluish during cough. 

Iodium. Tickling, dry cough; young persons subject to spitting blood; 
palpitation of the heart; swelling of cervical and bronchial glands; progress- 
ive emaciation with good appetite. 

Kreos. During dentition, when the child is extremely fretful, irritable, 
much agitated, and screaming in the night. Dry cough excited by a crawl- 
ing^sensation below the larynx. 

Laches. Cough is worse during and after sleep; in afternoon and even- 
ing; there is tickling in the pit of the throat and great sensitiveness of the 
throat to any touch; during cough, stitch pains in the hemorrhoidal tumors; 
the stools are fetid even if formed. 

Mangan. Spasmodic cough from afternoon till bedtime, ceasing on 
lying down, worse from motion; expectoration scanty and difficult, causing 
long efforts of coughing for its expulsion; in the morning easy. Sore and 
bruised feeling through the chest. 

Merc. sol. Catarrh of the whole mucous membrane from the nose down; 
chilliness and heat alternately; feels hot in bed and chilly when moving his 
feet to a cooler place; sweats without relief; cannot bear either warm or cold 
air; cough worse when lying on the right side; tongue coated thick, yellow- 
ish; great thirst for ice water, although it aggravates the cough. 

Nux mosch. Cough worse on getting warm in bed; excited by a creep- 
ing sensation from the chest to the throat; especially during pregnancy. 

Nux vom. Always after previous use of cough mixture; cough worse 
in the morning; excited by beer, relieved by warm drinks. Nose stopped 
up in the evening; headache; fever with chilliness from slightest motion; 
irritableness; oversensitiveness to light, noise and smells. Involuntary mic- 
turition when coughing, laughing or sneezing. 

Opium. Convulsive, dry tickling cough in paroxysms worse at night, 
with bluish redness and sweat in the face, and yawning after the cough. 
Drowsiness and inability to go to sleep. 

Phosphor. Tight cough, worse from evening till midnight; tightness 



THERAPEUTIC HINTS TO AFFECTIONS OF BRONCHIAL TUBES. 333 

across the chest; pain in the head, larynx and chest when coughing. Cough 
worse from speaking, laughing, eating, motion and on going into the cold 
air. Useful after onion syrup. 

Pulsat. Chilliness; thirstlessness; loose cough with yellow or greenish 
expectoration; tight in the evening on retiring to bed, often causing vomit- 
ing. After measles. 

Rhus tox. Cough excited by a tickling under the middle of the sternum, 
worse from uncovering any part of the body; from laughing, talking, sing- 
ing, and cold drinks; better from warm drinks. Pain in the limbs during 
rest, which feel stiff and lame on first moving, but get better during exercise; 
restlessness. 

Rumex. Dry cough in long paroxysms, brought on by any irregularity 
in breathing, taking a deeper breath than usual, talking; or from external 
pressure upon the throat-pit; worse in the evening after retiring; the patient 
covers his head all over, because the slightest draft of cold air at once brings 
on a distressing tickling in the throat-pit and behind the sternum, more 
towards the left side; in walking he covers mouth and nose. (Dunham.) 

Senega. Tough mucus causes the greatest, often ineffectual efforts of 
coughing and hawking for its expulsion. 

Sepia. Cough seems to come from stomach or abdomen; nausea during 
and after cough. Tickling cough before midnight in bed, coming in rapid 
concussions until breath is exhausted, followed by expectoration of mucus 
w T ith temporary relief. Worse in cold, wet weather. Eruption of hard 
papulae on a red base with burning and itching; herpetic eruptions and pas- 
sive congestion of the womb. 

Spongia. Cough wheezing and asthmatic, relieved by eating or drink- 
ing; oppression and breathing worse from lying with the head low. 

Sticta. Dry, racking cough, with splitting frontal headache, from 
tickling in right side of trachea, below larynx; cough excited by inspiration. 

Sulphur. Cough worse in evening on tying down, with itching in the 
bronchi, accompanied with retching. Hot flushes; cold feet; or hot palms 
and soles, hot vertex. Rheumatic pains in knees and hips at night, with 
coldness and soreness; itching of skin on retiring. 

Tart. emet. Rattling mucus; cough is followed by yawming; cough 
worse when lying; child wants to be carried about; worse after eating, with 
vomiting. Drowsiness; sticky perspiration; dyspnoea; cyanosis. 

Ver. alb. Capillary bronchitis, with livid face, blue nails, cold extremi- 
ties and tumultuous, irregular contractions of the heart; cold perspiration on 
forehead wdien coughing; eyes half open during sleep. 

Zincum. Child grasps the genitals when coughing. 

The Chronic forms may require any of the remedies above detailed; they 
may require one or the other of the following: 

Alum. Cough worse about 6 o'clock in the morning, on and after 

" getting up; raises but little after considerable coughing; sometimes the cough 

is troublesome at night; it often recurs with the cold season and lasts until 



334 THERAPEUTIC HINTS TO AFFECTIONS OF BRONCHIAL TUBES. 

the warm season sets in again; the cough is relieved by lying flat on the 
face. Irritable persons and women who easily laugh or cry. Follows well 
after Bryon. 

Ambra gris. Cough dry in the evening, gray sputa in the morning; 
excited by exertion and music. Aged people. 

Amm. carb. Cough dry, tickling, with a sensation of heat and burn- 
ing in windpipe under sternum, as of having swallowed alcohol; rough 
voice; from taking cold in rough, rather dry air. Aged people; adynamic 
state. 

Amm. mur. Cough, with profuse, thick, whitish expectoration, some- 
times in lumps, with heaving; mucous rattling in the chest, worse when 
lying, either with or without difficult expectoration; burning in the chest; 
dyspnoea on moving and when lying; rawness and soreness in fauces; cold- 
ness between the shoulders. Old age; bronchiectasias ; emphysema. 

Arg. nitr. Rattling cough; hoarse voice; marasmus, the legs are 
especially emaciated; child cries much, unless carried about; craving for 
sugar. 

Arse?i. ~Dry, spasmodic cough, with dyspnoea, asthma, suffocating 
spells, cardiac troubles; exhaustion, nervous irritability, hydrsemia. Worse 
at night; from lying down, drinking, and change of weather. 

Calc. carb. Expectoration yellow, lumpy, sweetish, sometimes fetid; 
when thrown into water, a lump is seen shooting to the botton, with a 
mucous trail behind, like a falling star. ( Fellger. ) For scrofulous indi- 
viduals and such who have to talk a great deal, who are subject to hoarse- 
ness, to perspiration from an} T exertion, and palpitation of the heart after 
eating. 

Carb. an. Cough, with hoarseness or night-sweats, very fetid and 
debilitating, following chill and fever in the evening; coldness and aching in 
lumbar region and lower extremities. 

Carb. veg. Burning in chest, heat and perspiration; great weakness; 
oppression; want to be fanned. Coldness of skin; pointed nose; rattling of 
large bubbles: cold knees in bed. Exhausted and aged persons. 

Cinchona. Black, difficult expectoration; cough worse with head lying 
low, or when lying on left side, or when moving, talking, etc.; better with 
head lying high. 

Coral, rubr. Cold expectoration. 

Hepar. Dirt}' yellowish expectoration, badly smelling; cough worse in 
the morning and when uncovering any part of the body; bronchiectasia. 

Iodium. Compare Acute Forms. 

Kali bichr. Ropy expectoration; cough excited from eating or drinking. 

Kali carb. Dry cough, as if excited by a dry membrane in the trachea, 
which cannot be detached; slimy, salty expectoration; cough worse about 3 
o'clock A. M., also from eating and drinking, with pain in lower part of the 
chest. Dry skin; dry stool; eyelids red and swollen, especially between the 
brows and upper lids. After measles. 



THERAPEUTIC HINTS TO AFFECTIONS OF BRONCHIAL TUBES. 335 

Laches. Compare Acute Forms. 

Lauroc, Short, titillating cough from cardiac affections. 

Lobe/, infl. "Spasmodic contraction of the diaphragm in emphysema, 
accompanied by pain in epigastrium, tympanitis of the abdomen, impossi- 
bility of deep inspirations; extreme dyspnoea and cyanosis." (Meyhoffer.) 

Lvcop. " Chronic pneumonia; bronchitis, with copious muco-serous, or 
muco-purulent secretion; emphysema; dilatation of the air- tubes; senile 
catarrh. Congestion of the liver, flatulency, constipation, cachectic com- 
plexion, red gravel, acid dyspepsia." (Meyhoffer. ) " Cough dry day and 
night in feeble, emaciated boys." (C. Wesselhoeft. ) The cough ends with 
a loud belch; salt}' expectoration. 

Natr. earb. Cough is excited by coming into a warm room. (Bryon.) 

A T atr. mur. Transparent, viscid sputa; weak voice; fluttering of the 
heart; worse on the seashore; cutting pain in the urethra after urination. 

Natr. sulph. When coughing at night has to sit up and hold his chest 
with both hands; asthmatic spells worse towards morning. Aggravation 
always from cold, damp and rainy weather. 

Nitr. ac. Cough with thirst in the morning. 

Phosphor. Besides a dry cough, there is in chronic cases often a free 
expectoration of abundant, tough mucus, especially in the morning. At 
times the expectoration is cold. Tremor when coughing. 

Phosph. ac. Cough in overgrown youths. 

Platina. Chronic cough dependent on uterine diseases with mental dis- 
turbances. 

Plumbum. Copious muco-purulent, or purulent expectoration. 

Sanguin. Cough worse at night; circumscribed redness of the cheeks; 
burning dryness of the mouth and throat, not relieved by drinking. 

Secale. Concussive cough ; profuse perspiration; sleepless nights; colic, 
diarrhoea, and bloatedness of the abdomen. Emphysema. 

Sepia. Compare Acute Forms. 

Silic. Expectoration of pus, which when thrown into water, falls to the 
bottom and spreads like a heavy sediment. (Fellger. ) Cough w T orse from 
cold, and better from warm drinks. 

Spojigia. Compare Acute Forms. 

Stannum. Bronchial dilatations with purulent expectoration; excessive 
muco-purulent expectoration; weak feeling in the chest. 

Staphis. Cough is excited by eating meat, or cleaning the teeth. Very 
sensitive, feeling easily hurt when being reproached. Cervical and axillary 
glands swollen. 

Sulphur. Often indicated in rheumatic, gouty, herpetic and scrofulous 
individuals, also when seemingly well indicated remedies refuse to act. 
Sensation as of ice in the chest whenever chilled, or perspiration is checked. 
Compare Acute Forms. 

Tart. emet. Compare Acute Forms. 



36 



DIGEST TO BRONCHITIS. 



Digest to Bronchitis. 



COUGH. CHARACTER OF: 
Barking : Bellad. 
Concussive : Seeate, Sepia. 
Convulsive: Opium. 

Dry in evening, gray sputa in morning: 
Ambra^ 

. with heat and burning in windpipe 

under sternum, as of having swallowed 
alcohol: Amm. card. 

. spasmodic, with dyspnoea, asthma, 

suffocating spells: Arsen. 

, hacking, especially at night: Cina. 

, tickling, only in daytime: Euphras. 

, spasmodic, titillating, nightly: 

Hyosc. 

. as if excited by a membrane in the 

trachea, which cannot be detached: 
Kali curb. 

, day and night, in feeble, emaciated 

boys: Lycop. 

, convulsive, tickling, in paroxysms: 

Opium. 

, or with free expectoration of tough 

mucus, especially in the morning: 
Phosphor. 

, in long paroxysms: Rumex. 

, before midnight, in rapid concus- 
sions, followed by expectoration: Sepia. 

, racking: Sticta. 

Loose, a.m., tight, p.m.: Badiaga. 

, or tight: Hepar. 

, from evening till midnight: Phos- 
phor. 

and rattling of mucus: Calc. carb., 

Tart. emet. 

Rattling: Arg. nitr. 

Rough, scraping: Eupat. per/. 

Spasmodic: Badiaga, Hyosc. 

, from afternoon till bedtime: Man- 

gan. 

In spells, far apart: Carb. veg. 

Tight: Phosphor. 

, or loose: Hepar. 

, in evening on retiring to bed, caus- 
ing vomiting: Pulsat. 

Titillating or tickling: Amm. earb., 
Chamom., Euphras., Ignat., /pee., 
Iodum, La it roe.. Sepia. 

, worse in lying: Hyosc. 

, with dyspnoea: I pee. 

Titillating, from cardiac affections: 
La it roe. 



before midnight, followed by ex- 
pectoration: Sepia. 

Wheezing and asthmatic: Spongia. 

Whizzing with difficult expectoration: 
Arsen. 

Expectoration, badly smelling: Calc. 
carb., Hepar. 

, black and difficult: Cinchona. 

blood-streaked sometimes: Brvon. 

, bloody: Arnica. 

, cold: Coral, rubr. 

, cool at times: Phosphor. 

, difficult: Alum., Atuica, Arsen., 

Cinchona, Mangan. 

. easy: Mangan. 

. frothy and tough: Arsen. 

, gray in the morning: Am bra gris. 

, mucous: Kali earb., Sepia. 

, muco-purulent: Calc. carb., Lycop., 

Plumbum, Stannum. 

, when thrown into water, a lump is 

seen shooting to the bottom, with a 
mucous trail behind, like a falling star: 
Calc. carb. 

. profuse: Amm. mur., Lyc^p., Stan- 

num. 

. purulent: Lycop. , Silic, Stannum. 

, when thrown into water, it falls to 

the bottom and spreads like a heavy 
sediment: Silic. 

, ropy: Kali bichr. 

. salty: Kali carb., Lycop. 

, scanty: Mangan. 

, sweetish: Calc. carb., Phosphor., 

Stannum. 

, thick, lumpy: Amm. mur., Calc. 

carb. 

, transparent, viscid: Natr. mur. 

, yellow, Calc. carb. 

, or greenish: Pulsat., Sulphur. 

, dirty yellowish : Hepar. 

COUGH, EXCITED BY : 

Crawling sensation below larynx: Kreos. 
Creeping sensation from chest to throat: 

Nux moseh. 
Suffocating constriction of throat, as if 

throat were throttled: Chamom. 
Tickling in pit of throat: Laches., 

Rumex. 
in right side of trachea below larynx: 

Sticta. 



DIGEST TO BRONCHITIS. 



337 



in trachea and under middle of ster- 
num: Arsen. 

under middle of sternum: Rhustox., 

Rum ex. 

in pit of stomach: Bryon. 

in abdomen: Ant., crud., Drosera, 

Sepia. 

Itching" in bronchi Sulphur. 

Tough, mucus in throat: Senega. 



Cold air : Phosphor, Si lie. 

Uncovering' any part of the body: 

Hepar, Rhus fox. 
Going into cold air: Carb. veg., Phosphor* 
Slightest draught, covers his head all 

over: Rumex. 
At seashore : Natr. mur. 
Entering a warm room: Bryon., Natr. 

carb. 
Getting warm in bed: Caustic., Nux 

mosch. 



Drinking: Arsen., Kali bichr., Kali 
carb., Hepar. 

cold water: Arsen. 

cold drinks: Rhus tox. 

ice water: Merc. sol. 

cold beer: Nux vom. 

Eating : Bryon., Kali bichr., Kali carb. 

meat: Staphis. 

, after: Kali carb. 

before and after meals: Eupat. fer. 

Smoking: Bryon. 



Motion: Bryon., Mangan., Phosphor. 
Crying in children: Arnica. 
Laughing, singing, talking: Act. rac, 

Cinchona, Conium, Laches., Phosphor., 

Rhus tox., Rumex. 
Inspiration: Sticta. 

Any irregularity in breathing, taking 

deep breath: Rumex. 
Exertion and music: Ambra. 
Lying : Conium. , Hyosc. , Tart. emet. 

down: Arsen. 

in evening, with retching: Sulphur. 

with head low: Cinchona. 

Lying on right side : Merc. sol. 
on left side: Cinchona. 



During sleep without waking: Arnica, 

Bellad., Calc. carb., Chamom. 
and after: Laches. 



Mental excitement: Arsen. 
Cleaning the teeth: Staphis. 
External pressure upon the pit of the 
throat: Rumex. 



Cough, < in the morning: Bellad. , Hepar, 

Nux vom., Pulsat. 

, < about 6 o'clock a. m. : Alum. 

, <T through day: Bryon., Euphras. 

, < day and night in feeble, emaciated 

boys: Lycop. 

, < in afternoon and evening: Laches. 

, < till bedtime: Mangan. 

, < in evening till midnight: Phos- 
phor. 
, < after retiring: Arsen., Pulsat., 

Rumex., Sulphur. 
, < in night: Alum., Arsen., Cina, 

Hyosc, Natr. sulph., Opium, Sanguin. 
, < in night, compelling to sit up: 

Bryon. 

, after midnight: Arsen. 

, < after 3 o'clock a. m. : Kali carb. 

, <" in paroxysms: Opium, Rumex. 

, < in spells far apart: Carb. veg. 

, ^ from wrapping up and keeping 

warm: Hepar. 
, > from covering mouth and nose 

when walking: Rumex. 
, > in bed: Caustic. 



, > while eating, especially during 

supper: Ferr. met. 

, > from eating or drinking: Spongia. 

, > from drinking small quantities 

of beer or water: Euphras. 
, > from drinking sips of cold water: 

Caustic. , Cuprum. 
, ^> from drinking warm drinks: Nux 

vom., Rhus tox., Silic. 



, > from lying down: Mangan. 

, /• from lying fiat on the face: Alum. 

Cough > from lying with head high: 
Cinchona. 

COUGH, ATTENDED WITH : 

Crying: Bellad., Bryon. 

and pressing hands upon head: 

Badiaga. 
Pain in head: Badiaga, Bryon., Nux 

vom., Phosphor. 
in forehead, splitting: Sticta. 



22 



338 



DIGEST TO BRONCHITIS. 



in chest, which he supports with his 

hands: Drosera, Eup. per/., Natr. 
sulph. 

in sides of chest: Bryon. 

in lower part of chest: Kali card. 

in chest, head and larynx: Phosphor. 

over left hip: Caustic. 

in pit of stomach and under short 

ribs: Bryon. 

in epigastrium: Lode/, infl. 

from small of back down into thighs: 

Arsen. 

Stitch pain in hsemorrhoidal tumors: 
Laches. 

Soreness in chest: Eup. per/. 

and bruised in chest: Mangan. 

Heat and burning in windpipe under 
sternum: Amm. carb. 

Itching" from throat down to centre of 
chest: Carb. veg. 

Convulsing the muscles of chest and ab- 
domen: Drosera. 

Dyspnoea: Arsen. 

Spurting of urine: Bryon., Caustic, 
Nux vom. 

Child grasps the genitals: Zincum. 

Strangling, face turning dark, and 
yellow, viscid mucus flying out of 
mouth and nostrils: Badiaga. 

Face pale, even bluish: Lpec. 

Bluish redness and sweat in the face: 
Opium. 

Cold perspiration on forehead: Ver. alb. 

Heat of body: Caib. veg. 

Tremor: Phosphor. 

Becoming stiff: Cina. 

COUGH, FOLLOWED BY: 

Swallowing as if something were rising 
in the throat: Cina. 

Clucking noise in throat down to stom- 
ach: Cina. 

Belching: Lycop. 

Nausea: Sepia. 

Vomiting: Pulsat. 

Yawning: Opium, Tart. emet. 

Trembling: Cuprum. 

GENERAL SYMPTOMS. 

Wants to be fanned: Carb. veg. 

carried about: Arg. nitr., Chamom., 

Tart. emet. 
Screams in the night: Kreos. 
Restless anxiety in the night: Arsen. 



Irritable: Arsen., Chamom., Kreos., 
Nux vom. 

persons and women who easily laugh 

or cry: Alum. 

Fretful: Kreos. 

Sensitive, feeling easily hurt, when be- 
ing reproached: S tap his. 

Irascibility and restlessness: Aeon. 

Oversensitive to light, noise and smells: 
Nux vom. 

Mental disturbances: Platina. 

Much agitated : Kreos. 



Headache : Nux vom. 
Eyelids red, and swollen between eye- 
brows and upper lids: Kali carb. 
Lachrymation and sneezing: Badiaga. 
Nose stopped in evening: Nux vom. 
Cold in head and diarrhoea: Arsen. 
Circumscribed redness of cheeks: San- 

guin. 
Livid face: Ver. alb. 
Cyanosis: Lobel. infl., Tart. emet. 
Cachectic complexion: Lycop. 
Pointed nose: Carb. veg. 
Stiffness and lameness of jaws: Caustic. 
Tongue coated thick, yellowish: Merc. 

sol. 
Burning dryness of mouth and throat not 

relieved \>y drinking: Sanguin. 
Rawness and soreness in fauces: Amm. 

mur. 
Cough with thirst in the morning: Nitr. 

ac. 
Thirst for ice water: Merc. sol. 
Thirstlessness : Pulsat. 
During Teething : Calc.carb., Chamom. 
Cervical and axillary glands swollen: 

Staphis. 

and bronchial glands swollen : Lodum. 

Sensitiveness of throat to any touch: 

Laches. 



Hoarseness: Arg. nitr., Carb. an. 

in the morning: Caustic. 

in the evening: Carb. veg. 

Rough voice: Amm. carb. 
Weak voice: Natr. mur. 



Burning in chest: Amm. mur. Carb. 
veg. 

under sternum: Carb. veg. 

Soreness of chest: Carb. veg. 
Tightness across the chest: Phosphor. 



DIGEST TO BRONCHITIS. 



339 



Asthma: Arsen., Natr. sulph., Spongia. 
Dyspnoea: Ipec, Tart. emet. 

with cyanosis: Lode/, infl. 

when moving and lying: A nun. 

mur. 
Oppression: Carb. veg. 
, worse from lying with head low : 

Spon gia. 
Impossibility of deep inspiration: Lobel. 

infl. 
Rattling in chest: Tart. emet. 
worse when lying, without or with 

difficult expectoration: Amm. mur. 

of large bubbles: Carb. veg. 

Catarrh on the chest of children: Aeon., 

Ferr. phosph. 

of the aged: Lycop. 

Capillary bronchitis: Ver. alb. 
Chronic pneumonia: Lycop. 
Bronchiectasia or bronchial dilatation: 

Amm. mur., Hepar., Lycop., Stannum. 
Emphysema: Amm. mur., Lycop., 

Secale. 
with spasmodic contraction of dia- 
phragm: Lobel. infl. 



Palpitation of the heart: Arsen., Eup. 

per/., Lodum. 

after eating: Calc. carb. 

Fluttering of the heart: Natr. mur. 
Tumultuous, irregular contractions: Ver. 

alb. 
Cardiac affections: Arsen., Lauroc. 



Craving for sugar: Arg. nitr. 

Pyrosis with great flow of water from 
mouth during day: Carb. veg. 

Heartburn and acidity after fat, saccha- 
rine and farinaceous food: Caustic. 

Nausea and vomiting: Ipec. 

Gastric derangement: Ant. crud. 

Acid dyspepsia: Lycop. 

Congestion of liver: Lycop. 

Flatulence: Lycop. 

Tympanitis : Lobel. infl. 

Colic, diarrhoea and bloatedness: Secale. 

Diarrhoea: Arsen., Lpec. 

Bowels moved more frequently towards 

evening: Calc. carb. 
Dry stool : Kali carb. 
Stools fetid even if formed: Laches. 
Tendency to piles with constipation: 

JEsc. hip p. 



Cutting in urethra after micturition: 

Natr mur. 
Red gravel : Lycop. 

Passive congestion of womb: Sepia. 

Uterine diseases with mental disturb- 
ances: Platina. 

During pregnancy : Nux mosch. 

Rheumatic pains in limbs: Arsen. 

during rest and on first moving, 

better from continued exercise: Rhus 
tox. 

in knees and hips at night, with 

coldness and soreness: Sulphur. 

in limbs and back: Eup. perf. 

Aching in lumbar region and lower ex- 
tremities, and coldness: Carb. an. 

Gouty diathesis: sEsc. hipp. 

Sudden cramps in the heel-cords in the 
night: Caustic. 



Drowsiness : Tart. emet. 

with inability to go to sleep : Bell ad. , 

Opium. 
Sleepless nights: Secale. 
Restlessness : Rhus tox. 
Starting in sleep: Bellad. 
Eyes half open during sleep: Ver. alb. 



Chilliness: Pulsat. 

in bed when moving the feet to a 

cooler place : Merc. sol. 

Chilliness and heat alternately: Merc.sol. 

Coldness of skin: Carb. veg. 

in bed: Carb. veg. 

Cold feet : Sulphur. 

knees in warm bed: Carb. veg. 

extremities with blue nails: Ver. 

alb. 

Sensation as of ice in chest whenever 
chilled or perspiration is checked : Sul- 
phur. 

Coldness between the shoulders: Amm. 
mur. 

and aching in lumbar region and 

lower extremities: Carb. an. 

High fever : Aeon. 

with chilliness from slightest motion: 

Nux vom. 
Fever followed by perspiration: Carb. an. 
Heat and perspiration: Carb. veg. 
Hot flushes : Sulphur. 
skin, inclined to be moist: Bellad. 



34Q 



BRONCHIAL ASTHMA. 



in bed and chilly when moving feet 

to a cooler place: Merc, sol . 

palms, soles and vertex: Sulphur. 

Perspiration, profuse: Secale. 

, sticky: Tart, ciuet. 

, without relief: Merc. sol. 

, immediately on waking from sleep: 

Drosera. 

, on head during sleep: Calc. card. 

, fetid and debilitating, after chill and 

fever in the evening: Card. an. 
from anv exertion : Calc. card. 



Dry skin : Kali card. 
Itching of skin on retiring: Sulphur. 
Hard papulae on a red base, with burn- 
ing and itching: Sepia. 



Exhaustion: Arsen. 

Weakness : Card. veg. 

Adynamic : Amm. card. 

Hydraemia: Arsen. 

Marasmus, especially legs emaciated: 
Arg. nitr. 

Progressive emaciation with good appe- 
tite: Iodum. 

Catarrh of the whole mucous membrane 
from nose down: Merc. sol. 

Cannot bear either warm or cold air: 
Merc. sol. 



During dentition: Bel lad., Calc. card. y 
Chamom., Kreos. 

Persons subject to hoarseness and who 
have to talk a great deal: Calc. card. 

Young persons subject to blood-spitting: 
Iodium. 

Too fast growing youths: Phosph. ac. 

Aged people : Ambra. % Amm. card., and 
mur., Card, veg., Tart. emet. 

Scrofulous individuals: Calc. card. 

Rheumatic, gouty, herpetic and scrofu- 
lous persons: Sulphur. 

Repelled eruptions: Hcpar. 

herpetic eruptions: Sepia. 

perspiration: Aeon. 

After measles : Kali card., Pulsat. 

cessation of hemorrhoidal flow: 

Euphras. 

Taking cold in rough, dry weather: 
Aeon., Amm. card., Hepar. 

in cold, wet weather: Xatr. sulph. y 

Sepia. 

Recurs with the cold season, lasting till 

warm season: Alum. 
Change of weather: Arsen., Bryon. 
Caused by bathing: Ant. crud. 
After the use of cough -mixtures: Nux 

vom. 

onion syrup: Phosphor. 

Alumina follows well after Bryon. 



Bronchial Asthma, Asthma Bronchiale Nervosum seu 

Convulsivum. 

Bronchial asthma is characterized by attacks of sudden dyspnoea, com- 
ing on after longer or shorter intervals, increasing rapidly in severity, and 
lasting for a few hours or for several days. Its nature is thought to be a spasm 
of the bronchial muscles (Biermer and others); a tonic spasm of the dia- 
phram (Wintrich); a tumefaction of the bronchial mucous membrane in 
consequence of dilatation of its blood vessels through vasomotor nervous in- 
fluence (Weber); a presence of fine-pointed crystals found in the sputa of 
asthmatic expectoration, which irritate the peripheral termination of the 
vagus nerve in the bronchial mucous membrane, and cause a reflex spasm of 
the musculature of the smaller bronchi (Leyden). It is quite likely that in 
individual cases these various conditions ma}' exist singly or conjointly, or 
may be produced either by a direct irritation of the vagus nerve, or in a 
reflex manner by irritation of various organs. For the first speak cases in 
which asthmatic and epileptic paroxysms, or asthmatic attacks with hemi- 
crania and with angina pectoris alternated. The reflex manner bj T which 
the bronchial branches of the vagus may be excited is by far more frequent. 
We see it originate in the sexual organs (uterine asthma), in the sensitive 



BRONCHIAL ASTHMA. 34 1 

nerves of the intestinal tract, as in disorders of digestion, irritation from 
worms (dyspeptic, verminous asthma), in the sensitive nerves of the skin 
(asthma from taking cold), in the sensitive nerves of the mucous membrane 
of the respiratory tract (asthma from nasal polypi); after measles and 
whooping-cough; from the smell (inhalation) of different drugs (ipecacuanha, 
3 T ellow oak, fresh coffee, violets, lamp-black, etc.); of the pollen of certain 
grasses (hay asthma). 

Essential anatomical alterations on post-mortem examination are not 
found. But Stork has demonstrated by tracheoscopic examinations that the 
mucous membrane of the trachea and main bronchi is intensely reddened 
during the attack. It is, therefore, scarcely to be doubted, that the mucous 
membrane of the smaller ones must be in a like condition, if not more so. 
It is also clear that long- continued and frequently recurring attacks will 
lead to changes which are characteristic of chronic bronchial catarrh, or to 
emphysema. 

Like all neuroses, bronchial asthma generally attacks in paroxysms, the 
intervals between which may amount to weeks, months and even years. It 
not unfrequently commences during sleep; then the patient gets restless; the 
gradual increasing difficulty of breathing causes terrible dreams and awakens 
him. On getting awake the patient has a desire to draw a long breath, but 
feels that the inhaled air does not reach and satisfactorily fill his lungs. We 
hear, and so does the patient, all sorts of hissing, whistling and rattling 
noises during inspiration, and especially during expiration. The dyspnoea 
increases; the respiratory and especially the expiratory muscles labor; the 
alse nasi move up and down; the sterno-cleido-mastoid muscles are put upon 
the stretch; the head is drawn backwards; the arms are pressed firmly upon 
the chair to widen the chest; or the patient leans forward, resting with head 
and arms upon a chair or table; but all in vain. The vesicular murmur 
ceases, and in place of it we observe here and there a hissing noise, sonorous 
and sibilant rales, coming and going suddenly; the inspiratory noise in the 
larynx and trachea, however, continues even stronger than normal. There 
is an anxious expression of countenance; the eyes are wide open; cold per- 
spiration covers the forehead. The color of the face is pale; the impulse of 
the heart is violent, uneven, irregular; the pulse at the wrist is weak and 
small; the hands and cheeks are cold. After some time, varying from an 
hour to several hours, with short intervals, the paroxysm ceases, either sud- 
denly, when the air rushes into the bronchial tubes, which are suddenly 
relieved from spasm, causing puerile respiration, or the relief is only gradual, 
attended with belching, yawning or increased secretion within the bronchial 
tubes, which excites cough and rattling of mucus for some time afterwards. 
On percussion, we will find the clear lung-sound extending on the right an- 
terior side of the chest, some two inches or more below the sixth rib, show- 
ing that the inflated lung has pressed the liver down into the abdominal 
cavity; while on the left side the cardiac dullness is sometimes diminished in 
consequence of the distention of the edges of the lung. There is also only a 



342 THERAPEUTIC HINTS TO BRONCHIAL ASTHMA. 

very slight change of the limits of the lower edges of the lung during inspi- 
ration and expiration, for the reason that during expiration the lung cannot 
rid itself of the air within on account of the spasmodic closure of the finer 
bronchi. So also shows the percussion sound a tympanitic quality, usually 
in the lower portions of the thorax, especially posteriorly and on the sides, 
which is due to the greater distention of the alveolar tissue. 

Its Diagnostic difference from spasm of the glottis lies in the difficulty 
of its expiration, similar to that of bronchial catarrh and emphysema, while 
the dyspnoea in croup, in oedema of the larynx, in stenosis of the trachea, in 
spasms of the glottis, and in paralysis of the dilators of the glottis is an 
inspiratory one. 

Its Prognosis is favorable. Asthma alone does not cause a fatal issue, 
but when complicated it ma}'. It has its own remedy within itself. The 
accumulation of carbon relaxes all the muscles of the body, and, of course, 
the contracted bronchial muscles. As soon, therefore, as they relax, respira- 
tion is free, and the paroxysm ceases. (Niemeyer.) 

Therapeutic Hints. 

Apis. Chest feels bruised; worse from heat; nettle-rash disappears. 

Arg. nitr. Must rise and walk about ; an effort to breathe deeply takes 
away the breath ; cannot talk ; drinking suffocates ; agony, thinks of killing 
himself. 

Aral. Dry, whistling respiration ; cannot lie down, must sit up ; gradual 
loosening and discharging of acrid mucus from nose and throat. (Hay 
asthma.) 

Arsen. Paroxysms from midnight till daybreak ; has to leave the bed, 
sit up bent forward ; great restlessness and anxiety, w T ith feeling hot and cold 
in turns ; fear that he will be compelled to destroy his own life ; sweat of 
whole body ; burning pain in chest ; prostration ; attacks from cellar-air, 
stormy weather, heavy atmosphere, change of temperature, rapid walking. 

Bellad. Paroxysms in the afternoon and evening, with sensation of 
dust in the lungs ; worse in hot, damp weather, and after sleep. 

Bromium. Asthma of sailors as soon as they go ashore. 

Cist. can. Feeling as if the windpipe were too narrow, must open 
the window and breathe fresh air, which relieves ; worse again on lying 
down. 

Card. veg. Attacks come during sleep, always after midnight ; must sit 
up by a table ; is full of wind, but cannot raise it; for old people; weakness, 
w 7 ith trembling; look as if dying. 

Cupriim. Attacks come on suddenly and after some hours cease 
suddenly; worse at night, when coughing, laughing, leaning backwards 
and after drinking ; also before and during menses, after fright, chagrin, or 
a cold. 

Fcrrum. Attacks after midnight, driving out of bed; better from, mov- 
ing slowly about and talking, from uncovering the chest. 



THERAPEUTIC HINTS TO BRONCHIAL, ASTHMA. 343 

Graphit. Paroxysm every night, wakes him out of sleep, usually 
after midnight ; he has to jump out of bed quickly, must hold himself fast 
at something and quickly eat a piece of bread, after which the paroxysm 
passes off. 

Hyper, Attacks return with changes of the weather, from clear to 
damp, or before storms; after lesion of the spine by a falh 

Ipec. Constriction of throat and chest; gasps for air at the open 
window; worse from least motion; constant cough, no phlegm yielding, 
although the chest seems full of it; cough causes gagging, vomiting, followed 
by relief; stiffness of the body; pale face; cold extremities and cold perspi- 
ration. 

Kali card. Must lean forward, with head on table; worse from motion 
and drinking; pressure and tension in pit of stomach, after eating the 
least; belching, nausea, vomiting; puffy around the eyes; dry stools; dry 
skin. 

Laches. Feeling of constriction in the throat and chest, as though a 
cord were tight around it, necessitating the loosening of the covering of the 
neck and epigastrium. Heart feels as if it turned over and ceased beating 
for a while, after which the pulsations increase. Dyspnoea worse after sleep, 
after eating, from moving the arms, and touching the throat; cannot lie, 
must sit- up; bent forward, with head thrown back. 

Lob el. infl. Worse from exertion; disordered stomach, especially a 
feeling of weakness in the pit of the stomach ; asthmatic attack, often pre- 
ceded by prickling all over, even to fingers and toes. 

Mephit. Inspiration difficult, expiration almost impossible; asthma as 
from inhaling vapor of sulphur; in sleep; of drunkards. 

Natr. sulph. In the morning, about 4 or 5 o'clock, with cough, and 
raising of glairy slime, and vomiting after eating; always worse in damp and 
rainy weather. 

Nux vom. For persons who drink much coffee or liquor, and who are 
very irritable; they feel full in the pit of the stomach, belch a good deal, and 
feel better after it. Asthma worse in the morning, after eating, from cold 
air or exercise. Spasms of the chest from vapor of copper or arsenic. 

Opium. Short inspiration, long, slow expiration with a marked draw- 
ing in of the epigastric region; fine rales, constant cough, soporous condition, 
bluish face; extreme anguish, with dread of suffocation; looks as if dying; 
slight relief from cold air and bending forward; worse from eating, drinking 
wine and smoking. 

Pulsat. Worse in the evening; constant chilliness; dizziness when ris- 
ing from a seat; nausea and vomiting; palpitation of the heart; deranged 
menstruation; suppressed rash. 

Sa7igai?i. Asthma with hay fever. 

Sepia. Long, difficult, noisy expirations. 

Silk. Breathing so difficult that eyes protrude from their sockets ; cloors 
and windows must be opened; always during thunder-storm. 



344 AFFECTIONS OF THE PULMONARY PARENCHYMA. 

Stannum. Attacks increase and decrease gradually. 

Sulphur. Attacks come on every eight days. Stooping posture; hunger 
and weakness every forenoon about 10 or n o'clock. 

Tart. and. Great difficulty in expiration; must be supported in a 
sitting posture; great rattling of mucus. Children and old people. 

Thuja. Little cough, but sensation as if something were grown fast in 
the region of the Teft lower rib. 

Pulmo vulpis. Has been recommended hy Von Grauvogl in asthma 
humid urn of old people when other remedies failed. 

b. AFFECTIONS OF THE PULMONARY PARENCHYMA. 
Lobular Pneumonia, Catarrhal Pneumonia. 

Catarrhal pneumonia never originates primarily in the alveoli, unless it 
be brought on by an irritant, such as chlorine, for instance, when an inflam- 
mation may arise in the alveoli and the bronchi simultaneously; otherwise it 
is always a secondary morbid process to bronchitis, which compare. For 
this reason it has received the name of Broncho-pneumonia; and as the in- 
flammatory process presents itself at first in isolated nodules, from the size 
of a pea to that of a hazel-nut within the collapsed portions of the lung 
tissue which still contains isolated portions accessible to air, it has also been 
named Lobular pneumonia. This morbid process may diffuse all over the 
lungs in the form of isolated infiltrations, and usually progresses from behind 
and below, forwards and upwards. 

According to all observations its most frequent occurrence is found in 
the first three years of life, and those of old age, and as indirect causes we 
may set down all disturbances that favor the development of bronchial ca- 
tarrh — such as measles, whooping-cough, diphtheria, influenza, rotheln; 
sometimes typhus, variola and scarlatina; also foreign bodies in the bronchi 
and inhalation of gases. The bacillus of tuberculosis, diplococcus of 
Fraenkel, streptococcus pyogenes aureus, and pneumococcus of Friedlander 
have repeatedly been discovered in the lobular consolidations. 

It presents no regular type of fever; the physical diagnosis is of great 
difficult)'; we must mainly rely on the presence of a capillary bronchitis; on 
the consolidation of the lung, beginning at its base, arising slowly, at first 
without any prominent signs and mostly bilateral; on the retraction of the 
lower ribs seen during inspiration; on the indefinite limitation of the disease, 
the absence of all critical periods and the fluctuations which occur in general 
and local symptoms. 

Therapeutic Hints. 

Compare Bronchitis and Croupous Pneumonia. 
Serous pneumonia, see (Edema of the lungs. 

Pneumonia from embolism happens only in otherwise diseased persons. 
The emboli are formed either from clots which have originated in the cavities 



LOBAR PNEUMONIA. 345 

of the right side of the heart, or in the viens of the systematic circulation. 
In the first place there is disease of the heart, and in the latter their sources 
are either large external wounds, venous thrombi of the uterus in puerperal 
women, or bed-sores, ulcerations and suppurations of various kinds. When 
these plugs are non-infectious, the}' produce mere hemorrhagic infarction; 
when they are of an infectious nature, they result in embolic or metastatic 
abscesses, which may perforate into the bronchi, or into the pleural cavity, 
or even break through the chest walls. Simple infarctions are often accom- 
panied with an effusion into the pleural sac, and are much oftener found in 
the right lung than in the left. 

Lobar Pneumonia, Croupous Pneumonia, Lung Fever. 

This is an acute infectious disease characterized by a fibrinous inflam- 
mation of the lung parenchyma, with infiltration and consolidation of the 
same. 

We classify it under affections of the lungs, owing to its marked clinical 
features. 

The exciting causative micro-organism is now generally conceded to be 
Fraenkel's diplococcus pneumoniae; some bacteriologists, however, particu- 
lar!}' Weichselbaum, think that other bacteria may also excite pneumonia, 
such as the streptococcus et staphylococcus pyogenes aureus and the pneu- 
moccocus of Friedlauder. 

The chief predisposing cause is unquestionably exposure to cold. It is 
a frequent sequela to other acute infectious diseases. 

It attacks in preference the inferior lobes of the lungs, especially on the 
right side; very rarely both lungs at the same time. It very rarely pervades 
one whole lung, being much oftener confined to limited portions, which may 
even be too small to be detected by percussion. It is also of rare occur- 
rence that the inflammation remains confined to a central portion of a lobe 
only (central pneumonia), but generally spreads to the surface of the lobe 
which joins the pleura. In aged persons and cachectic individuals the pos- 
terior parts of the lungs are most frequently attacked. When normally pro- 
gressing, pneumonia offers tjhree distinct stages for consideration: 1. The in- 
flammatory stage, or hyperemia of the capillaries in the lung tissue with ex- 
udation of the coagulable lymph. 2. Hepatization, or infiltration of the lung 
tissue with coagulable lymph. 3. Its resolution, or purulent infiltration. 

The characteristic signs of these different stages are as follows: 

First state. As a general thing the disease sets in with a violent chill, 
often attended with vomiting and followed by an intense fever, with a tem- 
perature of 104 to 105 ° in the evning and from 0.9 to 2.7 less in the morn- 
ing; the pulse rises to 100 or 1 10 and the respiration to 40 or 50 per minute. 
In other cases the disease sets in with several light chills or chilliness, or the 
chill is entirely absent and the scene opens with convulsions and complete 
loss of consciousness. The skin is at first very drv, but becomes moist usu- 



346 LOBAR PNEUMONIA. 

ally about the third day, though only temporarily. The face is purplish-red, 
and frequently only on that side which corresponds to the diseased side of 
the lungs. The lips become covered with hydroa (fever blisters) and also 
very often only on the affected side, or, at least, more marked on that side. 
The alae nasi make corresponding movements with respiration; the voice of 
the patient is low and he speaks in broken sentences. Cough is, in almost all 
cases, present, although in some less marked than in others; the patient 
generally tries to suppress it, on account of the pain which it gives. At first 
it is dry, but after a time it yields a tough, jelly-like, viscid sputum, difficult 
to expectorate, and adhering to the lips, from which it has to be wiped off; 
it soon changes to the characteristic color of rust, from an admixture of 
blood. 

When the patient complains during the coughing spells of stitch-pain in 
the chest, it is more or less a sign that the pleura participates in the morbid 
process; when he complains of dull, heavy pains, they probably originate in 
the bronchial tubes. 

In consequence of the disturbed circulation through the lungs, the blood 
being either not sufficiently oxygenized, or being prevented or retarded in 
its return from the brain, different brain symptoms originate, such as 
delirium, stupor, etc. , so that the case may take the appearance of t3 7 phoid 
fever, from which, however, it is easily distinguished by the hydroa on the 
lips, which are scarcely ever found in typhoid fever. 

In rare cases we observe jaundice combining with pneumonia. In such 
cases the liver appears enlarged on account of the engorgement which is 
brought about by the impeded circulation. As the hepatic veins cross the 
gall-ducts the latter become compressed and the gall retained. In other 
cases is seems that pneumonia is complicated with a parenchymatous inflam- 
mation of the liver, or a catarrh of the duodenum, causing in either case, 
icterus. 

The urine is scanty and concentrated, and deposits on cooling, a sedi- 
ment of brick-dust urates. The bowels are usually constipated. 

The Physical Signs of the first stage are the following: 

Inspection discovers decreased mobility of the diseased side of the thorax. 
In cases where both the lower lobes are engorged, the patient moves only the 
upper part of the thorax in breathing, whilst the abdomen remains quiet on 
account of the impossibility to retract the diaphragm. 

Palpation shows an increased vocal fremitus, unless the bronchial tubes 
should be stopped up by mucus. The impulse of the heart is also increased, 
but felt in its normal position. 

Percussion yields generally a short, tympanitic sound over the parts in- 
volved, as long as they still contain air. 

Ascultation reveals the crepitant sound which, according to Wintrich, 
arises in consequence of the sticking together of the walls of the air-cells, and 
their separation by inspiration. It is therefore heard only on inspiration. 

Second stage, hepatization. The above-mentioned symptoms — fever heat, 



LOBAR PNEUMONIA. 347 

dyspnoea, cough, pain, and brain symptoms — continue. The thorax appears, 
on inspection, still less movable during respiration; the vocal fremitus is 
strong, provided there does not intervene a pleuritic effusion between the 
hepatized lung and the thoracic wall. 

Percussion gives forth a dull sound, and the resistance of the thoracic 
walls to the percussing finger is increased, provided the hepatized portion of 
the lung have the thickness of about one inch, and a superficial extent of 
several inches. A central location of the hepatization alters the percussion 
sound very little, if an}- , on account of the intervening portion of lung con- 
taining air. 

Auscultation yields neither the natural vesicular breathing, nor the 
crepitant sound of the first stage, but bronchial breathing, bronchophony, and 
even pectoriloquy, provided the bronchial tubes, which are contained in the 
hepatized portion of the lung, be not stopped up by mucus, blood -coagula, 
etc. There are also heard all sorts of rattling noises, if mucus exists in the 
bronchial tubes. 

Third stage, resolution. This sets in sometimes with a sudden relaxation 
of all the violent symptoms — the temperature falls in from twelve to thirty- 
six hours to the normal, and at times even below the normal; the congested, 
even purplish face becomes pale, the skin moist, the dyspnoea ceases, the 
sputa becomes copious, frothy, yellowish, easily expectorated; the urine in- 
creases and becomes again natural. 

On inspection, we observe that the thoracic walls regain their natural 
mobility; the percussion sound again becomes tympanitic, and by means of 
auscultation we observe the bronchial breathing and bronchophony becoming 
weaker; the crepitation sound reappears, until, at length, the natural vesic- 
ular respiration is re-established. 

This is the regular process of simple pneumonia, lasting, on an average, 
from fourteen to twenty- five days, of which two, three, or five days are con- 
sumed by its first development, five to eight days by exudation progressing 
to perfect hepatization, and seven to fourteen days by the resorption of the 
exudation and convalescence. 

But, after the first invasion of inflammation, new invasions often follow, 
so that it is not uncommon to find in one lung all three stages united. 

Or, the adjoining portion of the healthy lung becomes ©edematous; that 
is, infiltrated by a serous exudation, in which case the dyspnoea increases to 
suffocation. There is, at the same time, a frothy expectoration and fine 
rattling noises in the lung not affected with croupous pneumonia. The im- 
possibility of breathing, on account of the serous infiltration, causes an ac- 
cumulation of carbon in the blood, and in consequence, death by suffocation. 

Or, the disease takes an asthenic form when the symptoms of the central 
nervous system assume great prominence from the beginning, so that the 
whole process might be mistaken for meningitis or typhus; still the infiltra- 
tion of the lung progresses slowly, and in severe cases is often attended with 
pleuritis, jaundice, albuminuria, and considerable enlargement of the spleen. 
This form is called Typhoid pneumonia. 



348 THERAPEUTIC HINTS TO LOBAR PNEUMONIA. 

Or, the morbid process combines with diseases of the heart, such as 
endocarditis, pericarditis or valvular affections, all of which lessen a favor- 
able prognosis considerably. 

Abscesses may form in the third stage of the disease, which, if small or 
deeply seated, offer no physical signs, and may discharge and heal. When 
large, and forming large cavities, we may hear pectoriloquy, and, in somo 
cases, metallic tinkling. 

The hepatization ma}' change into tubercular infiltration, which is espe- 
cially the case when the seat of inflammation is in the upper regions of the 
lungs. In such cases the fever does not leave altogether, but shows some 
aggravation every night; cough, dyspnoea and the dull percussion sound of 
hepatization continue, while auscultation reveals bronchial breathing and 
bronchophony. 

Again, the inflammation may assume a chronic form, and the hepatized 
lung become indurated or cirrhosed, the interstitial tissue growing tense and 
rendering the air-cells impervious to air. The patient is almost free from 
fever, but recovers very slowly in strength, and we observe, for a long time, 
the dull percussion sound and the bronchial breathing; whilst, the thorax, in 
these places, gradually sinks in. 

Or, the whole morbid process may end in gangrene, which happens very 
seldom, and which may be diagnosticated by the sudden general collapse and 
the cadaverous smell of the breath and expectoration; which is dark-blackish 
and copious. 

The mean or average time which it takes for pneumonia to run its course, 
if it is not interfered with by medicines, is, as above stated, twenty-five days. 
But this average may, by judicious treatment, be considerably shortened ; for 
pneumonia can be arrested in each of its stages. The most interesting data 
in this respect have been brought forth by Dr. Eidherr, of Vienna, who has 
collected all cases of pneumonia out of a large hospital practice, which had 
been recorded there for ten years. From these data it appears that under the 
application of the sixth decimal attenuation of the appropriate remedies the 
average came down to nineteen, under the application of the fifteenth 
potency to fourteen, and under the application of the thirteenth potency to 
eleven days. 

The Diagnosis must be based on the above detailed physical signs; but 
one of the most constant and characteristic signs is the great frequency of 
respirations compared with the pulse, which in very severe cases may approach 
that of the pulse, usually, however, amounting to one respiration for two or 
three beats of the heart, while in health the ratio is about 2 to 9, that is 1 
respiration to 4^ pulsations. 

The most fatal days of pneumonia are those between the fifth and eighth 
days. 

Therapeutic Hints. 

Sulphur. According to Eidherr, when exudation sets in, that is; when 
auscultation reveals the crepitation sound. 



THERAPEUTIC HINTS TO LOBAR PNEUMONIA. 349 

/odium or Kali hydr. According to Kafka, at the beginning, when the 
disease localizes itself. 

Bromium. In extersive hepatization of the lower lobes. 

Phosphor. In capillary bronchitis, or catarrhal pneumonia. 

Tart. cmct. In pleuro-pneumonia. 

Schiissler recommends Ferr. phosph. for the first, Kali mur for the 
second, and Calc. sulph. for the third stage. 

All this is very well, but will not suffice for all cases ; we will still have 
to consider the following : 

Aeon. First stage, high fever; must lie quietly upon the back; cannot 
lie on the right side, by stitching pains in the left. Raising is difficult, the 
expectoration being tenacious, falling in a round lump and of a dark cherry- 
red color. (C. Pearson.) 

Arnica. Traumatic cases. 

Arsen. Great anxiety and restlessness with tossing about; great thirst, 
but drinking little at a time; burning and heat in the chest; pale face; cold 
extremities; prostration. 

Baptis. " If I could only get my cough together; it seems to be in 
pieces, all scattered about, and I want to get it together." Typhoid form. 

Bell ad. Nervousness, delirium, threatening convulsions; drowsiness; 
inability to go to sleep; starting from sleep. Face flushed, eyes congested; 
congestion towards the brain. Dry, tickling cough, worse in the night. 

Bryon. Expiration shorter than inspiration; inclination to lie perfectly 
still; the slightest motion increases all the symptoms; great thirst, wanting 
large draughts of water; desire for acid drinks; or little or no thirst with 
dryness of the mouth. Better on lying on the painful side; sometimes the 
reverse. " Expectoration falling in round, jelly-like lumps, and of a yellow 
or soft brick shade." (C. Pearson.) 

Calc. card. Gray hepatization v/ith sputa, which fall in water to the 
bottom, leaving a trail of mucus behind, like a shooting star. (Eellger.) 
Perspiration about the head. 

Capsic. "When coughing, the air from the lungs causes a strange, 
offensive taste in the mouth, and a badly-smelling breath rushes out of the 
mouth." (A. R. Wright.) 

Card. veg. Third stage ; cough by spells, or no cough; hippocratic 
face, eyes half open, nose pinched and cold, lips blue, pupils insensible, no 
complaining or crying; pulse small, quick, difficult to count; body emaciated 
and marbled; feet and hands blue and cold; abdomen distended with gas; 
respiration frequent and superficial; breath cold — a perfect picture of 
collapse. 

Chelid. Right side; bilious symptoms; pain under right shoulder- 
blade; great and quite irregular palpitation of the heart. 

Cuprum. After a previous catarrh in the chest or in the bowels; sudden 
attacks of dyspnoea to suffocation; face earthy, dirt}', bluish, seldom red; 
roof of mouth always red; sweat not profuse, sometimes sour-smelling, with- 
out relief; diarrhoea. 



350 THERAPEUTIC HINTS TO LOBAR PNEUMONIA. 

Ferr. met. No ailments previous to the chill; dyspnoea increases 
slowly; face pale, and in adults it becomes collapsed, hippocratic or expres- 
sionless, stiff and stupid; the roof of the mouth always white; skin neither 
cold nor burning hot; pulse neither full nor hard; stool consistent, brown. 

Ferr. phosph. The expectoration is clear blood. 

Gelsem. After a sudden check of perspiration, with pain under the 
scapulae of both sides. (A. E. Small.) 

Hyosc. Typhoid pneumonia; sees persons in the room who are not 
there. 

Kali carb. Cough worse towards 3 o'clock a. m., almost choking; pain 
in lower part of chest, with dull percussion sound; pulse small and some- 
what irregular; face pale; skin and stool dry. 

Kali hydr. After shaking chill, fell in a deep sleep, out of which he 
could not be roused; snoring loudly with closed eyes, injected conjunctiva, 
hot head, dry tongue, bluish lips, sunken lower jaw, bluish finger-nails; 
irregular and intermitting pulse; lies upon his back; the extremities, when 
raised, fall back as if paralyzed; has not voided urine nor asked for any 
drink. Both upper portions of the lungs hepatized. (Kafka.) 

Laches. " Great dyspnoea, worse in the afternoon or after sleep; left side; 
badly-smelling stools, even if formed. 

Lycop. Circumscribed redness of the cheeks; lips and tongue ulcerated, 
red and dry; fan-like motion of the alae nasi; cannot bear to be covered; 
sweat without relief; cross on getting awake. ' 'The patient raises a whole 
mouthful of mucus at a time, of a light rusty color, stringy and easily sep- 
arated . " ( Pearson . ) 

Merc. sol. Right side; bilious symptoms; jaundice; diarrhoea. 

Nitrum. Annoying feeling of heaviness in the chest, as though some 
great load were pressing the thorax together; can drink only in little sips 
for want of breath; dyspnoea to suffocation. 

Nifr. ac. In protracted cases; in weak, cachectic individuals, where 
there is a sudden abatement of pain, and yet an increase of the pulse in 
smallness and quickness. 

Opium. Mr. H. F., aged 40 years, of a phlegmatic temperament; 
double pneumonia. At times feels as though he were not in his house .which 
he expresses by saying: "I wish I could be in the house with my family." 
Although in a desperate condition he is not much alarmed and wants to sit 
up a great part of the time, because the bed feels too hot. His whole body, 
except the lower extremities, perspire profusely, the sweat is very hot. The 
perspiring parts are covered by a heavy crop of sudamina. He gropes with 
his hands about the bed as though he were hunting something. Inasmuch as 
Opium is not one of the routine remedies in pneumonia, I wasted time in 
giving Bryon., Phosphor., etc. About the eleventh day Opium 6 was given, 
which was followed by a sudden change and a most satisfactory recovery, 
without the aid of any other remedy. If it is objected that pneumonia gets 
well without treatment, I reply that the time when resolution generally takes 



DIGEST TO PNEUMONIA. 35 1 

place had passed when Opium was given, and that in all likelihood nature 
was inadequate to the task in this case, where not only the whole left but a 
considerable part of the right lung was hepatized. I have treated another 
very similar case where the same remedy yielded the same results. (C. 
Bernreuter. ) 

Phosphor. ' 'Stupor with burning hot head; red, hot cheeks, red' ears, 
contracted pupils, closed mouth. Murmuring and gesticulating in delirium. 
Takes water when offered greedily, but cannot swallow more than one sip, 
on account of shortness of breath. Wing-like motion of alae nasi. The 
carotids pulsate violently; the heart beats strong; the pulse is very quick; 
the skin dry and hot. The lower portion of the posterior right lung is 
hepatized." (Kafka.) Great tightness across the' chest; diarrhoea. ''The 
expectoration, when falling on paper, will break and fly like thin batter." 
(Pearson.) 

Pulsat. Lies on the back, can't lie on the sides; semilateral perspira- 
tion (left side of the chest); can scarcely speak above a whisper; respiration 
50 per minute. 

Rhus fox. Restless moving, because lying still increases pain and dysp- 
noea; tongue red at tip. Typhoid pneumonia. 

Sa?iguin. Second and third stage; extreme dyspnoea; tough, rust- 
colored sputa; the patient lies upon his back; there is not much pain in his 
chest, and that of a burning, stitching character; pulse quick and small;' 
face and extremities inclined to be cold, or hands and feet burning, with 
circumscribed redness and burning heat of the cheeks, especially in the 
afternoon. 

Senega. Right side; violent stitches; sinking of strength; small, 
scarcely perceptible pulse; rare cough, without expectoration, but great 
rattling of mucus in the chest; somnolence; dejected features. 

Sulphur. May be indicated in any stage; sometimes also when other 
remedies fail. Its indications may be found in: hot palms and soles; hot 
vertex; faint, weak spells, especially in the forenoon; diarrhoea, especially 
early in the morning; suffocating spells, wants doors and windows open; 
restless and sleepless nights; cutaneous eruptions. 

Tart. emet. Great rattling of* mucus; much coughing, with copious, 
frothy expectoration, or else no expectoration; oedema of the lungs; impend- 
ing paralysis of the lungs; greatest dyspnoea and fits of suffocation; cyanosis. 
Pleuro-pneumonia . 

Ver. vir. Face flushed; red streak through the centre of the tongue; 
sinking, faint feeling in pit of stomach; regularly intermitting pulse; expec- 
toration of pus and florid blood. 

Digest to Pneumonia. 



First stage : Aeon., Ferr. phosph., Kali 

hydr., Sulphur. 
Second stage : Kali mur., Sanguin. 
Hepatization, gray: Calcar. 



— , lower lobes: Bromium. 
— , posterior lower lobes, right side: 
Phosphor. 
— both upper portions: Kali hydr. 



DIGEST TO PNEUMONIA. 



Pneumonia, right side: Chelid.. Merc. 

sol., Phosphor.. Senega. 

. left side: Laches., Rhus fox. 

Double pneumonia : Lycop.^ Opium. 
Catarrhal pneumonia: Phosphor. 
Third stage: Cole, sulph., Card. :eg.. 

Sa ngu in . , Su/ph ur. 
Pleuro-pneumonia : Tart, entet. 
Typhoid pneumonia: Baptis., Hyosc, 

Rhus tox. 
(Edema of lungs: Tart, entet. 
Cough, drv, tickling, worse in night: 

Bellad. 
. almost choking, worse towards 3 

a. m. : Kali car 1 . 

in spells, or no cough: Card. veg. 

rare, without expectoration, but 

great rattling in chest: Senega. 
, much, with copious, frothy expecto- 
ration, or none: Tart, entet. 
Expectoration when falling on paper 

will break and fly like thin batter: 

Phosphor. 
. difficult, tenacious, falling in a round 

lump, of a dark cherry-red color: Aeon. 
. falling in round, jelly-like lumps, 

and of a yellow, or soft brick shade: 

Bryon. 
falling in water to the bottom, and 

leaving a trail of mucus behind like a 

shooting star: Calc. card. 

rust colored: Sanguin. 

Expectoration rust colored, whole 

mouthful at a time, stringy and easily 

separated: Locop. 

. pus and florid blood: J'er. vir. 

. clear blood: Ferr. phosph. 



Stitches, violent: Senega. 

Stitching, burning, or little pain: San- 
guin. 

Burning and heat: Arsen. 

Pain in lower chest with dull percussion 
sound: Kali card. 

Respiration frequent and superficial: 
Card : ... 

50 per minute : Pulsat. 

Can scarcely speak above a whisper: 
Pulsat. 

Expiration shorter than inspiration: 
Bryon. 

Great rattling of mucus: Tart, entet. 

Heaviness, as though a great load were 
pressing the thorax together: Xiir. ac. 



Great tightness: Phosphor. 

Dyspnoea, great, extreme: Senega, Tart. 
entet. 

. increases slowly: Ferr. met. 

. worse in afternoon or after sleep: 

Laches. 

unto suffocation: Nitr. ac. 

. sudden attacks: Cuprum, Tart. 

em.-::. 

Suffocating spells, wants doors and win- 
dows open: Sulphur. 

Impending paralysis of lungs: Tart. 
entet. 



Heart beats strong: Phosphor. 
Palpitation great and irregular: Chelid. 
Carotids pulsate violently: Phosphor. 
Pulse quick : Phosphor. 

and small: Sanguin. 

small, scarcely perceptible: Senega. 

Pulse quick, difficult to count: Cat b. veg. 

irregular: Kali card. 

irregular and intermitting: Kali 

hydr. 

regularly intermitting: J'er. vir. 

every third beat: Xitr. ac. 

neither full nor hard: Ferr. met. 



ATTENDING SYMPTOMS. 

Stun or with burning hot head, red hot 
cheeks, red ears, contracted pupils, 
closed mouth: Phosphor. 

Delirium, nervousness: Bellad. 

. with murmuring and gesticulating: 

Phosphor. 

. -"if I could only get my cough to- 
gether; it seems to be in pieces, all scat- 
tered about. I want to get it together:" 
Baptis. 

. ' " I wish I could be in the house 

with my family:"' Opium. 

. he gropes with his hands about the 

bed as though he were hunting some- 
thing: Opium. 

, he sees persons in the room who are 

not there: Hyosc. 

Although in a desperate condition, he is 
not much alarmed: Opimn. 

No complaining or crying: Card. veg. 

Dejected features : Senega. 

Great anxiety and restlessness with toss- 
ing about: Arsen. 

Congestion towards the brain: Bellad. 

Hot head : Kali hydr. 



DIGEST TO PNEUMONIA. 



353 



Hot vertex: Sulphur. 



Eyes congested: Bellad., Kali hy dr. 

half open: Card. veg. 

Pupils contracted: Phosphor. 

insensible: Card. veg. 

Face flushed: Bellad., Ver. vir. 
Cheeks red and hot: Phosphor., Sanguin. 

circumscribed redness: Lycop. 

, especially in afternoon: Sanguin. 

Face pale: Arsen., Ferr. met., Kali catb. 
earthy, dirty, bluish, seldom red: 

Cuprum. 
expression stiff and stupid: Ferr. 

met. 
Face pale, hippocratic: Card, veg., Ferr. 

met. 
Cyanosis : Tart. emet. 
Nose cold and pinched. Card. veg. 
Fan-like or wing-like motion of alae nasi: 

Lycop., Phosphor. 
Lips bluish: Card, veg., Cuprum, Kali 

hydr. 
and tongue ulcerated, red and dry: 

Lycop. 
Lower jaw sunken: Kali hydr. 
Roof of mouth red: Cuprum. 

white: Ferrum. 

Tongue dry: Kali hydr. 

red at tip: Rhus tox. 

red streak down the centre : Ver. vir. 

Thirst, drinking little at a time: Arsen. 

, wanting large draughts: Bryon. 

Takes water greedily when offered: 

Phosphor., Sulphur. 
Cannot swallow more than a sip for want 

of breath: Phosphor., Nitr. ac. 
Little or no thirst with dryness of tongue : 

Br yon., Pulsat. 
Does not ask for drink: Kali hydr. 
Desire for acid drinks: Bryon. 

When COUghing", the air from the lungs 
causes a strange, offensive taste in the 
mouth; the breath smells badly: Capsic. 

Breath cold : Card. veg. 

Bilious symptoms : Chelid. , Merc. sol. 
Jaundice : Merc. sol. 
Diarrhoea: Merc, sol., Phosphor. 

worse in the morning: Sulphur. 

Stool brown, consistent: Ferrum. 

dry : Kali card. 

badly smelling, even if formed: 

Laches. \ 

23 



Abdomen distended with gas: Card. veg. 
Pain under right shoulder-blade: Chelid. 



Drowsiness and inability to go to sleep: 
Bellad. 

Somnolence : Kali hydr., Senega. 

Sleepless and restless: Rhus tox., Sul- 
phur. 

Starting in sleep : Bellad. 

Snoring loudly : Kali hydr. 

Lying upon his back: Kali hydr. 

Cross on getting awake: Lycop. 



Cold extremities: Arsen. 

and face: Sanguin. 

feet and hands blue: Card. veg. 

Bluish under nails: Kali hydr. 

Chill, previous to, no ailment: Ferr. met. 

, often, deep sleep, can't be roused: 

Kali hydr. 

High fever, first stage: Aeon. 

Hot palms, soles and vertex: Sulphur. 

and dry skin: Phosphor. 

Skin neither cold nor burning hot: 
Ferrum. 

Sweat, whole body except lower extremi- 
ties: Opium. 

, very hot: Opium. 

, not profuse, sometimes sour smell- 
ing: Cuprum. 

, semilateral (left side of chest): 

Pulsat. 

, without relief: Cuprum, Laches., 

Merc. sol. , Lycop. 

, with sudamina: Opium. 



Cutaneous eruptions : Sulphur. 
Skin dry : Kali card. 



Faint, weak spells, worse in forenoon: 

Sulphur. 
Prostration: Arsen. 
Sinking of strength: Sanguin. 
The extremities, when raised, fall back, 

as if paralyzed : Kali hydr. 
Body emaciated and marbled: Card. veg. 
Threatening convulsions : Bellad. 



Inclination to lie still: Bryon. 
Better on lying on the painful side; some- 
times the reverse: Bryon. 
Lies upon his back: Sanguin., Kali hydr. 

, can't lie on the sides: Pulsat. 

Must He quietly upon the back: Aeon. 



354 PULMONARY TUBERCULOSIS. 

Cannot He on the right side by stitching In traumatic cases: Arnica. 

pains in the left: Aeon. After a sudden check of perspiration with 

Slightest motion increases all symptoms: pain under the scapulae (both sides): 

Bryon. Gel son. 



Lying" still increases pain and dyspnoea: 

Rhus fox. 
Cannot bear to be covered: Lycop. 



After previous catarrh in the chest or 

bowels: Cuprum. 
In protracted cases of weak cachectic 



Wants to sit up, because the bed feels too individuals, where there is a sudden 

hot: Opium. abatement of pain, and yet an increase 

of the pulse: Nitr. ac. 

Pulmonary Tuberculosis, Phthisis Pulmonum, Pulmonary 

Consumption. 

Pulmonary tuberculosis may be defined as an infectious disease, charac- 
terized by consolidation and disorganization of lung tissue, great emaciation 
and febrile phenomena; and is due to the activity of the bacillus tuberculosis 
of Koch. 

It may pursue an acute or chronic course, and be due to either 
primary or secondary infection, in the latter case developing after tubercu- 
losis of the bones and joints, rectal fistulae, and other local tubercular lesions. 

It usually commences in the apices or the upper lobes of the lungs. 
Through the irritative action of the bacilli a hyperplasia of the fixed con- 
nective-tissue cells takes place together with an infiltration of leucocytes. The 
former are the epitheloid cells, and in the centre of groups of these, giant 
cells develeop, while on the periphery numerous lymphoid cells (leucocytes) 
aggregate. This constitutes a small gray tubercle, and as there is no vascular 
supply the entire mass soon undergoes caseation, which begins in the central 
portion of the nodule. The result of this process is the formation of a yel- 
lowish, cheesy mass, the yellow tubercle. 

When the process begins in the lobules, as is the case in primary infec- 
tion through the air passages, a proliferation of the epithelial cells takes 
place leading to a diffuse consolidation with subsequent inter-lobular changes, 
as mentioned above. 

Numerous tubercles in the diseased lung blend, the entire mass softens 
and breaks down. This is ejected through the bronchial tubes leaving a 
cavity behind, or the surrounding structure may become vascularized and in- 
flamed with round cell infiltration, the fluid portions of the degenerated mass 
being absorbed and the remaining dry cheesy mass becoming encapsuled; this 
occurs in the chronic forms. In the acute form there is a rapid infiltration 
and tubercle formation, followed by extensive destruction and degeneration 
(phthisis florida). 

Formerly fibroid phthisis and pneumonic phthisis were described as dis- 
tinct diseases and considered to be not necessarily of tubercular origin; they 
are now classed under the chronic form of pulmonary tuberculosis, and are 
names given to cases which present more or less fine clinical or pathological 
variations. 

Its characteristic symptoms ma}' be summed up as follows: 



PULMONARY TUBERCULOSIS. 355 

Cough, may not always be present, or at least not in a marked degree in 
the beginning, but once present it contiues to the end. Its severity is pro- 
portioned to the extent of the disease, and increases and decreases with the 
phases of the disease. Its character varies in different individuals, but 
towards the last it assumes a peculiar toneless sound, owing to the ulcerated 
state of the vocal cords and great muscular weakness. 

Expectoration is at first usually absent, and when it makes its appear- 
ance it is of no distinctive character; later with the increase of pneumonic 
infiltration it becomes glassy, glutinous and at times tinged with blood. 
Still later, and in some cases earlier, the sputa contain opaque grayish-white 
striae and granules, mixed with the rest of the yellow viscid mass. On pour- 
ing the whole into water the granules sink to the bottom, while the striae 
remain suspended; there appear also about this time elastic fibres of the 
lung tissue in the sputa, which sink to the bottom, if the sputa be mixed 
with an equal quantity of caustic soda, and be boiled in distilled water 
(18: ioo), to which, under frequent stirring, water three or four times its 
bulk is added, and the whole allowed to stand and settle in a conical glass. 

Still later, and by degrees, the sputa become globular and compact; they 
sink in water or hang attached to a thread of mucus; they come from cavi- 
ties formed by bronchiectases, and as the destructive process still further pro- 
gresses and cavities form, the sputa changes to purulent matter, which is 
often expectorated in large quantities. The presence of Koch's bacillus in 
the sputum is one of the earliest diagnostic signs of consumption. 

Haemoptysis may occur at any period of the disease, and is due either to 
a degeneration of the blood-vessels or to hard, straining spells of coughing. 
It may amount to a very small quantity of blood, merely staining the expec- 
toration, and it may be so profuse that it kills the patient instantaneously. 
I^arge haemorrhages take their origin from a rupture of larger vessels, mostly 
in cavities. 

Phthisis is rarely accompanied with any particular pain in the chest, 
unless accompanied with pleurisy, which causes a sharp stitch-pain; so also 
is the dyspnoea of little account, unless induced by supervening pleuritic exu- 
dation or pneumothorax; but the breathing is in all cases greatly accelerated 
and especially from any exertion. 

Inspection. The subclavicular region of the thorax sinks in, and the 
clavicles become prominent; the whole thorax is flat and elongated, and the 
shoulder-blades stick out ; the respiratory motion decreases or ceases alto- 
gether in those places, and in far advanced cases the respiratory motion takes 
place only at the lower portion of the thorax. The whole body of the 
patient is emaciated, pale, and covered by a loose, thin skin. But there are 
cases where the thorax shows no such aspect, but appears finely developed. 

Palpation reveals stronger fremitus in one or the other subclavicular 
region, and in the commencement an increased impulse of the heart. 

Percussion affords, at the beginning of the disease, no results whatever, 
because minute infiltrations cannot alter the sound, as they are surrounded 



356 



PULMONARY TUBERCULOSIS. 



by healthy, air-containing lung tissue. Only when the}* increase in size, and 
thus deprive the lung of air, the percussion sound will grow duller accord- 
ingly, and this is observable most apparently in the infraclavicular, acromial 
and suprascapular region. If at a still later period cavities have formed, 
with tense, smooth walls, well adapted for reflecting sound, and if they are 
near enough to the thoracic walls, percussion ma}* yield a tympanitic sound, 
or a metallic tinkling, or even a cracked-pot sound (if the cavity be con- 
nected with large bronchi), so that through percussion the air is forced out 
of the cavitv into the bronchial tubes. 





Tuberculous Infiltration. 
a. Fleshv and dull sound. 



After Bock.) 



c. Cavity with tympanitic sound, or metallic 

tinkling, etc. 
b. and e. Lung sound. 



Tuberculous Infiltration. (After Bock.) 

a. Fleshy percussion sound. 
•b. and d. Short dull sound. 
c. Lung sound. 

e. Heart. 
f. Liver. 



Auscultation at first yields an increased and prolongated expiratory mur- 
mur (Jackson), which is often heard in two distinct jerks; also fine rattling 
noises, which, from coughing, disappear only for a little while (Xiemeyer), 
and a systolic murmur in the subclavian artery on the affected side during 
expiration . ( Ruehle . ) 

When the tubercles commence to dissolve, we often hear the " click 
sound. 1 ' 

After the lung tissue has become infiltrated by tubercular masses, we 
hear, on auscultation, bronchial breathing and bronchophony, and all kinds 
of rattling noises. 

When cavities exist, which, with their smooth and tense walls, are well 
adapted for the reflection of sound, we hear the emphoric echo and metallic 
tinkling, also the cavernous respiration. 

The pulsation of the heart is generally heard, even on the right side, 
quite distinctly. 

Phthisis is almost always attended with laryngeal symptoms, such as 
hoarseness, difficulty of swallowing (food or drink go the wrong way), in 
consequence of tuberculous ulceration and inflammation. 

The circulation is accelerated; the pulse is rapid, soft and empty, the 
action of the heart is increased, causing palpitation, and all this at first with- 



PULMONARY TUBERCULOSIS. 357 

out an}- corresponding elevation of temperature. In short, the signs are 
those of any form of anaemia, which ultimately develops hydraemia; amen- 
orrhcea. 

In the digestive organs we frequent^ meet with loss of appetite, and in 
some cases even at the beginning; with nausea, occasional vomiting, especially 
after coughing, with pain or oppression in the pit of the stomach, in the 
bowels, with diarrhoea. The latter is of very frequent occurrence, at times 
showing itself at the commencement of the disease, at other times during its 
whole course in recurring spells; most commonly, however, it belongs to a 
later period, quickly exhausting the vital forces, or ending with a rapidly 
fatal peritonitis when the tuberculosis ulceration terminates in perforation. 

Phthisis is at times complicated with fatty liver and amyloid liver, with 
amyloid degeneration of the spleen and of the kidneys. 

The skin is conspicuous by its transparency and paleness, and by the 
distinctness of the veins; by its great sensitiveness to the slightest changes 
of temperature; by the easily flushing of the face on the slightest excite- 
ment, and the profuse perspiration with even moderate fever. The nails 
grow curved like claws, and there is a bulbous enlargement of the third 
phalanx. This symptom, however, is also found in other chronic diseases 
of the respiratory organs, such as emphysema, etc. The pink-red line on 
the lower gums occurs often at a very early period, though it is not found 
exclusively in phthisical persons. Pityriasis versicolor appears often at the * 
very beginning. 

One of the most constant signs of phthisis is emaciation noticeable from 
the very beginning and advancing steadily with the progress of the disease. 
During the periods of remission the loss is made up again, but if loss of weight 
should set in again without assignable cause, a renewed attack may be ex- 
pected. The total loss produced by the disease is generally from one-fourth 
to one-third part of the initial weight, and it involves not merely the fat, 
but also the tissues and the blood. On account of this wasting away the 
disease has appropriately been called consumption. 

The fever also is a conspicuous feature of phthisis. In acute cases — 
florid phthisis — it is of a continuous type, the morning temperature falls but 
little below 102 , and the evening temperature rises above 104 . In chronic 
cases it is intermitting, its minima are generally normal, or a little below the 
normal, while the maxima average from 101.3 to 102. 2 ° F. 

At last must be mentioned the brilliant eyes of the phthisical patient 
and his unchangeable hopefulness even to the last. 

Its Predisposing Cause is a scrofulous diathesis, therefore a tendency 
to phthisis is so frequently inherited. Still it may be acquired from lack of 
pure air, light, warmth and exercise, and from a deficiency and poor quality 
of food; in short, by anything that impairs the nourishment of the bod}', 
induces poverty of blood or depresses the nervous system. In scrofulous 
subjects these conditions of course will hasten the outbreak of a pulmonary 
lesion. The maximum of its occurrence lies between the fifteenth and 
twenty-fifth years. 



358 THERAPEUTIC HINTS TO PULMONARY TUBERCULOSIS. 

The bacillus tuberculosis of Koch is of a rod-like shape, and is best 
demonstrated by staining with the carbol-fnchsine solution of Ziehl-Neelsen, 
followed by Grabbet's acid methyl blue counter-stain. Such bacilli have 
been found in sputum, even before any physical signs of consumption are 
present, and they are carried by the air and inhaled when the sputa of tuber- 
cular patients are allowed to dry and to be converted into dust-form, or are 
taken in food, such as milk from tubercular cows, meat, etc. 

Elevated positions are known to protect against phthisis. A height of 
at least 1,000 or 2,000 feet above the sea seems to be requisite for this pur- 
pose. 

So also are goitre, emphysema, valvular diseases of the heart and con- 
siderable contractions of the chest by spinal curvatures said to be antago- 
nistic to the development of phthisis, although exceptions to this rule surely 
occur. 

As regards the contagiousness of consumption opinions have been at 
variance. Of late, however, experiments on animals seem to leave no doubt 
that the disease is communicable, and cases are met where through the in- 
timate relations existing between husband and wife the disease has been 
communicated; it is certainly good advice to be cautious in attending of and 
associating with those who are far advanced in the disease. 

Consumption furnishes the largest percentage of deaths amongst all other 
diseases; nevertheless man}- cases are cured, and the disease cannot be 
called incurable, though favorable conditions necessarily are required for a 
successful treatment. 

Therapeutic Hints. 

General rules, which may serve as preventives: Fresh air, and plenty 
of it; exercise in the open air, and gymnastic exercises, which tend to widen 
and strengthen the chest; methodical breathing exercises for the same pur- 
pose, which consist in regular, slow, and full inspirations and expirations; 
singing; a good and nourishing diet, and a careful attention to the skin by 
rubbing and washing, in order to keep up its activity and to harden it 
against atmospheric changes; rubbing the skin with olive oil has also been 
recommended, and a change of climate has certainly proved beneficial in 
many cases. 

About the time of puberty all efforts should be made to prevent the 
excitement of sexual desires, such as reading loose literature. Masturbation 
is in the highest degree hurtful; mental exertions, and depressions of all 
kinds, are also injurious. 

When catarrhal affections set in they must be treated according to their 
special symptoms, and so also all other features, changes and processes of 
the disease. 

When a well-selected remedy is allowed to act, it manifests itself— ac- 
cording to Nusser's observations — generally in one of the following symp- 
toms, which are favorable: 



SPECIAL HINTS. 359 

i. Swelling of the glands in the axilla. 

2. Rheumatism in the muscles of the neck, shoulders, thorax, hips or 
extremities. 

3. Swelling of the glands on the neck and ear. 

4. The materia peccans rises from within towards the outside, contrary 
to the air which passes during respiration from without inward. The chest 
feels lighter, but the trachea and larynx become affected in a manner to pro- 
duce hoarseness, which subsiding, the nose becomes sore and finally ends 
with pimples and pustules around the nose. 

5. The ears become affected, from a mere ringing in the ears to suppur- 
ation within them. 

6. The eyes become inflamed. 

7. Headache and toothache set in; in such a case let the patient suffer; 
a sudden suppression of them would quickly bring back all the troubles to 
the chest. 

8. An eruption on the thorax, with or without itching on the chest or 
back. 

9. Sweating of the feet. 

10. Hemorrhoidal irritations and tumors. 

11. Violent colds in the head, which may indicate Aeon, or Phosphor., 
and which almost always act beneficially. 

12. The morbid action goes down into the intestines, and throws out 
gall, acid, mucus or gas, until finally it develops itself in a cutaneous dis- 
ease, first attacking the head, the upper extremities, the thorax, and so all 
the way down, like small-pox. 

When a well-selected remedy brings forth any of these symptoms, never 
disturb its action by change or repetition. 

Special Hints. 

Compare the foregoing chapters on catarrhal and inflammatory diseases 
of the. respiratory organs, which may contain the hints just needed for the 
individual, case. Besides compare : 

Aeon. Intervening pleuritic stitches and blood-spitting. 

Act. rac. Intercurring congestions and inflammations from exposure, 
with dry, harrassing cough; night-sweats and diarrhoea. 

Arsen. Acute pain in the upper third of right lung; hurried respiration 
upon moderate exertion, or dyspnoea on lying down; cough dry, or with 
expectoration of frothy, glairy and transparent mucus, or yellow and grayish- 
yellow sputa; cough worse in the evening on lying down, and in the morning 
on rising; haemorrhage from the lung with burning in the upper portion of 
the right lung. (R. R. Gregg.) Prostration; exhausting diarrhoea; inter- 
mitting chills, fever and sweat; thrush in the mouth. 

Ars. jod. Soreness in larynx; hoarse, racking cough, day and night, 
with profuse purulent expectoration. (H. V. Miller.) 

Baptis. Chill in the forenoon or afternoon, followed b}' heat and pers- 



360 SPECIAL HINTS. 

piration, as in ague; general weakness and languor; sometimes loss of hope- 
fulness. (J. S. Mitchell.) 

Bellad. In the beginning of chronic lung disease, hollow, barking 
cough; often worse at midnight; violent stitching pains from right side of 
abdomen, upwards through the right lung to mamma, point of right shoulder 
of inner border of right scapula; also chronic nasal or bronchial fluent 
catarrh, attended with rattling respiration, in nervous or mentally active 
subjects. (R. R. Gregg.) 

Bryon. Pleuritic pain and exudation; chills and fever afterwards; 
cough all day, also in the night. 

Cole. card. Pain in upper half of right lung; cough with purulent 
sputa, worse in the morning on rising, and in the early evening, with par- 
oxysms during the day, less during the night. Loud breathing through the 
nose; bleeding from right nostril; rapidly growing children and youths. 
(R. R. Gregg.) Easily perspiring, with fatigue from an}' little exertion; 
dizziness and want of breath on going up stairs; paleness of face, with fre- 
quent flushes; nightly seminal emissions; too early and too profuse, or sup- 
pressed catamenia; inclined to loosenees of the' bowels, especially towards 
evening; damp, cold feet. " Expectoration falls to the bottom in water, with 
a trail of rough mucus behind, like a dropping star." (A. Fellger. ) "The 
patient appears gaunt, hollow-eyed, great emaciation; coughs little, but 
complains of stitching pains in the upper chest; loss of appetite; constipa- 
tion; fluttering of the heart upon the slightest exertion; weary of living; 
constant coldness and dampness of the feet; tongue covered with a thick, 
white, past}' coating; bad taste in mouth; dull, heavy, stupid feeling in 
head, particularly in the morning; pulse 94. Believes her chief troubles 
are uterine. Suppression of menses; complete loss of sexual desire, border- 
ing at times upon absolute aversion; leucorrhcea. Formerly troubled with 
chronic diarrhoea. Calc. ca?b., 30, brought out for a while diarrhoea again, 
and also the menses. Six weeks later, Calc. carb., 200. Soon recovered 
entirely." (H. R. Arndt., Weekly Med. Counsellor, June 7, 1882, p. 155.) 

Card. veg. Nosebleed in the night; cough, in hard spells, not Ceasing 
until masses of green or yellow, or purulent and offensive sputa are dis- 
charged; hoarseness in the evening; cool skin; cold knees at night in bed; 
great prostration; hippocratic face. 

Cinchona. After loss of blood, long-continued nursing, seminal emis- 
sions; intermittent fever; sweats when dropping asleep. 

Crocus. " Asthmatic or wheezy cough, attended by frothy expectora- 
tion, containing threads of translucent, whitish or yellowish mucus, of the 
size of coarse spool cotton or fine twine; worse in hot weather, a warm room, 
lying down, etc." (R. R. Gregg*) 

Dulcani. After taking cold from any change of weather; tough, 
greenish expectoration, with moderate cough; stitching pain here and there 
in the chest; diarrhoea. 

Ferr. met. Flying pains in the chest; nosebleed; spitting of blood; 



SPECIAL HINTS. 36 1 

feeling of fullness and pressure in the pit of the stomach ; vomiting of ingesta; 
paleness of the buccal cavity; painless diarrhoea; watery menstruation; hectic 
fever. Especially in persons who, in consequence of any little emotion or 
exertion, flush easily in the face, or get epistaxis, or cough, dyspnoea, spit- 
ting of blood, or palpitatiou of the heart; the symptoms are relieved by 
moving slowly about, and while eating. 

Guaiac. Pleuritic stitch-pains in the chest. 

Hepar. Cough excited when any part of the body gets cold from being 
uncovered; chilliness in the open air; keeps tightly covered even during pro- 
fuse sweat; paleness after any exertion; perspiration easily excited; after- 
wards burning redness of the face and dry heat in the palms of the hands. 
After pneumonia. The cough is barking, wheezing, choking, worse towards 
morning. 

Iodium. Cough from constant tickling in the windpipe and under the 
sternum, with expectoration of a transparent mucus, sometimes streaked with 
blood; morbid hunger even soon after a meal and yet loss of flesh, or else 
total loss of appetite; remarkable sense of weakness and loss of breath in 
going up stairs; emaciation of the mammae; copious menstruation; morning 
sweats; dark hair and eyes. 

Kali curb. Stitching pain in temples, eyes, ears, teeth, chest and different 
parts of the body; after dinner nausea, faintishness, sleep; about noon, chilli- 
ness; at night, heat; about 3 o'clock a. m., cough worse than ever. Puffi- 
ness of upper eyelids. Easily frightened; a slight touch of the feet causes 
the patient to jerk them up in affright; nursing mothers. "Expectoration 
of firm white globular masses of the size of a pea, flying from the mouth 
with considerable force when coughing or hawking; eruption of minute 
vesicles upon the soles of the feet, with extensive itching. Burning in top 
of head and soles of feet; sweaty paleness; circumscribed red spot on one 
cheek; gastric derangement, with belching, tasting like rotten eggs; hungry 
and faint about 10 A. m.; contraction of the heel cords; trembling sensation 
through the entire body, especially through the pelvic region." The 3d 
trituration cured, whereas the 200th had failed. (O. W. Smith.) 

Laches. Cough worse after sleep, sometimes only through the day, but 
also during sleep without wakening; expectoration difficult, has to hawk, 
hem, cough and spit a good while before he succeeds in getting a little tough 
phlegm away. Fever worse in the afternoon; stools smell very offensive, 
even if of a natural consistency. Sore mouth in last stage. 

Ledum. Phthisical symptoms, alternating with rheumatism. 

Lycop. After neglected pneumonias, expectoration of large quantities 
of pus; the expectoration tastes salty; cough day and night; hectic fever, 
circumscribed redness of the cheeks; worse from four to eight p. m. ; cannot 
bear covering; night-sweats. 

Merc. sol. "Great aggravation from, or utter impossibility of, lying 
upon the right side; fugitive pains, now here, then there, or anywhere, and 
changing place every hour, few hours, or day or two." (R. R. Gregg.) 

Myrtus com. • Stitching pain in the left chest, from the upper portion 



362 SPECIAL HINTS. 

straight through to the left shoulder-blade, worse from breathing, yawning 
and coughing; spitting of blood. 

Natr. bcnz. Has lately been employed successfully in consumption; 
special indications wanting. 

Natr. mur. Great dryness in the mouth; follicular catarrh of fauces; 
fluttering of the heart; the patient gets worse on the seashore. 

Nitr. ac. Patients tainted with syphilis or mercurial cachexia. Ulcers 
in mouth and throat; fetid breath; colliquative night-sweats, very offensive; 
morning thirst; habitual looseness or constipation of the bowels; fissures of 
the anus. 

Nux vom. "Violent racking paroxysms of cough, with or without 
expectoration; worse after eating and in the morning or forenoon; attended 
by severe headache, pain or bruised sensation in stomach, hypochondria or 
bowels, and a dull or subacute soreness of the abdomen under pressure." 
(R. R. Gregg.) 

01. jecor. aselli. The genuine article, which has not been "purified," 
has been of great use where scrofulous diathesis is conspicuous. 

Phosphor. Cough worse, dry and tight before midnight, tormenting; 
excited by talking, laughing, moving, eating or cold air; during cough, 
bursting pain in the head, and sore, burning pain in chest and larynx; pain 
in the left side of the chest; heat or burning in the back between the 
shoulders; evening chill, followed by heat and sweat during sleep till next 
morning; in the morning the cough is loose. Puffmess around the eyes; 
diarrhoea alternates with constipation; stool and flatus very fetid. 

Phosph. ac. For young persons that have grown very fast. 

Psorin. The exhalation from the body, its secretions and excretions 
have an offensive odor; after suppressed itch. 

Sambuc. Profuse sweats, but only while awake; during sleep the skin 
becomes dry and hot. 

Sanguin. Breath and sputa smell badly, to the patient himself dis- 
agreeable; before and after cough, belching of wind; after the cough, heat, 
and after the heat, gaping and stretching; circumscribed redness of the 
cheeks; diarrhoea; night-sweats; pain in the lower left side of chest, extend- 
ing upwards to left shoulder. 

Sepia. "Stitching or darting pains through the central portion of the 
right lung; cough dry in the evening; free expectoration in the morning, or 
expectoration only at night, none during the day; excessively fetid sputa." 
(R. R. Gregg.) Cough better when lying down; the cough sounds loose, 
but there is no expectoration, or only a little after great efforts. 

Silk. Profuse discharge of fetid pus; formation of cavities; profuse 
night-sweats; pale, wax-like appearance of the skin; stone-cutter's con- 
sumption. 

Spongia. Cough worse from evening until midnight, from cold air, 
from talking, singing or moving; better from eating or drinking; dyspnoea 
on lying down with the head low. 



DIGEST TO PHTHISIS. 



363 



St an num. Feeling of great weakness in the chest; can talk only a few 
words at a time, from want of breath; pressure and bloatedness of the 
stomach always after eating; great lassitude; hands and feet feel heavy and 
are cold, or else burning hot; constant chilliness, alternating with flushes of 
heat; profuse night and morning sweats; profuse expectoration, mostly of a 
sweetish taste. 

Sulphur. Dryness and burning in the throat; the breath appears hot 
to the patient; cough mostly dry, only now and then profuse discharge of 
purulent matter, which relieves for awhile; the patient complains constantly 
of being too hot, puts his feet out from under the cover; congestion towards 
the head and chest, with palpitation of the heart; profuse sweating at night; 
diarrhoea early in the morning; after suppressed chronic skin eruptions; pain 
in left side of chest in lower portion through to left shoulder-blade. 

Sulph. ac. Stitch-pain through the upper part of the left chest to the 
shoulder-blade. 

Tai'antula cubensis. ' ' It soothes the dying sufferer as I have never 
seen any other remedy do." (J. T. Kent.) 

Tuberculinum or bacillinum has been used by homoeopathic physicians 
with success in this disease. Dr. Burnett especially has given a whole list 
of cases in which he used it more or less successfully. 



Digest to Phthisis. 



LOCAL SYMPTOMS. 

Cough, barking: Bellad. 

, , choking, wheezing, worse in 

the morning: Hepar. 

, hoarse, racking: Ars. jod. 

, asthmatic wheezing: Crocus. 

, dry: Arsen. 

, in evening: Sepia. 

, , harrassing: Act. rac. 

, and tight, tormenting, before 

midnight: Phosphor. 

, paroxysmal during day, less during 

night: Calc. carb. 

, , not ceasing until masses of 

green and yellow, or purulent and of- 
fensive sputa are discharged : Carb. veg. 

, , racking: Nux vom. 

, all day: Bryon. 

, only through the day: Laches. 

, day and night: Lyc^p. 

, evening: Arsen., Spongia. 

, midnight: Arsen., Bellad. 

, morning at 3 o'clock: Kali carb. 

, during sleep without wakening: 

Laches. 

, worse on lying down: Arsen., Cro- 
cus. 



, on right side: Merc. sol. 

, on rising in the morning: Arsen. 

, after sleep: Laches. 

, from cold air: Phosphor., Spongia. 

, from a part of body being uncov- 
ered: Hepar. 

, in hot weather, a warm room: Cro- 
cus. 

, after eating and moving: Nux vom., 

Phosphor. 

, talking, laughing: Phosphor., 

Spongia. 

, better from eating or drinking: 

Ferritin, Spongia. 

, while lying down: Sepia. 



, with bursting pain in head: Bryon., 

Nux vom., Phosphor. 
, headache, or bruised sensation in 

stomach, bowels, hypochondria: Nux 

vom. 
, with sore, burning pain in chest and 

larynx: Phosphor. 
After cough, heat: Sanguin. 



Expectoration free in the morning: 
Phosphor., Sepia. 



>6 4 



DIGEST TO PHTHISIS. 



only at night, none during the day: 

Sepia. 
difficult, has to hawk, hem and spit 

a good while before a litle phlegm is 

brought away: Laches. 
, the cough sounds loose, but there is 

no expectoration, or only a little after 

great efforts: Sepia. 

frothy, with threads of whitish or 

yellowish mucus of the size of common 
spool cotton or fine twine: Crocus. 

, , glairy and transparent mucus: 

Arsen. 

, transparent mucus sometimes mixed 

with blood: Iodum. 

, firm, white globular masses, of the 

size of a pea, flying from the mouth 
when coughing or hawking: Kali card. 

falls to the bottom in water, with a 

trail of tough mucus behind like a drop- 
ping star: Calc. card. 

yellow, or grayish -yellow: Arsen., 

Card. veg. 

green or yellow: Card. veg. 

tough, greenish, with moderate 

cough: Dulcam. 

fetid, offensive: Card, veg., San- 

guin., Sepia, Si lie. 

, , with cough in hard spells: 

Card. veg. 

purulent: Ars. jod., Card, veg., 

Calc. card., Lycop., Si lie, Sulphur. 

, , worse in the morning on rising 

and early in the evening: Calc. card. 

, , with barking cough day and 

night: Arsen., Iodium. 

, , which relieves for a while; 

Sulphur. 

salty: Lycop. 

sweetish: Hamam. 

Spitting" of blood: Aeon., Arsen., Fer- 
ritin, Ferr. phosph., Myrt. com. 

, with burning in upper portion of 

right lung: Arsen. 



Breathing" hurried upon moderate exer- 
tion: Arsen. 

Loss of breath on going up stairs: Calc. 
card., /odium. 

, and dizziness: Calc. card. 

, sense of weakness: Podium. 

Dyspnoea on lying down: Arsen. 

with the head low: Spongia. 



Loud breathing through the nose: Calc. 
card. 

Breath appears hot to the patient: Sul- 
phur. 

of bad smell, fetid: Nitric ac, San- 

guin. 



Throat dry and burning: Sulphur. 
Larynx sore: Arsen., Iodium. 
Hoarseness in evening: Coccyx. 
Stitching" pain in upper third of right 
lung: Arsen. 

in upper half of right lung: Calc. 

card. 

through the central portion of right 

lung: Sepia. 
from right side of abdomen upwards 

to the right chest, mamma and right 

shoulder: Bel lad. 

through upper part of left chest: 

Sulph. ac. 

, worse from breathing, yawning 

and coughing: Myrt. com. 

Pain from lower portion of left chest 
through to the shoulder: Bryon, Sul- 
phur. 

from left lower chest up to left 

shoulder: Sanguin. 

in left chest: Phosphor. 

Stitching" pain here and there in chest: 
Dulcam. 

in chest and different parts of body : 

Kali card. 

, pleuritic: Guaj. 

, and blood-spitting: Aeon. 

, and exudation: Bryon. 

Flying pains in chest: Ferr. met. 

Congestion in chest and head, and pal- 
pitation of heart: Sulphur. 

from exposure : Act. rac. 

Feeling" of weakness in chest; can 
scarcely talk: Stan num. 

Chest symptoms alternate with rheu- 
matism: Ledum. 

Bronchial catarrh with rattling respira- 
tion: Bel lad. 

Formation of cavities: Si lie. 



Fluttering of heart: Natr. mur. 

upon slightest exertion: Calc. card. 

GENERAL SYMPTOMS. 

Dull, heavy, stupid, worse in morning: 
Calc. card. 



DIGEST TO PHTHISIS. 



365 



Thinks her troubles uterine: Calc. card. 
Loss of hopefulness, sometimes: Baptis. 
Easily frightened; a slight touch of the 

feet causes the patient to jerk them up 

in affright: Kali card. 
Burning in top of head and soles of feet : 

Art// cat b. 
Dark hair and eyes: Iodium. 
Pnffiness of upper eyelids: Kali curb. 

around eyes: Phosphor. 

Nasal catarrh: Bellad. 
Nosebleed: Ferrum. 

, right side: Calc. carb. 

, in the night: Carb. vcg. 

Burning" redness of face: Hepar. 
Circumscribed redness of cheeks: 

Lycop., Sanguin. 

of one cheek: Kali carb. 

Paleness: Kali carb. 

after any exertion: Hepar. 

with frequent flushes: Calc. carb. 

Hippocratic face: Carb. veg. 
Tongue white, pasty, thick: Calc. carb. 
Dryness of mouth: Natr. mur. 
Paleness of buccal cavity: Ferrum. 
Thrush in mouth in last stage: Arsen., 

Laches. 
Ulcers in mouth and throat: Nitr. ac. 
Follicular catarrh of fauces: Natr. mur. 
Bad taste: Calc. carb. 
Belching tasting like rotten eggs: Kali 

carb. 
Vomiting" of ingesta: Ferrum. 
Morning thirst: Nitr. ac. 
Hungry and faint about 10 a. m. : Kali 

carb., Sulphur. 
Morbid hunger even soon after a meal 

and yet loss of flesh: Iodium. 
After dinner nausea, faintishness: Kali 

carb. 
Loss of appetite: Calc. carb., Iodium. 
Pressure and bloatedness of stomach 

after eating: Stannum. 
and fullness in pit of stomach : Fer- 
rum. 
Soreness of abdomen on pressure: Nux 

vom. 
Diarrhoea: Dulcam., Sanguin. 

, exhausting: Arsen. 

, painless: Ferrum. 

and night-sweats: Nitr. ac. 

worse early in morning: Sulphur. 

worse towards evening: Calc. carb. 

, or constipation : A T itr. ac, Phosphor. 



Constipation: Calc. carb. 
StoOl Offensive: Laches. 

and flatus very fetid: Phosphor. 

Fissures of anus: Nitr. ac. 



Trembling" sensation through pelvic re- 
gion and all over: Kali carb. 
LOSS of sexual desire: Calc. carb. 
Nightly emissions: Calc. carb. 
Menstruation copious: Iodium. 

and too early: Calc. carb. 

watery: Ferrum. 

suppressed: Calc. carb. 

Leucorrhoea: Calc. carb. 
Emaciation of mammse: Iodium. 
Fugitive pains anywhere: Merc. sol. 
Contraction of heel cords: Kali carb. 



Coldness and dampness of feet: Calc. 
carb. 

and heaviness of hands and feet, or 

heat: Stannum. 

Cool skin: Carb. veg. 

Cold knees even in bed: Carb. veg. 

Chilliness, about noon: Kali carb. 

in open air: Hepar. 

constant with flushes of heat: Stan- 
num. 

Chill in forenoon, followed by heat and 
sweat in afternoon : Baptis. 

evening, followed by heat and sweat 

during sleep till morning: Phosphor. 

and fever afterwards: Br yon. 

Dry heat in palms of hands: Hepar, 
Stannum. 

Heat and burning in back between shoul- 
ders: Phosphor. 

Skin dry and hot during sleep: Sambuc. 

Heat at night: Kali carb. 

Hot all the time, puts feet from under 
cover: Sulphur. 

After heat, gaping and stretching: San- 
guin. 

Intermitting fever: Arsen., Baptis., 
Cinchona, Natr. mur. 

Hectic Fever: Ferrum, Lycop. 

Fever worse in afternoon: Laches. 

Easily perspiring: Calc. carb. , Hepar. 

Sweaty paleness: Kali carb. 

Sweats when dropping asleep: Cinchona. 

only while awake: Sambuc. 

keet tightly covered even during 

profuse. 

Night-sweats: Lycop., Sanguin. 

and diarrhoea: Act. rac. 



3 66 



EMPHYSEMA PULMOXUM. 



profuse: Silic, Sulphur. 

offensive and colliquative: Nitr. ac. 

and morning-sweats profuse: St an- 
num. 
Morning-sweats: Iodium. 



Eruption of minute vesicles upon soles 

of feet with excessive itching: Kali 

carb. 
Pale, wax-like appearance of skin: Silic. 
Exhalation from body, secretions and 

excretions of offensive odor: Psorin. 
Fatigue from any little exertion: Calf. 

card. 
Great lassitude: Stannum. 
General weakness and languor: Baptis. 
Prostration: Arsen., Carb. veg. 
Emaciation: Calc. carb., Iodium. 



Young" persons growing too fast: Calc. 

carb., Phosph. ac. 
Gaunt and hollow-eyed persons: Calc. 

carb. 
Nervous, active subjects: Bellad. 



Persons who from little emotion or ex- 
ertion flush easily, get epistaxis, cough, 
dyspnoea, spitting of blood, palpitation 
of heart; better from moving slowly 
about: Ferrum. 

After loss of blood, long-continued nurs- 
ing, seminal emissions: Cinchona. 

Scrofulous taint: 01. jecoris aselli. 

After suppressed itch: Psorin, Sulphur. 

Syphilitic or mercurial cachexia: Nitr. 
ac. 

After pneumonia: Hepar, Lycop. 

Stone-cutter's consumption: Silic. 



Worse in general from warm weather, 

warm room: Crocus. 
Cannot hear covering: Lycop. 
Worse from being uncovered and in cold 

air: Hepar, Phosphor. 
- on seashore: Arsen., Carb. veg., 

Natr. mur. 
from any change of weather: Dul- 

cam. 
from 4 to 8 p. m. : Lycop. 



Emphysema Pulmonum. 

It is an enlargement of the air-cells, either from distention, or from a 
union of seven into one, by destruction of their partition walls; or it is a 
transmission of air into the interlobular, or subpleural cellular tissue. Ac- 
cordingly, we find on post-mortem examination the lungs swell out of the 
thoracic cavity like a cushion filled with downy feathers; and if rubbed be- 
tween the fingers we do not feel that peculiar crepitation of a healthy lung; 
the air-cells are widened, sometimes to the size of peas (vesicular emphsema). 
In the second case, where it consists in an escape of air into the interlobular 
or subpleural cellular tissue, the pleura pulmonalis is raised into little blisters, 
which, by pressure with the fingers, can be shifted; in rare cases only is the 
pleura separated and filled by air to a large extent (interlobular emphysema.) 

The Vesicular emphysema originates always in the neighborhood of 
such portions of the lungs, the air-cells of which have been destroyed by 
morbid processes, such as tuberculosis and interstitial pneumonia. The vacant 
space caused by this loss of substance has to be filled up by a dilatation of the 
neighboring alveoli; it is therefore of a vicarious nature, and would often 
amount to a much greater extent, were it not that the thoracic walls them- 
selves sink in, and thus obliterate to a certain degree the vacant space caused 
by loss of substance inside. This same widening of the alveoli takes place 
when the two pleural blades have grown together to a large extent in conse- 
quence of pleuritis, and especially is this the case in the anterior and lower 
edges of the lungs, because the adhesion does not permit the upper portions 



EMPHYSEMA PUEMONUM. 



367 



of the lungs to extend as fully, as is the case when the two pleural blades 
move freely upon each other; the inspiratory act then overfills the lower 
anterior portions of the lungs and dilates the air-cells. The same result is 
effected when, in consequence of catarrhal inflammation of the finer bronchial 
tubes, their swollen state prevents the free ingress of air, or in pneumonia, 
where the sound portion of the lungs has to perform the office of the entire 
lung. But also forced expirations as during spasmus glottidis, spasmodic 
asthma, blowing wind-instruments, bearing-down efforts during parturition, 
etc., may cause dilation of the air-cells. 

The Interlobular emphysema originates in consequence of rupture 
of the alveoli. The air then escapes into the interlobular and subpleural 
connective tissue. It is mostly the consequence of violent coughing spells, 
bronchitis and croup. 

If we bring all this clearly before our minds, we can easily perceive the 
consequences which must follow from such conditions. For instance, that 
portion of the inhaled air which occupies the distended air-cells, is never fully 
replaced by the acts of respiration, the blood coursing here remains unoxy- 
genized. In the further progress of the disease still more of the air-cells 
perish as their partition. walls become destroyed, consequently still more of 
that surface is lost by which the oxygenization of the blood takes place, and, 
therefore, the insufficiency of respiration and the accumulation of carbon in 
the blood grow greater in the same ratio. This the patient shows by his 
dyspnoea, by his great hunger for air. He strains all the muscles to widen 




Emphysema (After Bock.) 
a. Heart, b. Etnig sound, c. Liver, d. Stomach. 



the thorax and to get breath, and, in consequence, the thorax becomes 
arched, barrel-shaped, permanently dilated, and the muscles of the neck 
voluminous. 

Another consequence, though later in appearing, is disturbed circulation. 
Hand-in-hand with the destruction of the air-cells goes the obliteration of the 
capillaries. The blood from the right ventricle does not find room within 
the lungs. Stagnation follows, and, in consequence, hypertrophy of the right 
ventricle with all its usual consequences, viz.: undulation of the right jugular 
vein; cyanosis of the face; varicosed veins on the cheeks and alee nasi, 



368 THERAPEUTIC HINTS TO EMPHYSEMA PULMONUM. 

swelling of the liver; catarrh in stomach and bowels; swelling of the haemor- 
rhodial veins; scanty urine, etc. 

Its Physical Signs, on inspection, are the arched, barrel-shaped, per- 
manently dilated thorax from its upper region down to the sixth rib. How- 
ever, this condition does not obtain in all cases. We find it only in those 
persons in whom the emphysema originated in forced expirations and closed 
glottis, at a time when the bony structure of the chest was yet yielding. In 
other persons, with a long, flat, so-called paralytic thorax, emphysema may 
exist, to a large exteut, without any such alteration of form. The hollow 
places above and below the clavicles bulge out during a fit of coughing, the 
neck appears short and thick, and the respiratory motion, notwithstanding 
the greatest exertion, is short, superficial, and, instead of being a successive 
motion of the single ribs, is a movement of the whole surface at once, a 
mask-motion. The intercostal spaces do not bulge out; on the contrary 
they often sink in during inspiration. 

Palpation, if emphysema exists in the left lung, discovers the point of 
the heart lower down and towards the pit of the stomach, on account of the 
lower position of diaphragm. 

Percussion affords the best diagnostic sign of emphysema, inasmuch 
as we may with certaint}^ ascertain by it whether the dull sounds of the 
heart and liver exist in their proper places or not. If we hear lung sound 
where we ought to hear the dull sound of the heart or liver, we may be sure 
that the heart or liver are covered by the distended lung. Characteristic of 
emphysema, therefore, is an abnormal extension of the lung sound over the 
heart and liver. The percussion note is an exaggerated resonance or 
vesiculotympanitic, because the air-cells are forcibly distended. 

Auscultation affords- no very positive information. In the presence of 
a catarrh, which is a frequent complication, we hear no vesicular breathing, 
but rattling and bubbling noises. The inspiratory murmur is weaker, while 
the expiratory sound is prolonged. 

An emphysema which is confined to a small place only is not diagnosti- 
cable, and the interlobular and subpleural form runs its course without any 
characteristic symptoms. 

The progress of this disease is always of a chronic nature, and its more 
acute attacks depend upon an increase of bronchial catarrhs, which more or 
less, alwa}~s accompany it. It usually ends in general dropsy, as a natural 
consequence of those obstructions in the circulation which have been detailed 
above. The patient may live to a good age. 

Therapeutic Hints. 

Compare Spasmus Glottidis, Croup, Whooping-cough, Bronchial 
Catarrh, Consumption. 

Arsen. Highest degree of dyspnoea, even to suffocation, with great 
anxiety and restlessness; face cyanotic, and covered with cold perspiration; 
consumptive symptoms, with pain through upper part of right lung. 



THERAPEUTIC HINTS TO EMPHYSEMA PUEMONUM. 369 

Bell ad. Disturbed circulation; dizziness, headache; palpitation of the 
heart; fullness of the abdomen. 

Bromium. After pneumonia, asthma; pressure in the stomach; must 
sit up in bed at night. 

Camphora. Asthma, worse after bodily exertion; cough from talking, 
inhaling of air, and a feeling of coldness, which commences in the pit of 
the stomach, and spreads from here over the chest is and exhaled as cold 
breath. 

Card. veg. Often after Arsen. ; great dyspncea; cough in violent spells, 
with great anxiety, with watery, profuse expectoration, and under great 
exertion. 

Chin. ars. Regularly every forenoon, at nine o'clock, attacks of suffo- 
cating spells in tuberculosis; limbs icy cold; cold, clammy sweat all over; 
greatest anxiety and unquenchable thirst; must sit up, bent forward, if pos- 
sible, at the open window. 

Chlorine. Easy inhalation; exhalation impossible. 

Cuprum. Asthmatic S3 T mptoms worse after walking against the wind. 

Digit. Complications with heart disease; better in lying perfectly quiet 
in a horizontal position. 

Hepar. Combined with bronchial catarrh, worse from slightest ex- 
posure; coughs from midnight till morning; sleeps with head thrown back. 

Ipec. Dry, spasmodic cough of old people; collection of mucus; diffi- 
cult to expectorate, and giving only temporary relief; nausea. 

Kali carb. D3'spncea worse at night; strong beat of the heart; loss of 
appetite; vomiting; dry skin. 

Laches. All covering around the neck and even chest unbearable; 
worse after sleeping; cough torturing until some little tough phlegm is 
raiseci; stool smelling badly; follows well after Arse?i. and Carb. veg. 

Lob el. infl. Inclination to sigh and take a deep breath. 

Naphthal. Recommended by V. Grauvogl for empl^sema in conse- 
quence of forced expirations in buglers, etc. , and after bronchial asthma 
without catarrh. 

Opium. Nightly asthma, with whizzing and rattling during expiration, 
which is long and attended with retraction of the epigastric region; inhala- 
tion short, without noise. 

Sarsap. Asthma worse after eating or motion. 

Senega. Feeling as though the thorax were too narrow, with constant 
inclination to widen it by deep inhalation; burning in the chest. 

Sepia, and Sulphur. Both worse after sleep; getting suddenly roused 
by asthma from a deep sleep. Difference between both, see Gross' Compara- 
tive Materia Medica. 

Tereb. Asthma worse from motion. 

Besides these compare Aspar. , Bryon., Lobel., Natr. mur., Nux vom. y 
Pulsat., Tart, emet., Veratr., and all that is mentioned under Asthma Spas- 
modicum. 
24 



370 HYPEREMIA AND CEDEMA OF THE LUNGS. 

Hyperemia and (Edema of the Lungs. 

This affection consists of a serous exudation into the air-cells and finest 
bronchial tubes of the lungs, and is either acute or chronic. Sometimes it 
is confined to a small portion, and sometimes it extends over both lungs. 
When acute, the lung appears strongly injected with blood, tense, leaving no 
dent on pressure; when cut in two there oozes out of it a blood}- serum, 
which contains a great deal of albumen. All the air is driven out by the 
serum, and the lung tissue is easily torn. On account of this similarity with 
pneumonia, acute oedema is also called Serous pneumonia. 

In chronic oedema the lung appears pale and tough; upon pressure a 
dent remains; the serum is pale yellowish, thin, and contains little albumen; 
it fills the air-cells and finest bronchial tubes. The lung is heavy and puffed 
similar to any dropsical swelling, and it is deprived of air as far as the infil- 
tration of serum extends. 

The acute form is generally the product of hyperaemia or active con- 
gestion — a fluxion of blood to the lungs, which may be caused i, by an in- 
creased action of the heart, during the period of puberty, or in consequence 
of passions, or bodily exertions, or the use of stimulants; or, 2, by direct 
irritations from inhaling cold air, or hot and irritating substances; or, 3, by 
obstruction of the free circulation in some portions of the lungs by pleuritic 
effusions, pneumonic or tubercular infiltrations — producing a collateral 
fluxion. 

The chronic form is generally the product of stagnation in consequence 
of heart diseases, especially of stenosis and insufficiency of the mitral valves; 
also of a weakened action of the heart, due to asthenic fever in the course of 
acute exanthemata, typhoid or puerperal fevers, etc., to fattj- degeneration 
of the heart, or myocarditis. • 

Its most prominent Symptoms are: 

1. Dyspnoea, which oftentimes reaches such a height that the patient, in 
the greatest distress, tries all possible positions to get breath — now sitting 
erect, now bending forward and supporting the head with the arms, etc. 

2. Spasmodic cough, with a great deal of frothy and serous, sometimes 
bloody expectoration. 

3. Cyanotic symptoms, in consequence of the obstruction to the circula- 
tion; and, finally, if the breathing is still more impeded and the blood be- 
comes overcharged with carbon. 

4. The patient sinks, his cheeks grow livid, and he dies of asphyxia — 
Apoplexia pulmonum vascularis. 

Physical signs. — Inspection and palpation show, notwithstanding the 
greatest efforts of the patient to draw in air, a decrease in the respiratory 
motion of the thoracic walls. 

Auscultation reveals all sorts of rattling and bubbling noises, at times a 
weak crepitant sound. 

Percussion, however, gives no results, unless the lung has become de- 



GANGR^NA PULMONUM. 37 I 

prived of air to a large extent, when, of course, the sound is dull, or tympa- 
nitic, when the lung tissue becomes compressed, so that it loses its natural 
elasticity. 

Therapeutic Hints. 

In acute oedema, compare: Aeon., Nux vom.,' Scilla, Sulphur, Tart, 
eniet. 

Amm. card. Somnolence; poisoning of the blood by carbon. 

Arsen. Great anxiety; restlessness; always worse towards midnight or 
soon after. 

Card. veg. Collapsed state. 

Cinchona. After debilitating losses. 

Ipec. Spasmodic cough; sickness of stomach; fine rattling noises in 
the chest. 

Kali hydi . Sputa like soap-suds. 

Laches. Suffocating fits; worse after sleep; dark, almost black urine; 
offensive discharge from the bowels. 

Phosphor. If worse before midnight, with tightness in the chest. 

Tart. emet. Large bubbling rattling; chest appears full of phlegm 
without capability of relieving itself. 

Besides may be indicated: Aurum, Bellad., Cactus, Cimicif., Gelsem., 
Glo?ioi?i., Sanguin., Spongia, Ver. vir. 

Compare Asthma, Pneumonia, Heart Diseases. 

Gangraena Pulmonum 

Is a process of mortification and putrefaction of the lung tissue, owing to the 
admission of air, as it occurs in all lifeless animal tissues when under the in- 
fluence of air, moisture and a certain temperature. It is either circum- 
scribed — that is, confined to one or several foci of various sizes — or diffused, 
without accurate lines of demarcation; the first form may degenerate into 
the latter. 

Its Causes are: interruption, or weakness of the blood-currents, by 
pneumonic infiltrations or emboli; putrid suppuration in the neighborhood 
of the air passages by perforation into a bronchus; decomposing foreign 
bodies, which have found their way into the lung through the trachea; 
putrid contents collected in dilated bronchial tubes; injuries caused by stabs 
or gunshot wounds. 

Its most characteristic symptom is the sputum, which consists of a 
greenish-gray or brownish-colored fluid, with an exceedingly offensive smell. 
The breath, too, or forced expiration, exhibits the same disgusting smell. 
There is almost always a racking cough attending the disease, and dangerous 
haemorrhages may ensue from the gangrenous erosion of blood-vessels. The 
temperature is usually very high. The diffused form runs a very rapid course 
with all signs of an asthenic fever, delirium, stupor, hiccough, colliquative 
diarrhoea and collapse. Physicial examination yields at first generally a tym- 



372 HEMORRHAGES OF THE LUNGS. 

panitic sound on percussion, which at a later period grows dull. Small 
gangrenous masses, or larger ones, which do not communicate with a bronchus, 
or which, from some other cause, cannot discharge their contents, are out of 
reach of diagnosis. The circumscribed gangrene may discharge and heal; 
the diffused form usually is fatal. 

Therapeutic Hints. 
Compare: Arsen., Card, ac, Card, veg., Kreos., Silic. 

Haemorrhages of the Lungs, Haemopotoe, Haemoptysis. 

Haemoptoe — haemorrhage of the respirator)' organs, Haemoptysis — 
expectoration of blood, consists either of mere exudation of blood- corpuscles 
through the uninjured walls of the capillaries — Diapedesis, or of a pouring 
out of blood through ruptured vessels. 

Haemorrhages occur most frequently in the smaller and terminal bronchi 
— Bronchial haemorrhages ; parenchymatous bleeding is less frequent, and 
is either confined and sharply outlined, without destruction of the parenchyma 
— Hemorrhagic infarction, — or, is diffuse; abundant and associated with 
destruction of the lung tissue, and causing the formation of cavities — Pul- 
monary apoplexy. 

Bronchial haemorrhages may be caused in the main by all such morbid 
conditions as will produce either active or passive congestion of the bronchial 
mucous membrane, for instance: bronchitis, whooping-cough, pneumonia, 
tuberbulous infiltrations, acute exanthemata, inhalation of irritating gases, 
excessive heat or cold, severe strains and bodily exertions, suppression of 
menstrual or haemorrhoidal flows, disorders in the circulation resulting from 
heart disease, and peculiar altered conditions of the blood, which impair the 
nutrition of the vascular parietes, and manifest themselves in scorbutus, 
hcemophilia, scarlatina, typhus, variola, etc. , also in bleedings from other 
portions of the body. 

Haemorrhagic infarctions are most frequently due to organic heart 
diseases, especially of the right heart, to pulmonary emphysema, senile or 
early acquired atrophy of the lungs, and thrombosis of the peripheric veins 
of the body. 

Pulmonary apoplexy arises from the rupture of large, generally arterial 
vessels, most frequently in consequence of injuries, gun-shot and penetrating 
wounds, contusions and concussions of the thorax; rarer from endarteritis 
and aneurismal changes of the walls of pulmonary arteries, or their erosion 
by cancer, abscesses and pulmonary gangrene. 

In order to decide whether the blood comes from the nose, larynx or 
trachea, a close inspection of these parts will best decide. If in doubt 
whether the haemorrhage comes from the stomach, we will have to inquire 
about the conditions of the digestive organs and those of the portal circula- 
tion. 



THERAPEUTIC HINTS TO HEMORRHAGES OF THE LUNGS. 373 

Small haemorrhages issue usually from capillaries, profuse ones from a 
large vessel; Hemorrhagic infarction is, as a rule, associated with a high 
degree of dyspnoea, the physical signs of a circumscribed pulmonary solidi- 
fication and heart disease. Pulmonary apoplexy kills, so to say, on the spot. 

Therapeutic Hints. 

Aeon. In many cases; but best indicated by restlessness, agitation, 
fright, expression of anxiety in the face, palpitation of the heart, congestion 
towards the chest and head, fear of death; after wine. The blood comes 
hot and fresh with every little cough. 

Arnica. After mechanical injury; from slight bodily exertion; in tuber- 
culous individuals; constant tickling cough, starting either from the larynx 
or from under the sternum. 

Arsen. After venesection or loss of blood otherwise; great weakness 
and fainting; restlessness, must walk about; burning in chest and stomach; 
suppressed menstruation. 

Bellad. Cough from constant tickling in the larynx; congestion to 
head and chest; stitching pain in chest, worse from motion; suppressed 
menstruation. 

Cad. grand. With heart disease. 

Card. veg. Pale face; cold skin; slow pulse, intermitting, scarcely per- 
ceptible; mostly attended with violent cough in paroxysms and hoarseness, 
worse towards evening; sometimes burning in chest. 

China. After great loss of blood or vital fluids; during nursing, etc.; 
with all the signs of weakness which arise from want of blood; continual 
pain in chest and stomach, worse from touch. 

Collin. Blood dark, tough, coagulated, enveloped in viscid phlegm; 
previous discharge of blood per annum; subsequent costiveness. 

Co7iium. Especially after masturbation. 

Croc. sat. Blood dark and stringy. 

Digit. Haemoptysis before menstruation, with pain in the chest, back 
and thighs; from obstruction of the pulmonary circulation in consequence of 
heart disease and tuberculosis. Engorged veins about the head, pale, livid 
complexion, coldness of skin, with cold sweats, irregular pulse and palpita- 
tion of the heart. 

Eriger. Dark coagula, passive haemorrhage. 

Ferrum. Always better from walking slowly about, notwithstanding 
weakness obliges the patient to lie down; quick motion and talking bring on 
cough; there is pain between the shoulders; the face has a yellowish tint; 
sleep is poor at night, and there is frequent palpitation of the heart. 

Hamam. Blood is venous; comes into the mouth without any effort, 
seemingly, like a warm current from out of the chest; mind calm; sometimes 
taste of sulphur in the mouth. 

Iodinm. Annoying tickling cough in phthisical persons; oppression and 
palpitation; trembling and coldness of the extremities. 



374 AFFECTIONS OF THE PLEURA. 

I pec. Blood froth}' and bright colored; gasping for breath, pulse small 
and frequent; face livid and anxious. 

Led. pal. Where there is stagnation in the liver and portal veins; 
congestion towards the head and chest; hardness of hearing; tickling in the 
larynx; spitting of bright red blood. Haemoptysis, alternating with rheu- 
matism. 

Millef. In tuberculosis. It bubbles up in the chest, as if warm blood 
were ascending, which is raised without cough. After injuries. 

Myrt. com. In phthisical persons; sharp pains through the upper part 
of the left lung, from front to shoulder-blade. 

Nitr. ac. According to Goullon, the best remedy. 

Nux vom. Especially after high living, suppressed haemorrhoidal dis- 
charges, and after fits of passion, etc. 

Opium. Blood is thick and frothy, mixed with phlegm; absence of all 
pain; slumber, with starting. 

Phosphor. Vicarious spitting of blood for the menses; tubercular 
diathesis, dry, tight cough, worse from evening till midnight; bronchitis. 

Phosph ac. Phthisis; typhoid fever, with diarrhoea and great rumbling 
in the bowels; fast growing youths. 

Pidsat. Dark, coagulated blood; chilliness; loose stools; suppressed 
menstruation; crying spells. 

Rhus tox. After straining, lifting, blowing of instruments, or worri- 
ment and mental excitement immediately renewed; blood bright. 

Senec. In suppressed menstruation; after venesection. 

Sulph. ac. In climacteric period; also habitual haemoptysis excited 
from least fright, vexation, talking, running, in persons who flush easily, 
have palpitation, perspire easily, are easily excited. Also in scorbutic, alco- 
holic affections, adynamic fevers, tuberculosis. 

Stannum. In phthisical patients, when at the same time there exists 
copious expectoration. 

Tart, evict. When, after the attack, there remains for a long time a 
bloody slimy expectoration. 

In suppressed menses, compare Arsen. , Bellad. , Millef. , Phosphor. , Senec. , 
Sulphur. 

After the suppression of habitually bleeding haemorrhoids, compare Aeon., 
Nux vom., Sulphur. 

After wine, Aeon. 

After whiskey, Mercur., Pulsat. 

After coffee, Nux vom. 

c. AFFECTIONS OF THE PLEURA. 

Pleuritis, Pleurisy, Inflammation of the Pleura. 

When we examine, post mortem, a case of pleurisy, we observe on the 
pleural surf aces pinkish dots or streaks here and there, consisting of enlarged 



AFFECTIONS OF THE PEEURA. 375 

capillaries, also irregular, dark red, ecchymosed patches of extravasation. 
The surface of the pleura, instead of being smooth and shining, appears dull 
and swollen, rough and villous from fine granulations and new cells upon it. 
This is the most frequent^ occurring form of pleurisy without exudation, 
and therefore called pleuritis sicca, dry pleurisy. 

In other cases, we observe, in addition to the above-stated features, 
which are, in fact, the ground-type of all forms of pleurisy, a scanty, fibrinous 
exudation, covering, like paste, or, (if in greater abundance) like a soft, 
croupous membrane, the inflamed pleural layers. During the progress of re- 
covery it gradually becomes dissolved by a fatty metamorphoris and is ab- 
sorbed ; but those fine granulations and new cells which lie underneath, and 
which are inherent parts of the inflamed pleura, frequently give rise to 
adhesions of the pleural surfaces. This fibrinous exudative pleurisy accom- 
panies almost always croupous pneumonia. 

In still other cases we observe an abundant serous fibrinous exudation, 
varying in amount from a few ounces to ten or more pints. It consists of a 
greenish-yellow serum, of coagulated fibrinous masses and pus corpuscles, 
which partly float in the serum and partly are deposited upon the pleural 
surfaces, where they adhere like croupous membranes. At times the pus 
corpuscles are in such abundance, that the exudation assumes a purulent 
character; and when from rupture of the finer blood-vessels, or simply by 
transudation in consequence of a hemorrhagic diathesis, large masses of 
blood-corpuscles mix with the exudation, we have a hemorrhagic effusion. 
In consequence of, and according to, the mass of the pleuritic effusion, the 
lung of the affected side becomes compressed at times to the fourth, sixth, or 
even to the eighth part of its normal volume; its arched costal portion is 
flattened down, and its substance appears pale reddish, or bluish-gray, or 
lead-colored, and becomes tough like leather, bloodless and airless. Heart 
or liver become displaced accordingly, as the effusion is either on the left or 
right side. The sound lung always shows more or less congestion, and in 
fatal cases a collateral oedema of high degree. 

In case of recovery the exudation is gradually absorbed, frequently 
leaving }^ellow cheesy masses behind, which are residues of unabsorbed pus- 
globules and fibrinous substances. 

In the same degree in which absorption takes place, the lung regains its 
normal volume and condition; provided the air-cells be not glued together, or 
closed by fibrinous deposits. In these conditions air cannot enter, and the 
lung, or such part of the lung, cannot regain its normal expansion. This 
would cause a vacuum in the thorax, were it not for the pressure of the 
external air, which at once flattens down the corresponding portion of the 
thoracic walls, or pushes heart or liver higher up in the thoracic cavity. 

The purulent exudation, which is so rich in pus-globules that it forms an 
opaque, yellow, thickish fluid, is called empyema or pyothorax. Even in 
such cases absorption is possible. Should, however, the pleural substance in 
consequence of the suppurating process be softened and perforated, the puru- 



376 AFFECTIONS OF THE PLEURA. 

lent matter would then escape either through the thoracic wall, in case the 
pleura costalis were destroyed, or through the bronchial tubes, if the pleura 
pulmouum were perforated. 

These four different forms of pleurisy must of course manifest them- 
selves by different symptoms. 

The first form pleuritis sicca, when, in consequence of inflammation, 
new cells form upon the pleural surfaces, but without exudation, seems to 
take place frequently without any particular signs. This statement is 
founded upon the existence of man)- adhesions, found in post-mortem 
examinations, in persons who had never complained of symptoms that could 
possibly have been taken as indications of pleurisy. 

The second form, with Scanty fibrinous exudation, is generally coupled 
with pneumonia or tuberculosis. It is characterized by a sharp stitching 
pain, which hinders deep inspiration, coughing, sneezing and motion, and 
for this reason the patient can breathe only superficially. If not compli- 
cated with pneumonia or tuberculosis, there is scarcely any cough attend- 
ing it. 

On inspection we observe, in consequence of the pain which is caused by 
breathing and moving, that the patient bends his body towards the affected 
side, in order to bring the ribs of that side nearer together to prevent their 
respiratory motion, in consequence of which the spine itself becomes curved, 
its convexity being directed towards the sound side. 

Palpation merely confirms the superficial breathing, and may yield the 
perception of a grating feel; more, however, towards the end than at the 
commencement of the disease, after the exudation has been absorbed, when, 
therefore, the surfaces are dryer and the breathing deeper again, so that the 
rough surfaces glide more forcibly one upon the other. 

For this same reason, auscultation reveals the friction sound more de- 
cidedly towards the end of the disease. 

The third form, with Abundant serous-fibrinous exudation, usually com- 
mences with a strong chill, followed by high fever. The chill is frequently 
repeated, and the whole affection may look very much like a tertian inter- 
mittent fever. It is also characterized, like the second form, by violent stitch- 
like pains in the sides of the chest, which, however, often subside, or at least 
diminish, before the inflammation and exudation has reached its full 
height. The subsidence of pain is therefore, in this form, not always a sign 
of conquered disease. 

Generally it is accompanied by dyspnoea as long as the fever lasts, and in 
such cases, and where an extensive exudation compresses the lung, and causes 
a hyperaemic state and catarrh in the adjoining portions of the lung, there 
is also cough. Otherwise the cough may be absent altogether. 

The disease generally reaches its height in about six or eight days, and 
commences its gradual decline from that time. Fever, pain and cough cease, 
and absorption of the pleuritic exudation takes place, diminishing at first 



AFFECTIONS OF THE PLEURA. 



377 



much more rapidly than towards the last, so that sometimes, even after 
weeks, some fluid can still be detected. 

In some cases this form comes on quite stealthily, without either promi- 
nent fever, pain or cough. The patient feels only a gradual loss of strength, 
some difficult}' of breathing; he grows pale, and loses flesh, and thinks that 
the source of all his troubles lies in his abdomen, especially when, by exuda- 
tion on the right side, the liver has become dislocated downwards. Even the 
physician may be astonished when he, by closer examination, finds the whole 
pleural sac filled with fluid, amounting to from ten to fifteen pints. Such an 
enormous quanthry, of course, can be absorbed at best only very slowly, 
being alternately augmented and decreased in the meantime. It terminates 
finally, in a great number of cases, in tuberculosis. 





Exudation on Right Side. (After Bock.) 

a. Exudate. 

b. Heart. 

c. Compressed lung with tympanitic sound. 

d. Lung sound. 

e. Displaced liver. 



Exudation on Left Side. (After Bock.) 

a. Exudate. 

b. Displaced heart. 

c. Compressed lung with tympanitic sound 

d. Right lung with normal sound. 

e. Liver. 



Inspection discovers an enlargement of the thorax in breadth and depth 
on the diseased side, if the exudation is sufficiently large. The intercostal 
spaces are wider, and are on a level with the ribs, or even bulging, out be- 
tween them. The respiratory motion is much less, or ceases altogether on 
the diseased side. 

Palpation reveals the absence of the vocal fremitus, which is the neces- 
sary consequence of the intervening fluid between the thoracic walls and the 
lung; it reveals dislocation of the heart or of the liver, and also sometimes 
the friction of the roughened pleural surfaces above the exudation. 

Percussion yields a somewhat duller sound, in case the exudation be 
moderate, so as not to compress the lung tissue to such a degree as to drive 
all air out of it; it yields a tympanitic sound, if the pressure upon the lung 
be just sufficient to deprive it of its natural tension and elasticity; it yields 
a flat, fleshy sound, if the secretion augments to such a degree as to deprive 
the lung of all the air; above the level of the liquid we hear again the tym- 
panitic sound (Skoda's sign), for here the lung, although compressed, is not 



37§ AFFECTIONS OF THE PLEURA. 

entirely without air. Variation in position does not always change the result 
of percussion, because the exudation is usually enclosed and bordered by 
adhesions. 

Auscultation reveals an absence of the respiratory murmur over the 
whole part that is covered by exudation. In other cases, however, w T e hear 
a loud bronchial breathing all over the thorax, especially in case of dyspnoea; 
no matter how much fluid intervenes between the thoracic walls and the 
lungs, or how much the lungs may be compressed. The auscultatory signs 
are therefore not very characteristic. 

The fourth form, Empyema or Pyothorax, differs from the latter only 
by the abundance of its pus-globules, and is frequently found in consequence 
of infectious diseases and a general pyaemic condition. Its physical signs 
are all the same, as above stated. 

When empyema is about to discharge through the thoracic walls, we 
observe, in the region of the fourth or fifth, rib, an oedematous swelling, 
which soon changes into a hard, tense swelling, protruding from between 
the ribs; by and by it becomes fluctuating, and lastly it bursts and discharges 
an immense quantity of pus. This opening sometimes remains for years, 
forming a thoracic fistula, and discharges every now and then larger or 
smaller quantities of pus. 

When empyema is about to discharge through the bronchial tubes there 
may appear, at first, symptoms of pneumonia, or the bursting takes place 
suddenly, when, with violent fits of coughing, the patient throws up large 
quantities of pus. Even here recovery is possible, though it may happen 
that the patient suffocates, or sinks under the influence of pyaemic poisoning. 
The empyema may also discharge downwards through the diaphragm into 
the abdominal cavity, where it occasions a violent peritonitis. 

When the course of pleuritis is very acute, the morning and evening 
temperatures rise to above io4°F., and the pulse to 120 and higher; there 
is frequently great disturbance of the sensorium, often violent delirium, 
great dryness of the tongue, excessive thirst and total loss of appetite; the 
anterior extremity of the spleen, even in the early days, can be distinctly 
felt, and diarrhoea may set in at this time, thus simulating a case of typhoid, 
though the deeply cyanosed complexion, the constant abnormal elevation of 
temperature and pulse, and the physical examination will soon correct an 
error of this kind. 

When in the first week of illness an unusual pallor presents itself, ac- 
companied with the rapid loss of strength, high fever and a considerable 
degree of pain in the affected side, we ma}' assume that a hemorrhagic exu- 
dation has taken place, in consequence of a tubercular pleuritis, in young 
persons; in old people the same symptoms hint to a tendency of the exuda- 
tion to become purulent. 

When the inflammation attacks the diaphragmatic portion of the pleura 
— known by the ancient physicians under the name of paraphrenias, then 
the pain is usually in the hypochondriac region, about the cartilages of the 



THERAPEUTIC HINTS. TO AFFECTIONS OF THE PLEURA. 379 

false ribs, at the level of the diaphragm; the respirations are short and quick, 
the inspirator}' expansion is confined to the upper ribs, the body is inclined 
forwards, the countenance is much altered, with twitchings about the lips, 
and occasionally risus sardonicus; there is also, at times, hiccough, nausea, 
and even actual vomiting. Still, these symptoms are not constant; there are 
cases of diaphragmatic pleurisy without the one or the other of these signs, 
or they appear in consequence of inflammation of one or more of the organs 
lying beneath the diaphragm. 

Pleurisy ma) r become complicated with many acute and chronic diseases, 
such as: pericarditis, tuberculosis (when it usually appears simultaneously 
on both sides), pneumonia, bronchial catarrh, inflammation of the mediasti- 
num and of the peritoneum (in purulent pleuritis), caries of the ribs and 
spine (also in its purulent form), scarlet fever, measles, smallpox, articular 
rheumatism. 

Its SequEL-E are: adhesions of the two pleural layers, inveterate bron- 
chial catarrh, caseous pneumonia, bronchiectasis, etc. 

The Differentiae Diagnosis between Pleurisy and Croupous pneu- 
monia is: 



Pleurisy. 

Repeated chills. 
Catarrhal sputa. 
Stitch-like pain. 



Enlargement of the thorax. 
Absence of vocal fremitus. 
Dislocation of heart, liver or spleen 
Friction sound. 



Pneumonia. 

One chill. 

Rust-colored sputa. 

No pain, or dull, when the bronchial 

tubes, and stitch-like when the pleura 

is involved. 
None. 

Increased vocal fremitus. 
None. 
Crepitant sound. 

Its Prognosis varies greatly according to its character. As unfavor- 
able signs, Fraentzel considers the following: "1. A double-sided pleuritis, 
as it almost always indicates tuberculous disease of the pleura. 2. Continued 
high fever. 3. Rapid increase of the effusion, accompanied with high fever 
and with great displacement of adjacent organs, unless, after a course of 
from four to six weeks, signs of commencing absorption are observed. 4. 
Symptoms of impending suffocation. 5. Discharge of the pus, either into 
the bronchi, with simultaneous production of pyo-pneumothorax, or externally 
through one of the intercostal spaces. 6. The rapid increase of an effusion, 
which for a long time remained stationary, because in that case the pleuritis, 
as a rule, has assumed a tuberculous and hsemorrhagic character. 7. A 
return or increase of the effusion after spontaneous, or a single or repeated 
artificial discharge of the same, especially where the quality of the dis- 
charged fluid degenerates and becomes purulent, bad-smelling, ichorous, 
chocolate-like, etc." 

Therapeutic Hints. 

Aeon. Chill; fever; great thirst; quick pulse; dry skin; anxious rest- 
lessness; agonizing tossing about; stitching pain in chest; inability to lie 



380 THERAPEUTIC HINTS TO AFFECTIONS OF THE PLUERA. 

on the right side; dry, hacking cough. Traumatic form, with torn pleurae 
and consequent external emphysema. 

Arnica. After mechanical injuries; bruised feeling in chest; expector- 
ation of bloody foam. Is followed well by Sulph. ac, in the traumatic form. 
Nervous persons; torpidity, even to sepsis; dry, cold extremites; head hot, 
remaining body cool: constant change of position on account of a feeling as 
though the bed were too hard. 

Arsen. Profuse serous effusion; great dyspnoea and little pain; weak 
and cachectic persons; drunkards; intermittent paroxysms; pyothorax. 

Bell ad. When the inflammation ascends from the diaphragm; plethoric, 
lymphatic persons, tuberculous women with affections of the cerebral mem- 
brane; in exan thematic, typhoid, puerperal phlogosis; after scarlet fever. 

Br yon. Stitching pain in chest, worse from slightest motion; better 
when lying on the affected side, not always, however; tongue white; thirst 
great. 

Calc. carb. Has rapidly diminished the pleuritic exudation. 

Canthar. Profuse serous exudation; frequent cough; dyspnoea; palpi- 
tation: profuse sweats; great weakness; tendency to syncope; scanty urine. 
(E. Faivre.) 

Carb. veg. Prostration; sunken features; sallow complexion; emacia- 
tion; hectic fever; purulent or ichorous degeneration. 

Colchic. Arthritic form; sour-smelling sweat not alleviating; scanty, 
turbid, red urine, with acid reaction and containing albumen. 

Hepar. Croupous exudation, with a yellow or yellowish-brown tint in 
face, in scrofulous and lymphatic persons; hectic fever, with intermittent 
paroxysms; empyema. 

Kali carb. When the violent stitching pain does not yield to Bryon., 
especially on the left side, with violent palpitation of the heart; the cough is 
dry and worse towards three o'clock A. m. Pain in epigastrium; throbbing 
and stitching pain in back up to the nape of the neck. 

Kali hydr. In pleuritic exudation. (Grubenmann.) 

Lauroc. For drunkards and melancholic persons at the beginning, with 
continuous suffocating cough; the pain in the pleura is severe and localized; 
pulse soft, though quick. 

Mercnr. In syphilitic or rheumatic patients when the pain persists after 
the fever, with copious, not alleviating sweats; frequent chills (feels chilly 
whenever moving the feet to a cooler place in bed); considerable thirst; 
gastric and intestinal catarrh, with icterus. Stitching pain through to the 
back when coughing or sneezing; right side. 

Nitr. ac. For old people, when the pain leaves and the pulse increases; 
great weakness and diarrhoea. 

Phosphoi . In complications with bronchitis; tightness across the chest; 
dry, tight cough, which is worse from evening until midnight. Later stages; 
purulent infiltration; hypertrophy of the right heart; Bright" s disease. 

Rhus lox. After exposure to wet, or from straining, lifting, wrestling, 



PNEUMOTHORAX. 38 1 

etc.; tip of tongue red; fever-blisters around the mouth and nose; very rest- 
less, notwithstanding the pain. 

Senega. After the inflammation has passed; copious mucous secretion, 
with difficult expectoration; tightness and burning in the chest. 

Sepia. Recommended by Kunkel, on the ground of the symptoms 1005 
to 1 1 90 in Hahnemann's Chronic Diseases. The changing of localities of the 
pain {Bell., Puis., Snlph., etc.,) hints often to this remedy. 

Squilla. Stitching pain in left side; short, rattling cough, disturbing 
sleep; inability to lie on the left side; grating of teeth; twitching of the lips, 
which are covered w T ith thick } T ellow crusts, more on left side; cheeks bright 
red; perspiring profusely, especially on forehead; red tip of tongue, yellow- 
ish covering on the back part. 

Sulphur. When the pain is in the left side, lower region, going through 
to the shoulder-blade and of a more steady nature; lips bright red; in con- 
nection with acute articular rheumatism or gout; fibrinous pleuro-pneumonia. 
Follows w 7 ell after Bryon. or Rhus tox. 

Tart. emet. In pleuro-pneumouia at the commencement, according to 
Kafka, specific. Dyspnoea, must sit up; palpitation; tingling and pinching 
in the pit of the stomach. When the healthy side is attacked by oedema. 

In neglected or badly treated cases, where the exudation is abundant, 
or in cases developed in cachectic constitutions, with a pyaemic tendency, we 
shall have to compare; Arsen., Cale. earl?., Camphora, Card, veg., China, 
Ferritin, Hepar, Iodinm, Kali hydr., Kreos., Laches., Lycop., Sepia, Senega, 
Si lie., and others. 

Paracentesis has seldom proved beneficial in acute cases; in chronic 
cases it may in rare instances be the indicatio vitalis, when the rapidly in- 
creasing purulent exudation threatens suffocation. The emptying ought to 
be effected by aspiration, in order to prevent the entrance of air into the 
pleural cavity. If, after several tappings, the purulent exudation persistently 
and profusely returns, the old school of late years opens the pleural cavity 
and washes it out with warm distilled water until every trace of purulent 
matter has disappeared, when injections of iodine, or carbolic acid, or other 
similar substances are made, until by granulation the pleural folds have 
healed together. "Radical cure," as it is termed. Compare Frsentzel on 
pleuritis, in Ziemssen's Cyclopaedia, Vol. IV. 

Pneumothorax. 

This consists of a collection of air or gas within the pleural sac. As air 
alone, however, is rarely found in this locality, but mostly in combination 
with pus, blood or serum, it is calle'd, according to the nature of the co-exist- 
ing fluid, either pyo-, or haemato-, or hydro-pneumothorax ; when an exudation 
of pus or blood follows a collection of gas in the pleural cavit}^, it is termed 
pneumo-pyo', or pneumo-haematothorax. 

Pneumothorax, whether it be in combination with fluids or not, isalwavs 



382 



PNEUMOTHORAX. 



characterized by an enormous extension of the thoracic wall of the affected 
side, the intercostal spaces of which bulge out. When on the left side, it 
pushes the heart towards the right; if on the right, it presses the liver down 
into the abdominal cavity. The lung itself is compressed to a small volume, 
containing little or no air, and lying close to the spine. 

The gas, which is collected within the pleural sac, consists mostly of 
carbonic acid gas and nitrogen, with very little oxygen; and in cases where 
decomposition has taken place, of sulphuretted hydrogen. These gaseous 
substances ma)' be diffused and fill the whole pleural cavity of one side, or 
the}' may, in rare cases, be limited therein to a certain portion, in conse- 
quence of previous pleuritic adhesions. 

The entrance of air into this cavity almost always causes, in a short 
time, a pleuritis with either sero-fibrinous or purulent exudation, and is 
occasioned either by a perforation of the pleura pulmonum, in consequence 
of lung diseases, especially pulmonary consumption and empyema, in which 
case the air enters from the air-cells of the lungs; or by a perforation of the 
thoracic wall, by traumatic causes, when the air enters from without; 
that gaseous substances may be formed by means of decomposition in a pyo- 
thorax has of late been greatlv doubted. 





Pneumothorax ox Right Side. (After Bock. 

a. Heart displaced. 

b. Liver displaced. 

c. Stomach. 

d. Distention by gas. 

e. Compressed lung and tuberculous deposit. 



Pxeumothorax ox Left Side. (After Bock. ) 

a. Heart displaced. 

b. Right lung. 

c. Compressed lung and tuberculous deposit. 

d. Distention by gas. 

e. Stomach. 

f. Liver. 

g. Spleen displaced. 

In cases in which the air fills the pleural sac through the lungs, it takes 
place almost always quite suddenly, and the patient has a sensation as though 
something had burst in the chest, which is in fact the case. At the same 
time he experiences great difficulty in breaching; he is obliged to sit erect, 
and can lie only on the diseased side, and for an obvious reason — to keep the 
sound lung free from any pressure. The worst cases are those which exist 
in consequence of tuberculosis, gangrene or carcinomatous degenerations of 
the lungs. Those in consequence of emphysema or external perforations are 
not so violent. 



HYDROTHORAX. 383 

Inspection. Enormous enlargement of the diseased side of the thorax; 
its intercostal spaces bulge out; perfect want of respiratory motion. 

Palpation. Total absence of vocal fremitus; liver or spleen displaced 
downwards; heart towards the middle or the right side of the thorax. 

Percussion. Tympanitic sound, unless greatly distended, when it loses 
the tympanitic quality and becomes dull. Dull sound in the upper posterior 
region, where the compressed lung lies, and in the lower regions of the 
thorax, when effusion exists, changing locality with the patient's change of 
position. 

Auscultation. Absence of respiratory murmur with fall resonant percus- 
sion sound; metallic tinkling when the patient talks, coughs or inhales 
deeply. Bronchial breathing and bronchophony, where the compressed lung 
lies. 

In cases where air and fluids co-exist we hear a splashing sound when- 
ever the patient moves quickly, just like water in a half-filled bottle, if it be 
shaken. 

Likewise do we sometimes hear a falling of drops with a metallic tink- 
ling sound, when the patient rises from a recumbent position. 

Differential Diagnosis. — Pneumothorax differs from emphysema by 
its dyspnoea coming on suddenly and growing worse steadily; by its one- 
sided distention of the thorax, the intercostal spaces of which bulge out; by 
its want of vocal fremitis, the absence of the vesicular murmur, and the 
presence of the metalic tinkling sound. 

It differs from large superficial cavities by the distention of the thorax 
and the displacement of heart, liver or spleen, and the absence of vocal 
fremitus. 

Therapeutic Hints. 

For the sudden dyspnoea, Arsen. 

When caused by external injury, A con., Arnica, Staphis., and others. 

When in connection with consumption, compare the remedies mentioned 
there. 

For the subsequent inflammation of the pleura, compare Pleuritis and 
Pneumonia. 

Hydrothorax, Dropsy of the Chest. 

This is a collection of serum in the pleural sac, without any inflamma- 
tory process in that locality. It is mostly found on both sides of the chest 
at the same time, although one side may contain more fluid than the other. 
The serum is clear, yellowish or greenish; sometimes reddish, when mixed 
with blood; it never contains fibrinous substances, as an exudation of pleu- 
risy always does, but in place of it a great deal of albumen. The pleura 
itself looks pale and dull, without any sign of inflammation; the lung is 
pressed towards the spine whenever a large amount of such fluid exists, and 
generally appears ©edematous. 



3S4 THERAPEUTIC HINTS TO HYDKOTHORAX. 

Hydrothorax originates mostly in consequence of lung and heart dis- 
eases, which cause obstruction to the venous circulation within the lungs; 
or in consequence of such morbid states of the body as cause the blood to be- 
come thin and watery, as is the case in Bright 's disease, in certain spleen and 
liver affections, in anaemia, in intermittent cachexia. It is, therefore, almost 
always attended by other dropsical conditions. 

From this it is apparent that its symptoms must vary greatly. Its most 
prominent feature, however, is dyspnoea, which is always worse in a lying, 
and better in a sitting position, and this for obvious reasons: when sitting 
the fluid settles to the lower part of the thoracic cavity and leaves the upper 
part of the lungs free for respiratory action; whilst in a horizontal position 
the whole lung becomes overflown and compressed by the fluid. Where there 
is a great deal of serous effusion the patient seems to suffocate whenever he 
tnrns in bed. Niemeyer explains this important sign in the following man- 
ner: as the fluid is not limited to a certain place, as in the case of pleuritic 
effusions, it changes its position freely whenever the patient changes his 
position, following the law of gravitation. Wherever it locates, there it 
naturally compresses the lungs, makes them unfit for respiration, whilst the 
uncompressed portion fulfils this office undisturbed. A turn of the body 
reverses at once the location of the fluid: it now compresses those portions 
of the lungs which were breathing, and sets others free that were com- 
pressed. Ere these can be pervaded by air, the patient has no breath. This 
explains fully those suffocating fits which such patients experience when 
turning in bed. 

Inspection. Enlargement of the thorax. 

Palpation. Absence of vocal fremitus and displacement of heart, liver, 
spleen. 

Percussion. Dull sound as far as the fluid reaches, changing locality in 
different positions of the patient. 

Auscultation. Absence of vesicular breathing where the fluid covers 
the lungs, but bronchial breathing about the spine, where the lungs are 
compressed. 

Therapeutic Hixts. 

Apis. Great oppression; inability to lie down; absence of thirst; urine 
dark, like coffee; after taking cold, during desquamation in scarlet fever. 

Apoc. cann. Inability to speak; catching of the breath: irritability of 
stomach so great that even a draught of cold water is rejected; suppression 
of urine. 

Asclcp. syr. Recommended especially after scarlet fever. 

Arsen. Dyspnoea, worse from any exertion; when lying down at night, 
if ever so carefully, the patient experiences a sense of suffocation; also when 
turning in bed: with great anxiety; palpitation of the heart and great dry- 
ness; drinking constantly but little at a time. 

A spa)-. Old people with heart diseases. 



H.EMATOTHORAX. 385 

Br von. Pain in the side; cough, with contraction of the diaphragm; 
vomiting and splitting pain in the head, excited by any motion; retarded 
stool and frequent desire to pass water, but only a few drops flow. 

Colchic. Asthma; cedematous swelling of hands and feet; constant 
urging to pass water, as from spasm of the bladder, but only a little is voided, 
and that with great pain; heart disease in consequence of acute rheumatism. 

Digit. Intermitting pulse; pale face; cold skin; flabby, cedematous 
swelling all over; difficult urination; cyanotic symptoms, with fainting. 

Helleb. Slow comprehension; slow in answering questions; pale face; 
griping pain in the bowels, with diarrhoea of a jelly-like slime. 

Kali carb. Whizzing breathing; oppression worse about three o'clock 
in the morning; cedematous swelling between the eyebrows and lids, looking 
like a little bag; insufficiency of the mitral valves; great dryness of the skin. 

Laches. Suffocating fits, waking from sleep, with throwing the arms 
about; cyanotic symptoms; swelling of the liver; black urine; offensive 
smell of feces. 

Lycop. Dyspnoea worse when lying on the back; constipation; rumb- 
ling in the left iliac region; red urine; exceedingly cross after getting awake. 

Mercnr. After scarlatina; cedematous swelling all over; sweating with- 
out improvement; dry, hard cough; inflammation of the genital organs. 

Squilla. Strong urging to urinate, with scanty and dark urine; con- 
tinous cough, with mucous expectoration; cedematous swelling of the body. 

Senega. Loose, faint, hacking cough, with expectoration of a little 
phlegm. 

Spigel. Dyspnoea during motion in bed; can lie only on the right side 
and with the trunk raised; danger of suffocation when making the least 
motion or raising the arms, with anxiety and palpitation of the heart. 

Sulphur. Sudden arrest of breathing at night in bed when turning to 
the other side, relieved when sitting; constipation, or diarrhoea in the 
morning; liver complaint; red lips. 

Tart. emet. Much coarse rattling in the chest; expectoration not 
equivalent to the secretion within; drowsiness; cyanotic symptoms. 

Haematothorax 

Is an effusion and accumulation of blood within the pleural cavity without 
inflammatory symptoms, brought on either by external injuries of the chest, 
from stabbing, gunshot wounds, fracture of the ribs, contusions, or from 
internal ruptures of blood-vessels, carcinoma and tubercles. 

The patient complains of sudden dyspnoea, with or without cough; his 
face grows pale ; he faints, has ringing in the ears; darkness comes before 
his eyes, and the skin is cold. 

Physical signs the same as in Hydrothorax. 

Therapeutic Hints. 

When from external causes, compare Aeon., Arnica, Cale?id., Eriger. y 

25 



386 THERAPEUTIC HINTS TO H.EMATOTHORAX. 

Hamam., Rhus fox. and the like. When from internal causes, they must be 
considered in each individual case, and reference should be taken to those 
remedies which are indicated in haemorrhages from the lungs. Great loss of 
blood indicates China, and a nourishing diet. 

For the subsequent pleuritis, compare the corresponding chapter. 



THE HEART 



Auscultation. 

First step: To know how the heart acts. 

The heart consists of four apartments: two antechambers (auricles) and 
two chambers (or ventricles), which are respectively named from their posi- 
tion, right and left. 

Into the right auricle the venae cavae empty all the blood which has been 
used in the body for its sustenance. From this antechamber a large aperture 
leads into the right ventricle, which is called the auriculo-ventricular open- 
ing, and which is guarded by a kind of gate, consisting of three triangular 
folds (the tricuspid valves), opening inwards. In the right ventricle we 
observe another opening, which leads into an artery called the pulmonary 
artery, because it conveys the deoxygenized blood to the lungs. This opening 
is likewise guarded by a set of valves, which, from their half -moon shape, 
are called semi-lunar valves, and which open outwards. 

This arrangement we find repeated in the left auricle and ventricle. 
Into the left auricle the pulmonary veins empty all the blood which has been 
oxygenized in the lungs. From this cavity a similar aperture leads into the 
left ventricle, which is likewise guarded by valves, consisting, however, of 
only two segments (the bicuspid or mitral valves), opening inwards. 

In the left ventricle we observe also an opening, which leads into an 
artery called the aorta, and which distributes the blood all over the body. 
This opening is likewise guarded by a set of valves of semi-lunar variety, 
which open outwards. 

Now let us study the action of this apparatus. The ventricles being fully 
distended, they immediately and simultaneously begin to contract. On account 
of the relation of the several valves to these two cavities, the action of the 
blood under the great pressure from this contraction forcibly shuts the 
tricuspid and mitral valves, thus closing the auriculo-ventricular openings, 
and the same action opens both sets of semi-lunar valves for the escape of the 
blood. Through the pulmonary artery the dark blood is propelled into the 
lungs, whence it is returned through the pulmonary veins to the left auricle, 
thus making the lesser circuit — the pulmonic circulation. Through the 
aortic valves and artery the red blood is propelled thiough the whole body, 
whence it is returned through the venae cavae to the right auricle, thus mak- 
ing the greater circuit — the systemic circulation. As the two ventricles 
contract, the two auricles dilate, and vice versa. The contraction of the 
ventricles and simultaneous dilation of the auricles is called the heart's systole, 
and by causing a forcible closure of the auriculo-ventricular valves produces 



3 88 



AUSCULTATION. 



the first sound of the heart. The dilatation of the ventricles and simultaneous 
contractions of the auricles is called the heart's diastole, and the forcible 
closing of the two sets of semi-lunar valves produces the second sound of the 
heart. This explanation of the two sounds of the heart suffices for my 
purpose, and may be demonstrated to the eye by the following diagram: 

We must firmly fix in our mind, if we wish to get along at all in reach- 
ing the goal of diagnosticating heart diseases, that the first sound is produced 
by the shutting of the tricuspid and mitral valves and the muscular con- 
traction of the ventricles. The second sound is the consequence of the 
shutting of the semi-lunar valves. 

Second step: How to find the exact situation of these different valves in 
the living subject. 

In order to find out the position of the heart, and its parts, we must first 
ascertain where it strikes against the thoracic wall. 




It does this with its apex, and in the majority of cases between the fifth 
and sixth ribs, about one inch to the right of a line drawn vertically through 
the left nipple, the person being in an upright position. In persons of short 
stature, we find the heart's impulse between the fourth and fifth ribs; and in 
persons with a long thorax, it may be felt much lower. So also different 
positions of the body change the place of impulse. In a person lying upon 
the back, it is observed nearer to the medium line; while lying upon the left 
side causes it to tilt over more towards the nipple line. This point of impulse 
we must take as a fixed point for determining the position of the left ventricle, 
which it never fails to represent. The other parts have a constant relation 
to this. 

The base of the heart, and consequently the aortic and pulmonary valves 
are almost invariably situated behind the middle of the sternum. 

The ascending aorta lies somewhat to the right of the vertebral column 



AUSCULTATION. 389 

and consequently its sounds and murmurs must always be sought for over the 
middle and somewhat to the right of the sternum. 

The mitral valves are situated nearly one inch below those of the aorta, 
and on the left side of the sternum. 

The tricuspid valves are to the right of and anterior to the mitral, and 
they are for the most part covered by the sternum. 

The position of the right ventricle is variable, and cannot be determined, 
unless that of the left ventricle and aorta has been previously ascertained; 
it lies mostly under the lower part of the sternum. 

The valves of the pulmonary artery are situated under the cartilage of 
the third rib to the left of the sternum. 

The diagram below shows the exact position of these parts. 




Now, if we remember all this, we shall hear those sounds which originate 
in the left ventricle, in the mitral valves, most distinctly at that part of the 
thorax against which the apex of the heart strikes; those sounds which 
originate in the ascending aorta we shall hear best a little to the right of the 
centre of the sternum, and from thence upwards; those sounds which origi- 
nate in the pulmonary artery we shall hear best a little to the left of the 
centre of the sternum; those sounds which originate in the tricuspid valves 
we shall hear loudest over the central and lower part of the sternum. 

If we now consider that diseases of the pulmonary valves and the tricus- 
pid valves are of very rare occurrence, we may centre our attention upon 
only these two points: 

1 . Upon the sounds of the mitral valves; heard best at that part of the 
thorax against which the apex of the heart strikes; and 



390 AUSCULTATION. 

2. Upon the sounds of the aortic valves ; heard best a little to the right 
of the centre of the sternum, in the second intercostal space, and thence up- 
wards. 

Third step : Of the different morbid sounds and murmurs of the heart. 

I. The left chamber during its systole. 

The first sound, heard clearly and most prominently at the apex, is proof, 

1. That the mitral valves shut perfectly, not allowing any blood to 
regurgitate into the auricle; and, 

2. That the aortic valves and orifice offer no obstacle to the direct pas- 
sage of the blood out of the left ventricle. 

But, if the mitral valves be deficient, so that they will not shut per- 
fectly during the rush of blood against them, what would be the consequence 
of this deficiency? Simply, the stream of blood would not be stopped there, 
but would re-enter the auricle and produce a noise, unlike the normal systolic 
heart sound. 

Or, suppose the aortic valves be stiffened or roughened, or the aortic 
opening constricted, so that the stream of blood in its course onward would 
be interfered w r ith, what would be the consequence of such obstruction? The 
stream of blood would rub against the obstacle and cause a noise or murmur 
at the same time when the closure of the mitral valves would give the first 
tick. 

Or, suppose the mitral valves be deficient, and, at the same time, the 
aortic valves stiffened and roughed, or the aortal opening constricted, what 
would be the consequence of this deficiency and obstruction? Well, the 
stream of blood would regurgitate through the auriculo- ventricular opening, 
and also rub against the obstacles in the aortic opening, and thus cause a 
noise without any tick. 

How then can we distinguish between these three different affections? 
In case of insufficiency of the mitral valves, the blood regurgitates at each 
contraction of the heart into the left auricle; and thus it becomes retarded in 
the whole lesser circuit. In consequence of this the right ventricle must 
make stronger efforts to drive it onward, and the pulmonary artery, becom- 
ing largely distended, contracts the more, thus causing a more violent shock 
backwards against its semi-lunar valves, and consequently a louder diastolic 
sound of the pulmonary artery. An increase of the second or diastolic sound 
of the pulmonan- artery is, therefore, almost invarably attending an insuf- 
ficiency of the mitral valves. We must, then, when we hear a noise instead 
of the systolic sound at the heart's apex, make sure whether there is also an 
increased second sound of the pulmonary artery. The valves of this artery 
are situated under the cartilage of the third rib to the left of the sternum — 
there we put the stethoscope, and if it turns out so, we may be sure that the 
noise which we hear at the apex, instead of the systolic sound, is caused by 
an insufficiency of the mitral valves. 

. In case of constriction of the aortic opening we hear the systolic sound 
and a noise besides. If we put our ear over the aorta, towards the right of 



AUSCULTATION. 39 1 

the centre of the sternum, we hear the noise there even plainer than at the 
apex, and it is transmitted into the carotids. 

In case of insufficiency of the mitral valves and constriction of the aortic 
orifice combined, we shall find these features united; an increased second 
sound of the pulmonary arten T , and a noise over the aorta. 

2. The left ventricle during diastole. 

The diastole or second sound of the heart, is proof — i, That the aortic 
valves shut well, not allowing any blood to regurgitate into the left ventricle; 
and 2 , that the mitral valves or the auriculo-ventricular opening offer no ob- 
stacle to the passage of blood out of the left auricle into the left ventricle. 

But, suppose the aortic valves be insufficient so that they would not close 
tightly after the blood had been driven through them; what would be the 
consequence of this insufficiency? The contraction of the aorta would drive 
some of the blood back into the left ventricle, and thus cause a noise or 
murmur instead of the second sound. 

Or, suppose the mitral valves be stiffened, roughened, or the auriculo- 
ventricular opening constricted, so that the passage of the blood into the 
ventricle were interfered with, what would be the consequence of such 
obstruction? The stream of blood would rub against the existing obstacle 
and cause a noise or murmur during the diastole of the ventricle at the same 
time when the closure of the aortic valves would give the diastolic sound. 
The murmur is generally heard most pronounced during the systole of the 
auricle, and as this occurs just before the contraction of the ventricles 
we get a presystolic murmur. 

Or, suppose the aortic valves be insufficient, and, at the same time, the 
mitral valves or auriculo-ventricular opening obstructed, what would be the 
consequence of this insufficiency and obstruction? Surely the stream of blood 
would regurgitate through the aortic valves into the left ventricle, and also 
rub against the obstacles in the mitral valves and auriculo-ventricular open- 
ing, and thus cause a noise or murmur, but no diastolic sound. 

And how can we distinguish between these different affections? In case 
of insufficiency of the aortic valves, we shall hear a noise or murmur instead 
of the second sound most distinctly over the aorta to the right of the centre 
of the sternum. 

In case of thickening of the mitral valves, or constriction of the auriculo- 
ventricular opening, the blood accumulates in the lesser circuit, produces 
hyperthrophy, with dilatation of the right ventricle, and an increased dias- 
tolic sound of the pulmonary artery much more readily than mere deficiency 
of the mitral valves. The more constricted the mitral orifice is, the longer 
will be the time necessary for the flow of the blood into the ventricle, and 
the more prolonged and louder the murmur. In cases of this kind the vibra- 
tions may even be felt and seen. 

In case of insufficiency of the aortic valves and constriction of the mitral 
orifice combined, we shall, of course, find both features united — a noise in- 



392 AUSCULTATION. 

stead of the second sound over the aorta and a murmur over the mitral valve, 
with an increase of the diastolic sound of the pulmonary artery. 

3. The left ventricle during its systole and diastole. 

The clear systolic sound indicates that the mitral valves close perfectly, 
and that the aortic opening is not constricted. The clear diastolic sound 
indicates that the aortic valves shut well, and that the mitral orifice is not 
constricted. But suppose the mitral valves be insufficient, and, at the same 
time, the auriculo-ventricular opening constricted, what would be the conse- 
quence of such insufficiency and constriction at the same time ? The systole 
would cause a regurgitation of the blood into the auricle, and the diastole a 
friction of the blood during its passage through the constricted mitral open- 
ing, and thus we would hear a see-saw, a noise instead of the first, and a 
noise accompanying the second sound. 

Or, suppose the aortic valves be insufficient, and, at the same time, the 
aortic orifice constricted, what will be the consequence of such a state? 

Undoubtedly the contraction of the heart would cause a noise by driving 
the blood through the constricted orifice, and during the dilatation of the 
heart the blood w T ould regurgitate and cause a murmur instead of the second 
sound. 

And how are we to distinguish between these two different affections? 

When the mitral valves are insufficient, and the auriculo-ventricular 
opening is at the same time constricted, we must find also an increased second 
sound of the pulmonary artery. When, however, insufficiency of the aortic 
valves and constriction exist in the aortic opening, we hear the murmur 
most distinctly over the aorta. 

A comparison of the diagram on circulation, page 427, will help much 
in elucidating these complicated states. 

All that I have said here of the left ventricle and its valves during its 
systole and diastole is almost verbally applicable to the right ventricle and 
its valves. As, however, valvular diseases on the right side of the heart 
are exceedingly rare compared with those of the left side, and even when 
present on the right side, they almost always exist to a greater extent upon 
the left than upon the right side (H. M. Hughes)', I think it best to break 
off here, so that I may not bring confusion upon, instead of elucidation to 
the subject. I shall now proceed to speak of those morbid sounds, resem- 
bling murmurs, but which have nothing to do with the valves of the heart. 

1. Anaemic murmurs. "They are ordinarily of the softer kind and 
resemble the blowing of a pair of bellows, but are sometimes harsh and re- 
semble the rougher morbid sounds, as that of filing or sawing." (H. M. 
Hughes. ) They are generally confined to the situation of the aortic or pul- 
monary valves, or both. They do not follow the course of the large vessels 
so fully or so frequently as do the murmurs arising from disease of the valves. 
The}' occur only during the systole of the ventricles; they are not generally 
heard below the left nipple, because the}' do not originate in the mitral open- 
ing. They are almost always accompanied with a smart, smacking impulse. 



AUSCULTATION. 393 

They generally disappear for a time, while the individual is quiet mentally 
as well as bodily, if by that quiet the heart assume a natural impulse; and 
they are always diminished and generally disappear entirely under suitable 
treatment. (H. M. Hughes.) 

The origin of these anaemic murmurs have been attributed: i, to a 
watery condition, or a diminution of ordinary viscidity of the blood, in con- 
sequence of which the particles of the fluid are more easily agitated and thus 
give rise to the vibrations which produce the murmur; 2, to the remarkably 
quick and sudden contraction of the ventricles, in consequence of which the 
fluid contents of the cavities are propelled quicker through the arterial open- 
ings than in health, and thus give rise to greater friction, which produces 
the murmur, although no actual constriction exists there. (H. M. Hughes.) 

2. Venous murmurs, (nun's murmur, top-murmur) are heard in many 
young persons in the anterior triangular space in which the external jugular 
vein descends. It is a continuous murmur, and is generally more audible 
on the right than on the left side. This murmur disappears when the cur- 
rent of blood is interrupted by pressure upon the jugular vein, by a deep 
expiration, or by any position of the body in which the head lies lower than 
the thorax. 

It is heard loudest in an erect position and during inspiration. 
It is thought to be in connection with anaemia, but Skoda says that he 
has found it also in young and quite healthy individuals. 

3. Pericardial murmurs. As long as the inner surface of the pericar- 
dium is in its natural condition, slippery and glistening, the heart moves 
within it without any sound; just as the two blades of the pleura glide over 
each other inaudibly as long as they are in a natural condition. Not so, 
however, wmen this slippery and glistening surface becomes roughened in 
consequence of inflammation and subsequent fibrinous exudation. Then we 
hear at once a friction sound, which, according to Skoda, may resemble per- 
fectly an endocardial murmur. 

How are we then to distinguish between a friction sound caused in the 
pericardium and a sound caused within the heart ? 

Skoda says: "I know no sign by which the friction sounds of the peri- 
cardium can be distinguished from the internal murmurs of the heart, ex- 
cepting this — that the internal murmurs correspond pretty exactly to the 
rhythm and to the natural sounds of the heart; whilst the pericardial friction 
sounds seem to follow upon the movements of the heart. This distinctive 
sign is only available when the murmur is somewhat prolonged; if it be of 
short duration, we cannot determine whether it is endocardial or pericardial." 
Skoda, p. 253. 

To this difficulty still 'another maybe added, viz.: the friction sound 
may also arise from a roughened condition of that portion of the pleura 
which covers the unattached parts of the pericardium. The sound is pro- 
duced by the rubbing of the pleura which covers the free portion of the 
pericardium, either against the thoracic walls or against the surface of the 



394 DISEASES OF THE PERICARDIUM. 

lungs. Being caused by the action of the heart, it coincides with its move- 
ments as completely as though it had been produced within the pericardium. 
The murmur thus arising external to the pericardium exactly resembles the 
murmur arising within it, and here we have no means of distinguishing. 

The special diseases of the heart I shall arrange under the following 
heads: 

i. Diseases of the pericardium. 2. Diseases of the endocardium and its 
valves. 3. Diseases of the heart muscle itself . 4. Nervous diseases of the 
heart. 

I. DISEASES OF THE PERICARDIUM. 

Pericarditis, Inflammation! of the Pericardium. 

The internal layer of the pericardium being a serous membrane, like the 
pleura, its inflammation presents precisely the same anatomical character as 
that of pleurisy. We find injection, swelling, and exudaton of either a 
serous or sero-fibrinous, or for the most part fibrinous fluid. In this latter 
case the fibrin is precipitated upon the walls of the pericardium, and forms 
net-work -like, villous masses, which have given rise to the name of cor villo- 
sum or hirsutum. most frequently found in pericarditis complicated with 
articular rheumatism. During the process of inflammation, sometimes the 
injected capillaries burst and thus cause a blood}' exudation. 

When pus globules form in great abundance, the exudation becomes 
purulent, and, if it undergoes decomposition, it becomes a fetid, discolored, 
ichorous fluid, as in empyema. 

In some cases the inflammation does not result in exudation of any 
kind — pericarditis sicca — in consequence of which adhesions form without 
any noticeable symptoms. 

The mere serous exudation is most thoroughly absorbed again, while 
the fibrinous fluid gives rise to adhesions between the heart and the pericar- 
dium. 

A large quantity of this fluid hinders the heart in its movements and 
pushes it back from the thoracic walls; at the same time it may compress 
part of the lung and the large vessels. 

It causes also congestion of the lungs, the brain, and the liver, serous 
exudation into the lower lobes of the lungs, the pleura, and the membranes 
of the brain and oedema of the lower extremities. 

Pericarditis may set in primarily in consequence of external injuries or 
taking cold; such, however, is very rarely the case; or, secondarily, during 
the progress of acute rheumatism, which is its most frequent occasion. But 
it may result also from pleurisy, pneumonia or ulcerative processes of the 
ribs, vertebrae, oesophagus, stomach, liver, etc.; or it may accompany mor- 
bus Brightii, tuberculosis, disease of the valves, cancer, intermittent fevers, 
etc. It occurs, too, in typhus, variola, pyaemia, puerperal and exanthematic 
fevers. 



DISEASES OF THE PERICARDIUM. 



395 



Chronic forms of pericarditis are caused by long-continued mental de- 
pressions, abuse of spirituous liquors, violent exertion of the body, and 
chronic, gouty affections. 

Its Symptoms, if it is a primary affection, or in combination with acute 
rheumatism, are — 

i. More or less violent fever, sometimes commencing with chills, fol- 
lowed by heat, great acceleration of pulse and palpitation of the heart. 

2. As in pleurisy, we must consider the stitch or sharp cutting pain in 
the region of the heart as a characteristic, subjective sign, which is increased 
by motion, deep inspiration and external pressure. 

3. Dyspnoea is present in almost all cases; sometimes to such a degree 
that the patient is incapable of lying down at all. 

4. Cough is sometimes wanting, but in most cases we find a short, dry, 
hacking cough. 




Pericarditic Exudation. (After Bock.) 
Pericardial sac filled with fluid, b. Diaphragm, c. Right lung. d. Compressed left lung. 
e. Iyiver. /. Stomach. 



5. The position of those patients who can lie down is on their left side 
or on their back. 

Pericarditis in combination with pleurisy or pneumonia may in some 
cases not be diagnosticable during its development even by the most careful 
physical examination. In complication with tuberculosis, Bright' s disease 
and chronic heart diseases, only careful physical examination will lead to its 
detection, which is also true if pericarditis sets in during the course of grave 
blood diseases, such as scarlatina, puerperal fever, etc. 

Auscultation reveals the heart sounds very weak, sometimes scarcely 
audible. This weak impulse of the heart's action is characteristic if we find 
at the same time on percussion the dull heart sound cover a larger space 
than normal. But the first physical sign which appears (although seldom 
during the first two or three days of the disease) is the friction sound, pro- 
duced by the deposition of fibrinous masses upon the smooth pericardial folds. 
The now roughened surfaces give this friction sound during their continual 
gliding over each other in consequence of the motion of the heart. It is 
frequently heard first and loudest over the base of the heart, but may also be 



396 DISEASES OF THE PERICARDIUM. 

heard first and loudest over any other part of the heart; it does not only 
accompany the heart sounds, but is prolonged beyond them, is interposed, as 
it were, between them (Skoda), and may occupy the whole duration of the 
cardiac movement. When the exudation increases largely, it grows weaker, 
and may disappear altogether, but on the decrease of the fluid, it reappears 
again. It may also be made audible again in some of such cases, by changing 
the position of the fluid by causing the patient to sit upright, or to bend his 
body forwards. 

Inspection shows in young persons a swelling or bulging out of the pre- 
cordial region in advanced cases, with a large quantity of exudation. In 
older persons, where the cartilages of the ribs have become ossified, such 
enlargement cannot take place. 

Palpation discovers in the beginning of the disease a stronger impulse 
of the heart at its normal place; but later this impulse becomes weaker and 
finally ceases altogether, when the collection of fluid pushes the heart back 
from off the thoracic walls. 

When there is a loud friction sound, this becomes noticeable also to the 
sense of touch, and feels like the purring of a cat. 

Percussion at first reveals nothing. There must be already a consider- 
able quantity of fluid exudation before we perceive the natural dull percus- 
sion sound of the heart spread over a larger circumference; and if the lung 
happens to be in a position that it covers the filled pericardium, we cannot 
get a dull sound in spite of even a very large quantity of fluid. 

At first the exudation is confined to the base of the heart and the origin 
of the arteries. Here then we have at first to look for an increase of dullness 
of the percussion sound. Later, the dull percussion sound may increase in 
the long diameter, down the heart; and if the effusion is very considerable, 
also in its transverse diameter, so that if, according to Skoda, the pericardium 
contains as much as two pounds of fluid, the percussion sound becomes com- 
pletely dull from the second left costal cartilage to the lower border of the 
thorax, and from the right edge of the sternum to the middle of the left 
lateral region. 

Secondary pericarditis of course develops itself differently. Being 
a mere additional symptom or consequence of, or complication of some 
other disease, its first onset is hidden by the symptoms of that disease. But, 
when once developed, its presence must of necessity be indicated by the same 
physical signs which I have detailed above. 

Uncomplicated pericarditis is, of course, much more easily cured than 
when complicated. In the latter case our prognosis has to be based alto- 
gether upon the nature of that complaint with which it is combined. 

Therapeutic Hints. 

Aeon. Chill at the commencement, followed by fever-heat; stitching 
pain in the region of the heart; impossibility to lie on the right side; great 
restlessness: frequent sighing and taking a deep breath; feeling of fullness in 
the chest, dyspnoea; fainting. 



HYDROPERICARDIUM. 397 

Arsen. In consequence of repelled measle or scarlet fever-rash; inex- 
pressible anguish and restlessness; worse at night; the patient finds no ease 
in an}' position; flushed face; paralytic feeling in the upper extremities; 
tingling in the finger; cold perspiration. 

Bryon. Stitching pain in the region of the heart, preventing motion 
and even breathing; wants to lie perfectly quiet. 

Cact. grand. Sensation of constriction in the heart, as if an iron hand 
prevented its normal movement; acute pains and stitches in the heart; diffi- 
culty of breathing; attacks of suffocation; with fainting; cold perspiration 
in the face, and loss of pulse; palpitation when walking, and at night when 
lying on the left side. 

Digit. Copious serous exudation, rheumatism; irregular, intermitting 
pulse; brick-dust sediment in the urine. 

Iodium. In complication with croupous pneumonia; purring feeling in 
the region of the heart; violent palpitation, increased from the slightest 
motion, better while lying perfectly quiet on the back; fainting spells. 

Kali card. Stitching pain in the region of the heart; swelling between 
the eyebrows and the upper lids, like little bags; jerking up of the limbs, 
much frightened when having the feet touched; everything worse about 
three o'clock in the morning. 

Laches. Restless and trembling; hasty talking; great oppression; 
anguish about the heart in rheumatism; irregularity in the beats of the heart. 

Psorin. Psoric nature; better while lying quietly. 

Pulsat. The patient weeps easily, is thirstless, often changes position, 
has a loose, rattling cough, worse on first going to bed; rheumatic pains, 
which quickly change locality; inclination to looseness of the bowels; sup- 
pressed menstruation. 

Rumex. During rheumatism; burning, stinging pain in the left side of 
the chest near the heart when taking a deep inspiration, when lying down 
in bed at night. 

Spigel. When, notwithstanding the use of Aconite, the fever continues 
and the rubbing sound commences; stitching pain in the chest from the very 
slightest motion. 

Sulphur. Palpitation after going up stairs, with shortness of breath; 
steady pain in the left side through to the shoulders; red lips; sleeplessness; 
after suppressed itch. 

Tart. emet. In complication with pleuro-pneumonia. 
Ver. vir. Faintness after rising from a recumbent position; syncope 
when walking: relieved only by lying down. 

Existing complications will no doubt hint to many other remedies: 
Hepar, etc. 

Hydropericardium. Dropsy of the Pericardium. 

The pathological character of this disease consists of a collection of 
serum without fibrin. A fibrinous exudation never takes place without an 



398 DISEASES OF THE ENDOCARDIUM. 

inflammatory process. The serum is a yellowish, clear fluid; sometimes, if 
mixed with blood, it is brownish or reddish, and always of alkaline reaction. 
In renal diseases it contains some urea, and in general icterus the coloring 
matter and acids of the bile. A small quantity of such fluid is found in most 
post-mortem examinations. To constitute dropsy of the pericardium, this sac 
must contain at least several ounces of serum, and it amounts in some cases 
even to over one pound. When such is the case, the pericardium is dis- 
tended, is of a dull whitish color, without lustre; the fat upon the heart is 
gone, and the cellular tissue appears oedematous; the lung becomes com- 
pressed and the thorax enlarged. 

Dropsy of the pericardium is generally the consequence of a hydraemic 
condition of the blood, or of diseases which cause dropsical affections in other 
parts also, such as chronic affections of the spleen, morbus Brightii, cancer, 
anaemia, dilatation of the right ventricle, etc. It is also found in consequence 
of conditions which prevent the necessary oxygenation and free circulation 
of the blood, as in emphysema, in cirr hosed lungs, in defects of the valves of 
the heart. 

Hydropericardium is, therefore, altogether a disease of secondary nature, 
and its symptoms do not become very prominent, unless a very considerable 
quantity of fluid collects within the pericardium. Then we observe great 
dyspnoea, which prevents the patients from lying down; any effort to do so at 
once causes an attack of suffocation; they have to sit up day and night with 
their bodies bent forwards. The jugular veins swell and dropsical affections 
appear also on other parts of the bod}*; first in the lower extremities; then 
in the genitals; later, within the peritoneum and the pleurae; finally, the 
dropsical swelling invades the whole bod}*, and the impeded respiration and 
circulation cause stupor and death. 

The physical signs are: no friction sound; distention of the precordial 
region in young subjects; impulse of the heart either absent or weak; weak 
sounds of the heart ; and dull percussion sound in a wider circumference than 
the heart alone would give rise to. 

Therapeutic Hints. 

Compare Hydrothorax. The leading features will have to be taken 
from the fundamental disease. 

H. DISEASES OF THE ENDOCARDIUM. 

Endocarditis. 

Inflammations of the endocardium end either in ulcers, in thickenings 
of the membrane, or in villous formation of the connective tissue, which in 
course of time undergo further changes. 

i. The Acute ulcerative form is usually found in the left side 
of the heart, most frequently affecting the mitral and aortic valves, 
although the walls of the auricles and ventricles are not exempted. 



ENDOCARDITIS. 399 

At first the lining membrane appears only dirty gray, opaque and dull, but 
soon shows proliferations in the connective tissue, and a deposition of fibrin- 
ous masses, which, after softening and crumbling away, leave ulcers on the 
surface. As the ulceration eats through one lamella of the valves, the 
lamellae underneath stretch and bulge out by the strain of circulation and 
cause the so-called Valvular aneurisms, which, when situated on the auriculo- 
ventricular vhlves, project into the auricles, or when on the semi-lunar valves, 
into the ventricles; they may enlarge to such a degree, as to form an acute 
stenosis of the ostium. Ulceration in the ventricles, when complicated with 
myocarditis, may lead to a so-called Partial cardiac aneurism ; when situated 
at the septum, may cause perforation of the same and establish a communi- 
cation between the two ventricles; the particles of the crumbling masses in 
the left ventricle may be swept into the terminal arteries and valveless veins 
of the spleen, kidneys, brain or eyes, producing infarctions in these organs, 
or when arising from the right side of the heart, bring about abscesses from 
embolism in the lungs. 

The sj'mptoms of ulcerative endocarditis may be similar to typhoid 
fever; the heart symptoms are not characteristic. Usually, however, we 
hear a loud, systolic and occasionally a diastolic murmur, loudest at times 
over the apex, at other times over the base, and especially in the neighbor- 
hood of the aortic ostium. Of course, in complication with pericarditis the 
physical signs change accordingly. For this reason endocarditis may easily 
be confounded with typhoid fever, for in both the spleen is almost always 
enlarged, and a roseolar or petechial exanthema is very often present, and 
frequently accompanied by meteorism. But endocarditis has not the charac- 
teristic typhoid curve of temperature, exhibits a remarkable frequency of the 
pulse and is usually found as complication of acute articular rheumatism or 
in connection with puerperal fever, pyaemia, diphtheria, scarlatina, chronic 
valvular disease and infectious diseases in general. It is most frequently 
met with as a complication of acute articular rheumatism. 

2. The Verrucose form of endocarditis is also more prevalent on the 
left side of the heart, and takes its favorite seat on those surfaces of the 
valves which face the current of the blood; then we see it occur on the chordae 
tendineae and relatively seldom on the lining of the ventricles. The verrucose 
products are the fruit of inflammatory changes in the parenchyma in con- 
sequence of irritation. They consist of proliferations of the connective 
tissue, and appear either as a mere velvety coating on the smooth valvular 
surfaces, or amount to opaque spots with wart-like, papillous, knotty and 
cauliflower-shaped excrescences of a red or gray-red color, firm at the base 
and soft or jelly-like at their points. Parts of these growths may be driven 
into the general circulation and form emboli. From the left side the kidneys 
are the organs most liable to infarction, while in affections of the right 
heart the inferior lobes of the right lung are most liable to be invaded. 

Verrucose endocarditis is almost alwa} T s accompanied by pericarditis, 
and most frequently complicated with rheumatic arthritis; it also has been 



400 THERAPEUTIC HINTS TO ENDOCARDITIS. 

found the offspring of childbirth and pregnancy, of old valvular affections, 
and of acute exanthematic diseases. 

Its invasion, during these different affections, generally takes place un- 
noticed ; because it is quite seldom that the patient complains of pain in the 
region of the heart when attacked in this way. But once established, we 
observe the following symptoms: 

i. Palpitation of the heart, and soft, easily compressible and small pulse. 

2. Dyspnoea, which is the greater the more the respirator}' organs be- 
come involved in the morbid process, causing quick and unequal respiration, 
fainting, or congestion of the brain, with headache, delirium, sleeplessness, 
sopor. 

3. Higher degrees of endocarditis are frequently attended by icterus. 
Its physical signs are the following: 

1. The normal sounds of the heart are stronger, and audible over a 
larger space than natural — in the beginning of the disease. 

2. In place of the first tick we hear, at the apex of the heart, a noise, 
which shows that the mitral valves have become diseased. 

3. The second tick of the pulmonary artery is increased in consequence 
of the insufficiency of the mitral valves, causing an overflow in that artery. 

4. Percussion at first reveals nothing, but at a later period yields a dull 
sound over a greater space than natural, because of the dilatation of the right 
ventricle in consequence of impeded circulation. 

Both forms of endocarditis may result in recovery, but generally leave 
diseases of the valves, either thickening, adhesion, or perforation, and in 
consequence hereof, dilatation and hypertrophy of the heart. 

Therapeutic Hints. 

Compare what has been said under Pericarditis. The characteristics of 
the remedies acting upon the heart must be applied here to. In addition, I 
shall mention only — 

Spigel. The most important; waving palpitation, not synchronous with 
the pulse; pulsating and trembling carotids; purring feel over the heart; 
rheumatism. 

Allium. Rheumatic pains, previously wandering from joint to joint, 
become fixed in the region of the heart and cause great anxiety; the patient 
has to sit perfectly quiet in an upright position; palpitation, with irregular, 
intermitting pulse and short breath, feeling as though the heart ceased beat- 
ing for a while, and then at once one hard thump is felt. 

Bismuth. Has not yet been tested in practice, but its pathological effects 
seem strongly to indicate it; the}' are: inflamed spots in the endocardium, 
black coagulum in the heart. 

Iodium. According to Kafka, if Spigel. has failed to act favorably during 
twenty-four to thirty-six hours. 

Kali card. Where, in place of the first tick, a blowing noise and a louder 



INSUFFICENCY OF THE MITRAL OR BICUSPID VAEVE. 4OI 

second tick of the pulmonary artery is heard (Kafka); where there conse- 
quently exists already a stagnation in the pulmonary circulation. 

Spo?igia. In consequence of endocarditis, attacks of severe oppression 
and pain in the region of the heart; all symptoms worse from lying with the 
head low; inability to lie down at all. 

In consequence of Endocarditis originate diseases of the valves, which 
consist either in — 

1. Insufficiency of the valves; or — 

2. Constriction of the valvular openings. 

1. Insufficiency of the Mitral or Bicuspid Valve. 

Mostly in consequence of endocarditis the valves become shortened and 
thickened, sometimes by flat calcareous substances stiffened and the fine 
fringes on their free borders obliterated; at other times the valves are torn 
from the chordae tendineae; seldom are the chordae tendineae grown fast to 
the wall of the ventricle; not unfrequently the capillary muscles are in a 
state of callous degeneration. 

There are also characteristic changes of other parts of the heart attend- 
ing this disease, namely: always a dilatation and hypertrophy of the left 
auricle, of the pulmonary veins and artery and of the right ventricle and 
auricle. 

In consequence of these defects of the mitral valves, the blood regurgi- 
tates during the systole into the left auricle, thus checking the normal flow 
of the blood through the pulmonary vein. This causes an accumulation of 
blood in the lungs, in consequence of which the blood is pressed backwards 
into the pulmonary artery, causing here a widening of its volume, and, in 
consequence, a louder second tick. This increased second tick of the pul- 
monary artery is the most characteristic sign of insufficiency of the mitral 
valves. 

The check of circulation in the lungs causes further dilatation and 
hypertrophy of the right ventricle, because it requires greater power to force 
on the accumulated and obstructed blood. By-and-by, however, this increase 
of power in the right ventricle diminishes again, and thus the veins of the 
lungs become permanently overcharged with blood; the same result takes 
place in the venae cavae, and, in consequence, the liver, spleen and kidnej-s 
grow hyperaemic, which finally ends in dropsy. This stagnation of blood in 
the lungs causes also dyspnoea, bronchial catarrhs, periodical haemorrhages 
from the lungs, passive hyperaemia of the brain, an undulation of the jugular 
veins, cyanosis, jaundice and dropsy, which usually commences in the lower 
extremities growing gradually upwards. 

The characteristic physical signs are the following: 

1 . In place of the S3^stolic sound we hear a murmur at the point where 
the apex strikes at the thoracic wall. 

2. The diastolic of the pulmonary artery is much increased. 
26 



4-02 CONSTRICTION OF THE LEFT AURICULO-VENTRICULAR OPENING. 

3. The dull percussion sound of the heart extends further in breadth, to 
the right, on account of the dilatation of the right ventricle. 

2. Constriction or Stenosis of the Left Auriculo-Ventricular 

Opening. 

It originates mostly in this way — the mitral valves shrink and grow 
harder and narrower, or that their points grow together, or that the chordae 
tendineae adhere to the valves, or that the valves become covered with cal- 
careous substances. This state of things naturally produces at the same time 
insufficiency of the mitral valves and therefore we find in the great majority 
of cases stenosis complicated with insufficiency. The other changes in the 
heart are like those of insufficiency; the left ventricle, however, grows 
smaller and the aorta narrower on account of the diminished flow of blood 
through them. 

As in this case the narrowed and roughened orifice does not allow the 
blood to enter freely into the left ventricle, its passage through this opening 
is perceptible to the ear — we hear during the diastole a noise at the apex of the 
heart. At the same time the narrowed opening prevents the normal quantity 
of blood from passing through into the left ventricle, which causes an accu- 
mulation of blood in the left auricle; hence, a check of flow in the pulmonary 
vein; hence, an overfilling of the lungs; hence, a greater backward pressure 
into the pulmonary artery; and hence all the consequences which I have 
detailed under the head of defective mitral valves, only much more rapid 
and much more intense. 

Its characteristic physical signs are the following: 

1. We hear at heart's apex a presystolic murmur. This noise is some- 
times similar to the purring of a cat, so that it even may be felt. 

2. The diastolic sound of the pulmonary artery is louder. 

3. The dull percussion sound of the heart extends further to the right, 
on account of dilatation and hypertropy of the right ventricle. 

In cases where the mitral valve is defective and the left auriculo-ven- 
tricular opening constricted at the same time, when we hear a noise during 
the systole as well as before it. The sound of the aorta is mostly weak. 
The pulse is in most cases weak, not corresponding to the violent palpitation 
of the heart. 

3. Insufficiency of the Aortic Valves. 

As soon as these valves do not shut tightly, the blood which has been 
driven during the heart's systole into the aorta, rushes, during its diastole, 
back into the left ventricle, causing an abnormal quantity of blood to collect 
there. To get rid of this the left ventricle has to make greater efforts to rid 
itself of it: and, in this way, it gradually grows wider and thicker — eccentric 
hypertrophy of the left ventricle. By this increased capacity of the left ven- 
tricle the consequences of the defective aortic valves become, so to speak, 
counterbalanced. For a good while it prevents an overfilling with blood in 



CONTRACTION OR STENOSIS OF THE AORTIC OPENING. 403 

the pulmonary veins; we observe no slowness of pulse, no decrease of 
arterial blood, no cyanosis or dropsy. For, although the defective valves 
retard the circulation and tend to make the blood venous, the hypertrophy of 
the left ventricle hastens the circulation and compensates for it. 

Therefore, we find that patients thus affected suffer at first comparatively 
little; the most frequent signs are: congestion of the brain, which manifests 
itself as dizziness, noise in the ears, flickering before the eyes, headache, 
hallucinations, red face, etc., as a consequence of the hypertrophied left 
ventricle. 

Later, however, the increased capacity of the left ventricle is not suf- 
ficient any longer to overcome the consequences of the defective valves, and 
thus all the symptoms of impeded circulation, as described above, commence 
to set in. The characteristic physical signs of defective aortic valves are the 
following : 

1. Diastolic murmur of the aorta, in consequence of the regurgitation of 
blood into the left ventricle during the heart's diastole. 

2. Greater extension of the dull percussion sound in the heart's long 
axis and to the left, on account of the hypertrophy of the left ventricle. 

3. Arched appearance of the region of the heart for the same reason. 

4. The impulse of the heart's apex is felt lower down and outside of the 
nipple line. 

5. Strong, jumping pulsation of the carotid arteries. 

6. Pulsus celer et alius; strong, full pulse, with sudden collapse. 
Traube adds: 

7. The sounding of the crural artery. 

8. The rough systolic after-noise in the carotids. 

9. The want of the systolic sound at the heart's apex. 

4. Constriction or Stenosis of the Aortic Opening. 

The disturbance of circulation is, in such a case, of course, still greater 
than by mere defect of the valves; and therefore the. patient soon shows 
symptoms of deficient circulation; such as paleness, small, thread-like pulse; 
fits of fainting; coolness of the extremities; anaemia of the brain. At a later 
period the veins become overcharged with blood, and in consequence we find 
the patient suffer with dyspnoea, cyanosis, and all the other symptoms of 
heart disease. 

Its characteristic physical symptoms are: 

1. Systolic murmur, which is often heard in the carotid. 

2. Dull percussion sound, somewhat extended in the direction of the 
longitudinal axis of the heart, in consequence of dilatation and hypertrophy 
of the left ventricle. 

3. Apex lower down and outside of the nipple line. 

4. Pulse small, wiry, irregular and thread-like. 

In case there exists at the same time a defect in the aortic valves, we 
may also hear a diastolic noise. 



404 IXSIFFICEXCV OF THE TRICUSPID VALVES. 

5. Insufficiency of the Tricuspid Valves. 

This defect allows the blood to regurgitate into the right auricle, when 
the heart contracts. Thence the retrograde stream of blood goes into the 
venae eavae and jugular veins; hence we feel a pulsation of the jugular vein, 
synchronous with the arterial pulse. This retrograde motion of the blood 
causes overfilling of all the veins, and its consequent results are hyperaemia, 
cyanosis, hydrops, etc. 

Its characteristic physical signs are: 

1. Systolic noise in the right ventricle. 

2. Swelling and pulsation of the jugular veins. 

3. More extended dull percussion sound in the direction of the breadth 
of the heart on account of its right auricle having become enlarged and 
hypertrophied . 

This complaint is generally a secondary affection, due to dilatation of 
the right ventricle, in consequence of diseases of other valves, and then, of 
course, is attended by all the above-mentioned disturbances and signs. 

6. Stenosis of the Right Auriculo-Ventricular Opening, 

7. Insufficiency of the Pulmonary Valves, 

8. Stenosis of the Pulmonary Opening 

Are, uncomplicated, of such rare occurrence, that even Skoda did not observe 
them on the living. Skoda, p. 371. 

The Treatment of all these different valvular affections has to be adapted 
to each single case, and it is not the diseased valve which points to any par- 
ticular remedy, but the individual symptoms by which the whole morbid 
process manifests itself. 

Still I might give some general dietetic rules, which are of great 
importance for'the treatment of those different affections. 

Patients in whom we find symptoms of congestion of the brain or chest 
ought not to eat much animal food; must avoid all sorts of stimulants, and 
especially coffee and all kinds of spices. Mental excitements and depressions 
are alike hurtful to them; and neither too high nor too low a degree of tem- 
perature is advisable. 

Patients, however, in whom anaemia and debility prevail, ought to eat 
animal food and drink beer or wine; ought not to overexert themselves, and 
ought to have all the fresh, pure air they can get. 

Aeon. Usual symptoms of great restlessness, anxiety, fear of death, 
stitch-pains, haemoptysis, with hacking cough, etc. 

Act. vac. Catching pain in region of heart, worse on moving or bending 
forward, preventing inspiration; palpitation and faintness; sexual disturb- 
ances in females. 

Arnica. Heart feels as if bruised; palpitation from any exertion. 



STENOSIS OF THE RIGHT AURICULO- VENTRICULAR OPENING. 405 

Arsen. Precordial anxiety and oppression; palpitation at night, with 
anguish, cannot lie on back; after suppressed eruptions or foot-sweat. 

Cact. grand. Livid complexion, sunken face; difficult breathing, worse 
from exertion; constant pain, darting and cutting from region of heart to the 
left shoulder and down the arm, worse from damp weather or any emotion; 
oedema, especially of left hand and legs up to the knees; icy-cold feet; inter- 
mittent pulse. Insufficiency of mitral valves. 

Calc. card. Trembling pulsation of the heart, worse after eating, at 
night with anguish; inclination to take deep breaths; menses too early and 
too profuse. 

Digit. Irregular, intermittent beats of the heart; very slow when 
keeping still, but easily accelerated by any exertion; feeling at times as if 
the heart stood still, with great anxiety, oedema of the lungs; bluish-red face, 
or death-like appearance. 

Ferrum. Chlorotic symptoms; congestion of the head; spitting blood; 
palpitation, better from slowly moving about. 

Gelsem. "Fears that unless constantly on the move her heart will cease 
beating. ' ' 

Kali hydr. Darts in the region of the heart when walking; after mer- 
curial poisoning; after repeated attacks of inflammation of the heart. 

Laches. Restless, trembling; anxiety about the heart; hasty speech; 
suffocating on lying down; weight on the chest; heart feels constricted; 
numbness of the left arm. * 

Lauroc. Persistence of the ductus Botalli (arterial duct), in conse- 
quence of which there exists a cyanotic discoloration of the face, fingers and 
feet, worse from external cold; dyspnoea; acute or dull pain in the heart, 
worse from a deep inspiration. Heart's action irregular; blowing sound on 
the heart's apex. (Bibliotheque homceopathique, September, 1881.) 

Lil. tigr. Heart feels as if grasped, with pain and heaviness of left 
mamma to scapula; pulsations over whole body, and outpressing in hands 
and arms, as if blood would burst through the vessels; fluttering; awakens 
her at night, with cold hands and feet covered with cold sweat, with sharp, 
quick pain in left chest. 

Lithium. Soreness about the heart, worse stooping; pain in the limbs; 
finger-joints tender and painful; sleeplessness. 

Natr. mur. Irregularly intermitting pulsation; fluttering of the heart, 
with weak, faint feeling and necessity to lie down; coldness of hands and 
feet; numbness of hands relieved by rubbing; cutting pain in the urethra 
after micturition; scanty menses. 

Phosphor. Congestion of the lungs; tightness across the chest and 
tight cough; spitting of blood; palpitation worse after eating, or mental 
emotion; yellow spots on the chest; painless diarrhoea. 

Psorin. Stenosis of left osteum venosum; purring in the region of the 
apex; cyanotic lips; dyspnoea and shortness of breath when walking in open 
air; better when lying down. 



406 HEART-CLOTS. 

Rhus tox. Palpitation worse during rest; pain from region of the 
heart into left arm, with numbness; rheumatism. 

Spigcl. Stitches about the heart; anxiety and oppression; can only lie 
on right side, or with head very high; least motion aggravates. 

Spongia. Violent palpitation, awakens after midnight with a sense of 
suffocation; loud cough, great alarm, agitation, anxiety and difficult breath- 
ing; violent gasping respiration; pain in the heart. 

Zincum. Cyanotic face; great dyspnoea; drops}* of the lower extremities, 
ascites and anasarca of the upper extremities. Dilatation and hypertrophy 
of heart; insufficiency of mitral valve; urine scanty with albumen; appetite 
tolerable; bronchial catarrh. (Dr. A. Pfander. ) 

Besides compare : Anac, Iodium, Kali carb., Lycop. , Xaja, Plumbum, 
Pulsat., Sepia, Sulphur, Veratr. 

Heart-clots. 

Fibrinous coagulations, especially in the right ventricle and auricle, are 
very frequently found on post-mortem examinations. If they have originated 
recenth', either soon after death or during death-struggle, they are of a 
whitish-yellow, generally translucent appearance, frequently jelly-like in 
consistency, moist and shiny, as if cedematous, and infiltrated with blood on 
their lower surface; they may extend into the vessels and be drawn out like 
strings or cords, and aan easily be separated from the subjacent parts without 
injury to either; they are the result of the natural coagulation of the blood 
during the retardation and final cessation of its current. 

But clots ma}* also form during life, either in consequence of a slacken- 
ing in the current of the blood from some obstruction or loss of propelling 
force; or in consequence of gradual deposition of fibrine on roughened sur- . 
faces produced by vegetations or inflammatory processes of the inner wall of 
the heart; or in consequence of fibrinous coagula from distant portions of 
the vascular system, serving as nuclei for more extensive fibrinous clots; or 
perhaps also in consequence of an increase of fibrine in the blood during 
certain diseases, or a greater tendency of the blood to coagulate. 

These clots, called True polypi of the heart, are dull in appearance, 
dry, rotten, friable, of a whitish-yellow, or gray color, consist of various 
layers of different color and contain at times deposits of lime salts and in 
their centre a purulent fluid. They are of various sizes, and usually firmly 
attached to the inner walls of the heart; they are found particularly at the 
apex of the left ventricle and in the appendices of the auricles. 

The Symptoms of this affection are not characteristic enough to distin- 
guish it from other heart affections, with which it may be complicated. 
Heart- clots may occasion sudden death in patients previously in apparent 
good health. 

In other cases they may produce dyspnoea, cyanosis, or pallor of the 
whole surface, expectoration of bloody sputa, coldness of the extremities, 



DISEASESES OF THE HEART-MUSCLE. 



407 



stupor, convulsions, loss of consciousness, death. The heart's action usually 
is slow, seldom irregularly violent. Dropsical effusions may occur if the 
patient survives long enough. The physical signs which are occasioned by 
the clots are of no diagnostical value. The presence of heart-clots may, 
therefore, be guessed at but cannot be proven positively. 

m. DISEASES OF THE HEART-MUSCLE. 



Myocarditis, Carditis, Inflammation of the Heart-muscle, 

Is found always in connection with peri- or endocaditis; and then its seat is 
generally the left ventricle. The substance of the muscle appears yellowish, 
sometimes fatty degenerated. Its most frequent occasion is acute rheumatism 
of the joints, but it has also been observed in the course of puerperal and 
exanthematic fevers. 

There are no characteristic signs of this complaint, because it is almost 
always mixed up with peri- or endocarditis. Mild forms pass over without 
any consequences; but if it extends to the formation of abscesses, it may 
cause widening of the heart-muscle (partial aneurism), or bursting of the 
heart-muscle, and consequent sudden death. When the abscess discharges 
into the ventricle it causes the formation of emboli, with their consequences. 

Hypertrophy and Dilatation of the Heart. 

Hypertrophy consists of an increase in mass of the heart-muscle, or a 
thickening of its walls, whereby the inner cavity becomes narrower: this is 
the so-called concentric hypertrophy; or the heart-muscle is increased in 





Hypertrophy of L,eft Ventricle. 

a. Heart elongated. 

b. Liver. 

c. Stomach. 

d. L,ungs. 



Eccentric Hypertrophy of Right Ventricle. 

a. Heart widened. 

b. Left lung. 

c. Right lung. 

d. Enlarged liver. 

e. Stomach. 

f. Enlarged spleen. 



thickness, and the inner cavity widened at the same time: this is the so- 
called eccentric hypertrophy. 

When, however, the inner cavity is widened, and the heart-muscle at 
the same time has grown thinner, it is called dilatation of the heart. 



408 THERAPEUTIC HINTS TO DISEASES OF THE HEART-MUSCLE. 

The most frequent of these three forms of altered conditions is eccentric 
hypertrophy. 

But it is not always the whole heart that is enlarged or dilated; it is 
generally only one-half of it that is thus affected. A hypertrophied left ven- 
tricle makes the heart longer, reaching further down in the left thorax, while 
an eccentric hypertrophy of the right ventricle makes the heart broader, so 
that it reaches further over into the right thorax. 

Both, hypertrophy and dilatation, are most frequently caused by dis- 
turbed circulation, in consequence either of diseases of the valves or diseases 
of the arteries, like aneurism, or obstacles in the capillaries in the lungs. 
Also pericarditis and myocarditis, mental excitements, strong coffee, tea, and 
spirituous liquors have been found exciting causes of this complaint. 

Eccentric hypertrophy of the left ventricle manifests itself by an increased 
impulse of the heart, either heaving in character or jarring the chest- wall, 
more or less towards the left of the nipple-line and further down, in some 
cases even as far as the seventh and eighth intercostal space; it is an enlarge- 
ment of the heart in its long axis, and causes sometimes an intensification of 
the sounds, especially of the second sound in the aorta, sometimes a metallic 
clink, increased pulsation of the carotids, murmurs in the larger arteries and 
also in the small vessels far removed from the heart, and a pulse perceptibly 
larger in volume under the finger. 

"In hypertrophyof the right ventricle, the heart's impulse is not increased, 
except occasionally near the lower portion of the sternum; the apex beats 
further to the left, but not lower down. The area of dullness is increased in 
breadth, and the second sound in the pulmonary artery is accentuated." 

1 ' In total hypertrophy we find a combination of symptoms corresponding 
to the hypertrophy of the ventricles. It is seldom, however, that w 7 e can 
succeed in declaring with accuracy which half of the heart is the more 
enlarged." (Schroeter. ) 

Dilatation is found more frequently of the right than of the left ventricle. 
The impulse of the heart is, as a rule, weaker than normal. There follows 
retardation of circulation, and consequently dyspnoea, cj^anosis and dropsy. 
Pulsation of the veins of the neck are characteristic to a dilatation of the 
right auricle. 

Therapeutic Hints. 

Compare what has been said of the different affections of the heart. As 
hypertrophy is more or less a consequence of the one or the other, tig char- 
acteristic indications of the different remedies there described must also fit 
here. I have only to add: 

Arsen. Dilatation of right ventricle, with swelling of legs and vertigo; 
scanty urine without albumen. 

Plumb, ac. Stitch in the region of the heart during an inspiration, 
with anxiety; heat and redness of the face; rushing of blood in the region 
of the heart during a rapid walk; anguish about the heart, with cold sweat; 
palpitation of the heart. 



FATTY DEGENERATION OF THE HEART. 409 

Post-mortem, after poisoning, has shown -that the serous coat of the 
pericardium is lined with a layer of reddish-gray, fine villous, meshy, firm, 
exuded lymph. The heart is more than double its natural size. The wall 
of the left ventricle is more than an inch thick. 

Kalmia lat. After rheumatism; hypertrophy; palpitation; dyspnoea; 
pain in the limbs; stitch-pain in the lower part of the chest; prosopalgia on 
right side. ■ 

Fatty Heart and Fatty Degeneration of the Heart. 

Under Fatty heart is understood an accumulation of fat in the sub- 
pericardial connective tissue, at the apex, in the ventricular furrows along the 
course of the vessels, at the base around the junction of the auricles and 
ventricles, at the origin of both the great vessels, and at times embracing the 
whole heart like capsule of fat. By its spreading along the course of the 
fibres of the connective tissue in between the muscular bundles it causes the 
latter to atrophy and appear as thin pale stripes and layers. It is usually 
accompanied with a simultaneous deposit of fat throughout the system, espe- 
cially in drinkers. 

The Fatty degeneration of the heart takes place in the primitive bundles 
of the muscular fibres themselves; they appear cloudy and their transverse 
striae disappear; the heart substance thereby becomes pale and yellowish in 
color, and its texture flabby and friable. It may be acute and chronic. Its 
Causes are: various chronic diseases, protracted suppuration, great loss of 
blood, tubercular and cancerous cachexia, severe forms of syphilis, profound 
anaemia, and also diseases of the heart itself, such as pericarditis, endocar- 
ditis, valvular lesions, chronic parenchymatous myocarditis. Its acute form 
occurs after puerperal, typhoid, remittent and exanthematous fevers, after 
yellow atrophy of the liver and Bright' s disease, also in consequence of 
poisoning with phosphorus, mineral and vegetable acids and alcohol. 

The Symptoms of this disease are in no way very characteristic. Its 
acute form is usually obscured by the attending primary disease, and a de- 
posit of epicardial fat, which leads to atrophy of the muscular tissue, cannot 
be distinguished from the true fatty degeneration. Still its occurrence, es- 
pecially in advanced age, in corpulent people, its usually feeble impulse and 
pulse, its occasional attacks of dizziness and fainting, the presence of the 
arcus senilis may, by a careful exclusion of all other diseases in which simi- 
lar symptoms occur, lead to a correct diagnosis. 

Both forms may exist for many years if they act only partially destruc- 
tive to the heart-muscle, or are kept in check by judicious treatment; death 
may occur from paralysis or rupture of the heart. 

Therapeutic Hints. 

An undue accumulation of fat should be prevented by a judicious diet, 
avoiding fat meat, butter, milk and such articles which consist principally of 



4IO NERVOUS AFFECTIONS OF THE HEART. 

starch and sugar. Allowable are lean meats, fish, vegetables. Of drinks, 
malt liquors should be forbidden, while red wines, claret and the like mod- 
erately used ma\- be of benefit. Water is the safest drink. In case of 
syncope an alcoholic stimulant may be of use, and for the spells of 
dizziness, the stooping with the head low down between the knees has 
been found of great benefit, because it helps mechanically to bring a 
sufficient quantity of blood to the brain, which the weakened propelling 
force of the heart alone is not capable of doing. For the same reason 
in case of syncope the head should be put low. Among the remedial agents 
we ma}' especially turn our attention to remedies that have proved beneficial 
to persons in whom a tendency of growing fat was manifest, e. g., Arsen., 
Calc. carb., Ferritin, Sulphur. 

Arnica. Recommended by Kafka. 

Aur. niur. Has relieved when there was a peculiar hacking cough 
with weak impulse, also where a pain existed as if from angina pectoris 
attended with blood-spitting. 

Digit. Where there is slow or irregular action of the heart. 

Phosphor. Produces all the symptoms of fatty degeneration in different 
parts of the body. 

IV. NERVOUS AFFECTIONS OF THE HEART. 
Nervous Palpitation of the Heart 

Is an increased action of the heart without any detachable organic lesion of 
that organ. 

The heart's activity is accelerated by irritation of the ganglia which we 
find imbedded in its substance; by irritation of the cardiac branches of the 
ganglion stellatum, w 7 hich take their origin from fibres of the cervical por- 
tion of the sympathetic; by irritation of the nerve fibres which originate in 
the medulla oblongata, run down the spinal cord, pass out from the cord 
with the spinal nerves and become entwined with the sj T mpathetic; and by 
irritation of the sympathetic in general, causing a contraction of the vessels, 
and thereby an increased blood pressure in the aortic system with conse- 
quent increased labor of the heart. These are the exitor nerves of the heart's 
activity; its restraining or inhibitor}' forces rest in the pneumogastric and its 
ramifications. An irritation of the vagus slackens the movements of the 
heart in frequency, but a division of the vagi increases this frequency for 
the reason that then the exitor nerves have no restraining power to over- 
come. 

The blood too, as regards its quantity, as well as its quality, has a 
powerful influence on the action of the heart. 

The Special Causes of palpitation are mental excitements of all 
kinds, such as fear, joy,, anger and the like; diseases of the brain and spinal 
cord of various kinds, amongst them: hyperaemia and inflammation of these 



THERAPEUTIC HINTS TO NERVOUS AFFECTIONS OF THE HEART. 411 

organs, psychoses, hypochondria, hysteria, exhaustion from protracted night- 
watching, or venereal and other excesses; diseases of the abdominal cavity, 
such as accumulation of gas in the intestines, worms, gall-stones, renal cal- 
culi and affections of the genital apparatus; partial hyperaemia from sup- 
pressed menstrual or haemorrhoidal flow; chlorosis and anaemia, and first 
stages of consumption, gout and different drugs, especially alcohol, coffee, 
tea and tobacco. 

Nervous palpitation of the heart is at times attended with dyspnoea, dis- 
tress and even pain in the chest, with throbbing of the carotids, flushing of 
the face, or (oftener) with pallor and cold sweat, with dizziness, faintness, 
and specks or flashes of light before the eyes. Some persons cannot lie 
down, must sit up, or cannot lie on the left side. Auscultation often reveals 
the first sound increased and of a metallic quality; " the second sound is 
wanting only in cases of tremendous acceleration of the heart's movements, 
where the heart has not had time fully to complete its diastole." 
(Schroeter. ) 

After the attack the absence of murmurs, or of enlargement of the heart, 
establishes its Diagnosis. The presence of a diastolic murmur excludes the 
diagnosis of a simple nervous palpitation, because such murmurs never occur 
without organic changes in the heart. 

Its Prognosis depends entirely on the nature of the underlying cause; 
if that is removable, its effect will cease. In old people with atheroma of 
the arteries, it may end with apoplexy. 

Therapeutic Hints. 

Aeon. In young subjects; after fright; after wine. 

Arsen. After suppressed herpes circinatus and suppressed perspiration 
of the feet. 

Aurum mur. Palpitation, sleeplessness, depression of spirits, with 
thoughts of suicide, constipation. Motion, wine or beer have no influence. 

Asaf. In women, after suppressed discharges, or bodily exertions, with 
small pulse; breathing not oppressed. 

Be Had. With congestion of the head. 

Benz. ac. Worse at night and when lying; alternating with tearing 
rheumatic pains in the extremities. 

Cad. grand. Palpitation is preceded by rumbling in the stomach; 
pains in shoulders and arms; change of life. 

Calc. carb. After suppressed eruptions and pimples on the face; onan- 
ism. Cold lower extremities; vertigo on going up stairs, or up a hill; bloat- 
ing in the pit of the stomach; craving for boiled eggs; copious menstruation. 

Camphora. When attended with coldness of the skin; cold extremities; 
pale face; and sudden oppression of breathing. 

China. Great weakness from loss of vital fluids; long-continued nurs- 
ing. 

Coccul. Tremulous palpitation from quick motion and mental excite- 
ment with dizziness and faintness. 



412 AXGIXA PECTORIS. 

Coffea. After excessive exaltation, joy, surprise. 

Digit. Attended with apncea, danger of suffocation; yellow and blue 
face, worse from motion, from moving the arms. 

Ferrum. Anaemia; throbbing in all the blood-vessels; soft bellows- 
sound at the apex, with anxiety in chest and heat rising from pit of stomach; 
with fear; after bodily exercise; also must move about, can neither sit nor 
stand. 

Graphit. Amenorrhcea; pimples on the face about the menstrual period. 

Kali card. Throat feels as if squeezed, as if the lungs came in the 
throat; stitch-pain and anxiety in pit of stomach and through the chest; 
pale grayish color of the face; dizziness in walking; cold feet; scant}' 
menses. 

Merc. sol. Wakes with nervous trembling; thumping of the heart and 
agitation as if he had been frightened; weakness at the heart as if dying. 

Moschus. When combined with hysterical symptoms. 

Nux mosch. Paroxysms after midnight, as if the heart were stopping, 
and then beating violently, with loud belching; better from drinking hot 
water and keeping warm; must walk about. Hysteria. 

Nux vom. After coffee, wine, liquors, spices. 

Nab . mii?\ Fluttering, long-standing chlorosis, with torpid skin and 
suppressed menses. 

Nitr. ac. When caused hy the slightest mental excitement. 

Opium. After alarming events, causing fright, grief, sorrow, etc. 

Phosphor. Dyspnoea, tightness across the chest, great weakness, and 
after any little mental excitement; violent hammering in the chest, aggra- 
vated by motion, benumbing all over. 

Phosph. ac. In children and young persons who grow too fast; after 
self-abuse, long grieving. 

Pulsat. Young girls during the time of puberty; from suppressed 
menses. 

Rhus tox. Always worse when being quiet. 

Secale. With profuse menstruation of a watery discharge; after sexual 
excesses; comes in paroxysms with spasmodic shocks from right side of chest 
into right arm and leg; coldness and numbness of right hand and stinging 
in fourth and fifth fingers; worse at night, after each meal; better in 
open air. 

Sepia. Tremulous, intermitting pulsation; suppressed menstruation. 

Silic. Always after quick or violent motions, such as playing ball, etc. ; 
panaritia. 

Thea. After exciting talk and mental exertions, with sleeplessness. 
Ver. alb. Headache, nausea, vomiting, diarrhoea; bleeding of the nose 
occasionally; cold perspiration on forehead. 

Angina Pectoris, Stenocardia, 

Is characterized by: " Pain in the region of the heart, occurring in parox- 
ysms, which usually radiates over the left side of the thorax and the left 



THERAPEUTIC HINTS TO ANGINA PECTORIS. 413 

arm, more rarely over both sides and arms; the pain is associated with pecu- 
liar sensation of anxiety and constriction, and often also with other motor, 
vasomotor and sensitive disturbances." (Eulenburg. ) 

It is often complicated with organic diseases of the heart, such as: faults 
in the valves, or fatty degeneration of the heart, or atheromatous processes 
in the aorta, or ossification and contraction of the coronary arteries. In its 
real nature, however, it is a neurosis and may be classed according to its 
symptomatology, with the visceral neuralgias, including cardialgia, colic, 
hysteralgia, etc. For this reason it may be divided: 

1. In a Ganglionic angina pectoris, when there is either an irritation of 
the excitomotor nerves with acceleration of the pulse, or a paralysis of the 
same with retardation of the pulse. 

2. In a Regulator angina pectoris, when there is either an irritation of 
the vagus with retarded but full and hard pulse, increased force of impulse 
of the heart, sometimes a temporary arrest of the same and disturbance of 
phonation and deglutition; or, more rarely, a paralysis of the vagus with 
acceleration of the pulse. 

3. In a Reflex angina pectoris, when there is a reflex neurosis of the 
vagus from diseases of the abdominal organs with the symptoms of irritation 
of the vagus. 

4. In a Vaso angina pectoris, when there is either an irritation of the 
vasomotor nerves which run in the sympathetic, with contraction of the 
vessels and increased pressure causing arterial anaemia, paleness and coldness 
of the skin and but little acceleration of the pulse, if any; or, more rarely, a 
paralysis with opposite symptoms. 

These principal t}'pes will, in given cases, not always be so clearly ex- 
pressed, that a recognition or distinction between them could be called an 
easy matter; the great variability of the circulatory symptoms during an 
attack of angina pectoris, on the contrary, hints to the possibility that there 
exist manifold complications between these diiferent types. Of greater prac- 
tical importance, however, is it to find out whether these attacks be com- 
plicated, as they often are, with an organic disease of the heart, or of an 
abdominal organ, or whether they be a pure neurosis. If the latter, the 
prognosis is more favorable than in the case of such complications where it 
entirely depends upon the nature of the latter. 

Therapeutic Hints. 

B. T. Blake advises the patient on the advent of an attack to take a deep 
inspiration, and if possible to hold the breath; to use no tea, tobacco, etc., 
and to avoid all unusual exertions or violent emotions. 

Kafka gives the following hints: 

Aur. mur? Where there is hyperemia in consequence of stagnation of 
blood in the heart. 

Glonoin? As an intercurrent remedy to prevent the orgasm from get- 
ting accustomed to the influence of Aur. mur. 



414 THERAPEUTIC HINTS TO AXGIXA PECTORIS. 

Agar.'' In the gastralgic or spasmodic form. 

Kali curb. When Agar, seems to lose its favorable influence; in other 
cases, however, Card, veg., or Lad. vir., or Lycop., are better indicated than 
Kali carb. 

Sambuc} Where the pressure proceeds from the spine; in individuals 
formerly fat and robust and now emaciated in consequence of mental emo- 
tions or sexual indulgence. 

Phosphor;' As an intercurrent remedy, if the pressing pain is worse 
under the sternum. 

Petrol. 7 ' If the pressing pain is worse between the shoulder-blades. 

Kali carb. Is likewise indicated in this form, either alone or in alter- 
nation with the above. This change of remedies is best resorted to after eight 
or twelve days, if improvement seems to come to a standstill. 

Chin, sidph. Where marasmus is a prominent symptom. So may also 
Phosphor., or Cuprum, or Ipec, or Veratr., be indicated. 

Arsen., Laches., Chin, ars., are indicated when dropsical symptoms, 
with venous hyperaemia and cyanosis make their appearance. 

Nux vom., Carb. veg., are important when there is loss of appetite and 
accumulation of £as in the bowels. 



&' 



The following remedies have also proved beneficial: 

Aeon. Anxious restlessness with fear of death; general and local 
tingling. 

Amy I. 7iitr. 

Arnica. Bruised pain in region of heart; fatty degeneration. 

Arsen. Anxious restlessness with great weakness; great thirst, but 
drinks little at a time; great oppression; attacks worse after midnight; worse 
from motion. 

Cact. grand. Suffocating constriction at throat, with full, throbbing 
carotids; wants to lie perfectly quiet on the back; mental or physical exer- 
tion causes palpitation; attacks come on also in sleep with anxious and 
frightful dreams. Fear of some organic lesion of the heart which will cause 
sudden death. 

Coca. A girl, climbing a mountain, was seized with an attack and be- 
came quite cold. (Richter. ) 

Cuprum. Attacks from excitement and exertion; slow pulse. 

Digit. Indescribable deathly anguish; death-like feeling in pit of 
stomach; vertigo and fainting. Pulse feeble, irregular, slow, intermitting; 
heart's action more vigorous than pulse. 

Diosc.vill. Neuralgic pain in stomach ; cannot speak; laborious breath- 
ing; sudden severe pain in middle of sternum, extending to both arms and 
hands; cannot move; cold, clammy sweat all over; impulse very feeble; 
pulseless. (F. E. Brown.) 

Hcpar. When after the attack: dyspnoea; dry, nervous cough all night; 
pain in neck; faintness and inability to recline. 



DISEASES OF THE AORTA. 415 

Laches. Choking constriction and rising in the throat; worse after 
sleep. 

Lact. vir. Tightness and oppression of the chest waking from sleep; 
feels as if suffocating, must get out of bed. 

Lauroc. Suffocation and gasping for breath; violent pain in stomach 
with loss of speech; eructations tasting of bitter almonds; cold, moist skin; 
convulsions of the muscles of the face. 

Naja trip. Similar to Laches. 

Ox. ac Violent irritation of the alimentary canal; costiveness; diffi- 
culty of breathing; jerking inspiration, and sudden and forced expiration, as 
though the patient made a sudden effort to relieve himself of intense pain by 
expelling the air from the lungs. Oppression of the chest, especially towards 
the right side; pain on expiration; sharp, darting or lancinating pains in the 
heart and left lung, also in the arms; jerking pains like short stitches, con- 
fined to a small space, lasting for a few seconds. Numbness and weakness 
in back and limbs; peculiar numbness of whole body, approaching to palsy; 
coldness and complete loss of power of motion in the limbs. Movement ex- 
cites and aggravates pain. Periodical remission for some hours or days. 
After other remedies had failed. (P. Dudley.) 

Phytol. Pain goes to the right arm, or right side. 

Rhus tox. Pain extending to the left arm; painful stiffness all over, 
worse in rest. 

Spigel. Exceedingly sharp pain worse from any motion; frequently 
indicated; also in complication with other heart affections. 

Spongia. Suffocating spells at night; worse with head lying low; has 
to sit up. 

Tabac. Neuralgia up into the neck; pain between the shoulders; pulse 
small, irregular, imperceptible; lividity of the skin; features drawn. Deathly 
nausea with cold perspiration. 

Ver. alb. Periodical attacks of crampy pain in left chest; or cutting 
pain with excessive agony, extending to the shoulders; general prostration, 
skin cold and clammy. 

To all these may be added for further consideration: Amm. carb., 
Amy I. nitr., August., Apiol, Arg. nitr., Act. rac, Bellad., Bryon., Cinchona, 
Caustic, Hydr. ac, Ipec, Juglans ci?i., Moschus, Sepia, Stramon., Sulphur 
and Tar ant. 

V. DISEASES OF THE AORTA. 
Aneurism of the Thoracic Aorta. 

Aneurism means a dilatation of a short piece of an artery forming a 
kind of sac at that place. Such dilatations are more frequently found in the 
aorta ascendens than in the aorta descendens. It can be diagnosticated only 
when it reaches the exterior thoracic wall. In such a case it renders that 
part of the chest perfectly dull on percussion and more resisting to the touch. 



41 6 INFLAMMATION OF THE DIAPHRAGM. 

Also, we often observe on that part a pulsating swelling with a peculiar kind 
of purring in it, which extends up into the carotid arteries. We find this 
swelling on the right side of the sternum, between the second and third rib, 
if the aneurism is an enlargement of the convex part of the aorta. It makes 
its appearance, however, on the left side of the sternum in the same intercos- 
tal space when the aneurism has formed on the concave part of the aorta. 
Its symptoms are; palpitation of the heart, dyspnoea, asthma, bronchial ca- 
tarrh, haemoptoe, swelling of the jugular veins, with cyanosis, oedema of the 
upper extremities, difficulty in swallowing, hypersemia of the brain — all 
symptoms in consequence of its pressure either upon the lungs or the oesopha- 
gus, and in consequence of disturbed circulation. 

The aneurism of the arch of the aorta has its seat behind the manubrium 
sterni, and a deep pressure with the finger into the fossa jugularis may detect 
its pulsation and purring. 

The aneurism of the aorta descendens must be very large in order to 
cause a duller sound on percussion, or swelling between the left shoulder- 
blade and the spine. Its symptoms are the same as those of aneurism of the 
ascending aorta; and, in addition, it may cause paralysis of the lower ex- 
tremities, rectum and bladder. 

Therapeutic Hints. 

Ergot. Has been used hypodermically with success by Yon Langen- 
beck "' on account of its power to contract muscular fibres. Two cases (both 
women I of aneurism of the mesenteric artery are reported as having been 
cured by Secede™. (T. M. Pearce, Med. Inv., 1875, Vol. I., p. 48.) 

Gallic ac. In drop doses of the tincture cured a case of aortic aneurism. 
( Helmuth , Gilchrist . ) 

Evcop 11 . Is reported by R. Hughes as having cured a carotid aneurism 
in four days. {British Journal, 70, p. 792.) 

Spigel., then Carb. i'eg., and later Bryon. and Spigel., have cured a 
thoracic aneurism. ( C. F. Nichols, Xezc Eng. Gazette, March, 1873, p. 
106.) 

Spongia. Has relieved the paroxysmal, dry, suffocative cough, coming 
at irregular intervals, especially on lying down or drinking hot tea, also a 
distressing fullness in the stomach after eating which attended an aneurism 
of the descending aorta. < T. C. Fanning, Amer. Jour, of Horn. Mat. Med., 
Vol. III., p. 10.) 

To finish the morbid affections of the thoracic organs I have yet to speak 
of the affections of the diaphragm, that muscle which forms the partition be- 
tween the thoracic and abdominal cavity, and which participates greatly in 
the acts of respiration. 

1. Diaphragmitis, or Inflammation of the Diaphragm. 

The substance of the diaphragm being a muscular, tendinous tissue, is 
scarcely ever primarily affected, while its serous lining on its upper surface, 



THERAPEUTIC HINTS TO INFLAMMATION OF THE DIAPHRAGM. 417 

a continuation of the pleura and pericardium, and on its lower surface a con- 
tinuation of the peritoneum, frequently participates in inflammations of these 
membranes. Symptoms, such as impossibility of taking a deep breath, hic- 
cough, yawning, risus sardonicus, pain in the shoulders, vomiting of green 
masses, great difficulty in swallowing, even hydrophobia, denote in pleuritis, 
pericarditis, or peritonitis, an extension of the inflammatory process to the 
diaphragm. 

Physical signs, are none. 

Therapeutic Hints. 

Aco?i. Hard, feverish pulse; thirst; anxious impatience; restless toss- 
ing about; painful cough; difficult} 7 in breathing, and pain and heat in the 
upper region of the abdomen. 

Apis. Burning pain; must bend forwards from a contractive pain in 
the hypochondria. 

Bellad. In plethoric persons with sympathetic affection or inflamma- 
tion of the liver; or in consequence of concrements in liver or kidneys; in 
pylephlebitis; in puerpural affections; in violent headache with active 
hyperemia. (Buchner.) 

Bryon. Stitching pain in the region of the diaphgram, worse from any 
motion, from coughing; white, dry tongue without thirst, or else great thirst 
with drinking large quantities of water. 

Cad. grand. Feeling as of a cord around hypochondria; congestion to 
the chest; shooting pains through to the back and up each side of the chest; 
cannot lie down; dry, tickling cough as from dust in throat. 

Chamom. Throbbing, burning pain in the region of the short ribs and 
pit of the stomach, worse from pressure; short and anxious breathing; short, 
dry cough; vomiting; belching; restlessness; tossing about; loud complain- 
ing, etc. 

Colchic. Similar to Bryon., for gouty persons; albuminuria. 

Digit. After pleuritis; grasping pain; nausea and vomiting; oppression 
in middle of the chest, difficult breathing; pulse at first suppressed, then 
quick; nails blue; face long and cold. In spite of ansemia the patient can 
bear no high temperature. Better in sitting than in lying. (Buchner.) 

Dulcam. In rheumatic affections of the spinal cord. (Buchner.) 

Hepar. After Bryon., in fibrinosis, promotes resorption. (Buchner.) 

Lycop. Sense of constriction from the right side all around the short 
ribs; cannot stretch himself or lie upon the back; neither stand upright. 

Nux vom. Muscular pain of a grasping, rooting nature, with nausea or 
vomiting. 

Rims tox. Worse when lying still; or disposition to move notwithstand- 
ing the pain caused by it; commencing on the left side and going to the 
right. 

Str anion. Mixture of hyperemia and spasm in consequence of affec- 
tions of the spine and the diaphragm with hiccough, sympathetic spasms of 
the epiglottis and the similar symptoms. (Buchner.) 
27 



41 8 SINGULTUS. 

Sulphur after Bryon., in fibrinosis, promotes resorption. 

Tabac. Muscular pain caused by renal calculi when incarcerated in 
one of the ureters; it contracts the longitudinal (Be/iad., the circular) fibres. 
(Buchner.) 

Compare Pleuritis and Peritonitis. 

2. Singultus, Hiccough. 

Hiccough consists in a spasmodic contraction of the diaphragm, by 
which the air is suddenly drawn in, causing that sound peculiar to hiccough. 
Its causes may be of a cerebral origin, as in diseases of the brain; it may be 
the consequence of anaemia from long-standing, weakening diseases, after 
great loss of blood and vital fluids; of strong mental affections, like fright, 
anger, etc. 

Or, it ma}* be a mere reflex from diseases of the pleura or pericardium; 
or it ma}* accompany different affections of the stomach, the liver, the intes- 
tinal canal. If it takes place in consequence of exhausting diseases, like 
morbus Brightii, tuberculosis, typhus, cholera, pleurisy, with abundant exu- 
dation, large abscesses, etc., it is always a dangerous symptom, continues for 
days and may be the forerunner of a fatal issue. According to the different 
causes many remedies may be indicated. 

Therapeutic Hints. 

Buchner gives the following: 

Arsen. After cold fruit. 

Hyosc. When there is inflammation of intestinal organs. 

Ignat. Especially in children. 

Nux vom. After cold drinks. 

Pulsat. After cold fruit. 

Ruta. When associated with depression. 

Str anion. In the most obstinate forms; in children when attended with 
restlessness in the night and screaming during sleep. 

Ver. alb. After hot drinks. 

Also the following remedies may come into consideration: Amy I nitr. y 
Bismuth., Curb, veg., Crot. tigl., Ferrum, Laches., Marum ver., Moschus. y 
Niccol., Ranunc., Ratan., Staphis., Zincum. 

3. Neuralgias of the Diaphragm 

Require Atrop., Rhus tox., Mezer. ; in inveterate cases: Silic. ; in inter- 
mittent cases: Ignat. and the Alkalies in combination with arsenious acid. 
(Buchner.) 

4. Rupture and Perforation of the Diaphragm. 

Ruptures are caused by violent concussions or heavy lifting; whilst 
perforations are the result of suppurating processes either in the thoracic or 



RUPTURE OF THE DIAPHRAGM. 419 

abdominal cavity. When ruptures take place from out of the thorax they 
are generally attended by dyspnoea, cough, hiccough, suffocating spells and 
fainting. When from out of the abdomen, by vomiting, colic, obstinate con- 
stipation. 

Perforation takes place from suppurating processes in the thoracic cav- 
ity; for example, in consequence of pyothorax; when the fluid discharges 
into the abdominal cavity it causes peritonitis. 



ABDOMEN 



When we examine the abdomen by sight or inspection, we have to take 
into consideration the following conditions: 

1. Its appearance in regard to size. 

a. Enlargement of the abdomen may be partial or general. 

Partial enlargement depends upon abnormal sizes of the abdominal vis- 
cera; either the stomach, liver, spleen, uterus, ovaries, kidneys, glandular 
structures, bladder, and so on. Also upon pathological products, as tumors 
of all kinds, encysted exudation, extra-uterine pregnancy, hernia, and so on. 

General enlargement may arise from ©edematous infiltration of the 
abdominal walls; or from accumulation of fat in the subcutaneous cellular 
tissue, and the omentum; from an accumulation of gas in the stomach and 
intestines; from a collection of gas or fluid in the peritoneal sac; from large 
tumors, which fill the whole abdominal cavity; from pregnane}- , and some- 
times in consequence of frequent pregnancies, the so-called pot-belliedness, 
and likewise in scrofulous children from enlarged mesenteric glands. 

b. The abdomen appears smaller — sunken in — sometimes to such a 
degree that the spinal vertebrae may be felt through the abdominal walls. 
This we observe in persons' who have been starving for a considerable time ; 
also in cases of general marasmus; in strictures of the oesophagus, the cardia, 
the pylorus, or the duodenum; after severe and long-continued diarrhoea 
and cholera; it is also a sign of painter's colic from poisoning with lead, and 
quite characteristic in brain diseases, especially tubercular meningitis. 

2. Its appearance in regard to motion. 

a. Respiratory motion. The diaphragm, moving up and down, makes, 
as we know, the abdomen participate in the respiratory motions of the chest. 

This respiratory motion of the abdomen is increased in such affections 
of the chest as prevent a normal extension of the thorax, as pneumonia, 
pleurisy, etc. 

It is decreased, or ceases altogether, in inflammation of the peritoneum, 
in large effusions of fluids or gas in the abdominal cavity, in consequence of 
large tumors which fill the abdomen, and also from injuries of the dia- 
phragm. 

b. Pulsation. We observe it generally in the pit of the stomach, some- 
times lower down, nearly to the umbilical region, rarely below the navel. 

This palpitation may have different causes: 

i. Abnormal position of the heart, its apex lying towards the pit of the 
stomach. In this case we hear, on auscultation, both ticks of the heart, or 
noises, if there are any, in the pit of the stomach and not at the normal place 
below the nipple. 



ABDOMEN. 42 1 

2. It is caused by the right ventricle, which communicates its motion to 
the left lobe of the liver. In this case we hear also, on auscultation, both 
ticks of the heart at the pit of the stomach, and at the same time at the 
normal place. 

3. It is caused by the descending aorta, and the pulsation extends then 
further down towards the navel. In this case we hear, on auscultation, only 
one sound, or one noise, if there be any; this, however, appears a little later 
than the impulse of the heart at its normal place. 

The causes of this abdominal pulsation may be — 

a. Relaxed and thin abdominal walls; collapsed state of the abdomen. 

b. A curvature of the spine forwards, whereby the aorta comes nearer 
to the abdominal walls. 

c. A thickened left lobe of the liver. 

d. Increased impulse of the heart, as in hysteric individuals; or hyper- 
trophy of the left ventricle in consequence of insufficiency of the aortic 
valves. 

3. Its appearance in regard to the elasticity of its external walls. We 
find it greatly relaxed, hanging down like a loose sack, in old women, or in 
those who have given birth to many children; also after absorption of 
large quantities of fluids, by which the abdominal parietes had been largely 
distended. 

A similar effect is produced by a large accumulation of fat within the 
subcutaneous cellular tissue. 

Great distention of the abdomen, especially pregnancy, sometimes 
causes the straight muscles of the abdomen (the m. recti) to be driven 
asunder, so that a space of several inches occurs between them, which is very 
thin, consisting merely of the fasciae of the oblique muscles, the peritoneum, 
and the external covering; whilst the recti muscles lie on the sides of the 
abdomen, forming there a pad-like protuberance. The thin, yielding space 
in the middle between them, however, bulges out as soon as the person as- 
sumes a standing position, not being strong enough to keep the abdominal 
viscera in their normal position. 

4. Its appearance in regard to the development of its subcutaneous veins. 
We observe these veins largely distended whenever there exists an obstacle 
to the free circulation of the blood through the vena cava inferior. This 
may be caused by stricture or obliteration of the vein itself, or by pres- 
sure of enlarged abdominal organs, or abdominal tumors upon it. Some of 
the blood which cannot pass there is brought by way of the venae inter- 
costales, mammarise or axillares, from the lower portion of the bod} T into the 
superior vena cava. 

The so-called Caput Medusae, which is a network of enlarged veins 
around the navel, arises from the umbilical vein, which has not become 
obliterated. 

5. Its appearance in regard to changes of color. Here I have to men- 
tion the straight line which we observe in pregnant women, extending from 



422 SPECIAL FORMS OF ADOMIXAL DISORDERS. 

the navel to the symphysis pubis, either of a pale yellowish, brownis hor 
even blackish color. This line has been observed quite exceptionally, how- 
ever, in men, children and also such women as never had been pregnant. 
We sometimes observe also, whitish or bluish- white stripes like cicatrices on 
the sides of the abdomen, which are generally signs of a previous pregnane}', 
as other distentions of the abdomen rarely cause them. 

On further examination of the abdomen by means of Palpation, we may 
learn, first, the seat of the, affection. 

a If in the abdominal walls, we are able to raise the affected part during 
a relaxed state of the abdomen; or if the abdominal walls be put upon 
the stretch, we shall observe the swelling in it becoming more prominent. 

b. If the seat of the affection is in one of the abdominal organs, the 
swelling feels deeper and cannot be raised by lifting the relaxed abdominal 
walls. In order to decide which organ is affected, we, of course, must be 
entirely familiar with the normal positions of these different organs. 

Palpation teaches further the nature of the swollen parts in the 
abdomen. 

A solid swelling we feel as such, whilst a fluid exudation gives to the 
examaining hand a sense of fluctuation; provided the sac which contains it be 
not too much distended, in which case it feels as solid and hard as a stone, 
and without any fluctuation. 

Palpation is also important to become certain of the character of pain 
which the patient experiences on pressure. 

If the pain is increased by slight pressure and ameliorated by gradual 
deeper and deeper pressure, the affection is mostly of a nervous nature. 
When, however, the pain increases as the pressure is increased, generally it 
indicates an inflammatory affection. Pressure upon the stomach frequenth* 
causes sickness and belching; pressure upon the colon, desire for stool; and 
pressure upon the bladder, desire to urinate. 

Percussion gives a tympanitic tone whenever there is gas or air in the 
abdomen, unless the enclosed walls are too greatly distended; and a dull 
tone wherever there are solid bodies or fluid effusions in the abdomen. 

In this way we are enabled to determine the extent of the enlarged 
liver, spleen, hardened stomach, tumors and fluid effusions of the peritoneum 
or ovaries; also, the accumulation of gas in the stomach and intestines, or 
the peritoneal sac. 

Auscultation teaches very little, except what I have mentioned already , 
in regard to the visible pulsation of the abdomen. Fcetal pulsations. 

a. SPECIAL FORMS OF ABDOMINAL DISORDERS. 

There are many organs in the abdominal cavity; each of them may be 
differently affected; consequently the special forms of abdominal affections 
must amount to quite a considerable number. 

I shall speak at first of the pathological conditions of the stomach. 



DYSPEPSIA. 423 

Dyspepsia, Indigestion. 

Dyspepsia signifies difficult digestion; indigestion implies a failure to 
digest. If we consider for a moment all the causes by which dyspepsia may 
be brought about, we will comprehend at once the wide mouth and the big 
belly of that bag which is called dyspepsia. Still, if, according to Pope, 
"One truth is clear, whatever is, is right," I shall not attempt to destroy 
this convenient bag, but shall merely endeavor to divide it, for a more intelli- 
gent use, into the following four departments: 

1 . Dyspepsia may be caused b}' anatomical changes in the digestive ap- 
paratus, such as catarrh, inflammation, thickening, ulceration, eruptions on 
the membranes of the stomach. 

2. D}'spepsia may be caused by quantitative or qualitative alterations of 
the digestive secretions, such as alteration of the gastric juice, of the secre- 
tion of the pancreas, or of the secretions of the liver and of the intestines. 

3. Dyspepsia may be caused b}^ an abnormal condition of the nervous 
system, as we observe in consequence of mental excitement, of too great 
mental exertion, and all such influences as disturb the normal action of the 
nervous system. It is a notable symptom of neurasthenia. 

4. And lastly, dyspepsia may be caused by the use of irritating or stim- 
ulating food or drink; so that we find a whiskey-dyspepsia, a pepper-and- 
mustard-dyspepsia, a coffee-dyspepsia, and all sort of other dyspepsias, 
among which we ought not to forget the ice-cream dyspepsia and the sugar 
dyspepsia. 

The symptoms of a disease which has so many different causes, must, 
of course, be variable, and I shall try to state only its most prominent 
features. 

Dyspepsia is characterized by — 

1. Want of appetite, or morbid appetite: craving for sour, acrid, spicy 
things, etc. 

2. Accumulation of wind in the stomach, and, in consequence of which, 
belching, oppression, palpitation of the' heart. 

3. Formation of acids in the stomach, and, in consequence, sour, rancid 
eructations, pyrosis or heartburn, waterbrash. 

4. The food may not digest at all, causing vomiting or diarrhoea. 

5. The pit of the stomach is mostly sore to the touch; very sensitive to 
the pressure of clothes; it feels full, and is oftentimes swollen. 

6. The patient feels unfit for mental and bodily work: he is morose, irri- 
table, sleeps badly; and, if asleep, his sleep is full of dreams. 

7. His face shows a relaxed, tired, weary, sad expression, with sunken, 
dull eyes; pale grayish or yellowish color and pale lips. 

8. His hands and feet are generally cold, and he is very sensitive to the 
cold. 

9. Gradual falling away in flesh and strength. 



424 vomiting. 

Therapeutic Hints. 

When we find, in an acute disease, a patient strongly craving a particu- 
lar thing to eat or drink, it is well and wise for the physician to satisfy this 
desire. In chronic cases, however, such as dyspepsia, which may have grown 
big by yielding to morbid desires, it is absolutely necessary to strictly forbid 
the use of all irritating nourishment, otherwise we feed the animal which we 
want to destroy. 

For special hints, compare Gastric Catarrh, acute and chronic; Liver 
Affections, Pancreatic troubles, Neurasthenia, etc. 

Vomiting. 

Vomiting consists pathologically in an antiperistaltic contraction of the 
stomach, and a spasmodic contraction of the diaphragm and abdominal mus- 
cles, caused either by a direct influence of the brain, or, which is much more 
frequently the case, an irritation of the nervus vagus, either in the stomach 
or in the pharynx, or by irradiation — (sympathetic). 

In cases of sudden and violent vomiting, especially if it happens to other- 
wise healthy persons, we ought to think: 

Of poison: to ascertain which we must examine chemically what the 
patient throws up or what remains of what he partook. It may be arseni- 
cum, corrosive sublimate, nitrate of silver, zincum, or stannum, tartarus 
emeticus, phosphorus, iodine, different kinds of acid, sulphuric, nitric, or 
muriatic, alkalies, as caustic potash, or vegetable or animal poisons. 

Of pregnancy: it sets in sometimes immediately after conception, some- 
times not before the first menstrual discharge should come on and does not. 
It lasts, in many cases, through the first half of pregnancy, in some longer, 
and in some it passes over quickly or does not set in at all. During partu- 
rition I have frequently observed vomiting shortly before the birth of the 
child. 

Of incarcerated hernia, intussusception, or invagination, which is gener- 
ally attended with obstinate constipation. 

Vomiting from affections of the stomach may have its cause in a simple 
overloading of the stomach with indigestible food, or in catarrh of the mu- 
cous membrane of the stomach; for example, in drunkards; or, in an ulcer- 
ated state of this membrane, and in cancer of the stomach. 

Vomiting may also be caused by diseases of the peritoneum and intesti- 
nal canal; from affections of the liver, spleen, pancreas, and urinaty organs. 

Sometimes it ma}' be merely the effect of the mechanical concussion 
during hard coughing, laughing, etc. 

Vomiting from affections of the brain is found in consequence of exter- 
nal injuries of the head and concussion of the brain; may be caused by 
strong impressions upon the sensorial and sensitive nerves; the swinging 
motion of a ship, seasickness, etc. ; is found in hypersemia and anaemia of 



ACUTE CATARRH OF THE STOMACH. 425 

the membranes of the brain; in inflammation of the brain and its membranes; 
in different organic diseases of the brain; in megrim and sick headache. 

Therapeutic Hints. 

If vomiting be caused by poison, the poison should be removed or 
neutralized as soon as possible. The stomach-pump is often greatly prefer- 
able to emetics. 

The antidotes of the different poisons may be found in the Materia 
Medica, and they are well arranged in Dr. Hering's " Domestic Physician." 

If it be caused by an incarcerated hernia, the hernia sac should be put 
back by taxis or surgical operation. Compare: 

Aeon., Lycop., Nux vom., Opium., Plumbum, Sulphur, Tabac. 

For vomiting in pregnancy, Nux vom., Veratr., and many others. 

Stramon. Vomiting of grass-green masses, aggravated by raising the 
head, and, at times, by light. (S. A. Jones.) 

For all other kinds of vomiting we must select the remedy in accordance 
with the indications in each individual case, and its underlying cause. 

Acute Catarrh of the Stomach, Gastritis. 

Pathologically gastritis is similar to catarrhal inflammation of any 
other mucous membrane. We observe redness and velvet-like swelling of 
the mucous membrane, which is oftentimes covered with a tough, transparent 
or whitish-gray slime. In severe cases the mucous membrane appears sof- 
tened so that it may easily be scraped off like a mushy covering; but this 
change may be the result of self- digestion after death, due to the specific 
contents of the stomach. (Compare Softening of the Stomach.) 

Primarily, catarrh may be caused by taking cold or getting wet, like 
any other catarrh; but principally it is caused by either too cold or too hot 
food or drink; or certain kinds of food, like too fat or old meat and fish, 
pork sausages, cheese, alcoholic drinks, ice cream, ice water; iced milk is 
still worse than ice water. 

Starvation is not less a cause of it. Also mental exertions and excite- 
ment, fright, grief, worriment and the like may cause it. 

Secondarily, we find it in combination with the perforating round ulcer of 
the stomach; cancer of the stomach; as a continuation of inflammation of 
the fauces and the oesophagus; inflammation of the intestines; or as a con- 
comitant of typhus, pneumonia, exanthematic fevers and erysipelas. 

The heat of the summer is most favorable for its development ; no doubt 
on account of the free use of ice water in a heated stomach; but it also fre- 
quently occurs in spring and fall. 

Symptoms. — The patient is morose; feels weak and chilly, with paleness 
of the face and cool extremities. The chilliness alternates with flushes of 
heat, red face and febrile motions. The pit of the stomach feels full, and sore 
to the touch, so that even the pressure of the garment feels uncomfortable- 



426 THERAPEUTIC HINTS TO ACUTE CATARRH OF THE STOMACH. 

The appetite is gone; thirst, however, is generally present. At the same 
time the patient feels nauseated; frequently gulps up a sour or flat-tasting 
fluid: and generation of gas in the stomach swells the region of the stomach 
and causes belching of wind. In the cases in which the catarrhal affection 
extends into the bowels, it causes rumbling flatulency, escape of fetid flatus, 
and mushy, fetid discharges. At the commencement of the disease the 
bowels are mostly constipated and the urine is dark-colored. Toward the 
close we frequently observe the formation of herpes labialis or hydroa. 

In some cases gastritis is attended with a higher or less degree of fever, 
and then it goes under the name of Gastric fever. The fever generally aug- 
ments in the first days, shows evening exacerbation, and may last from one 
to two weeks, when the patient gradually recovers. 

In other cases, which generally are characterized by great obstinacy, 
there is an abundant secretion of tough mucus, not only throughout the ali- 
mentary canal, but also in the bronchial tubes and the urinary organs. This 
form is known under the name of Febris mucosa. The patient becomes 
greatly exhausted and apathic, and after a slow recovery is very liable to 
relapses. 

Still another form is the so-called Bilious fever, when the gastric catarrh 
is complicated with an abundant secretion of bile. Here the pulse is much 
more frequent and the temperature much higher than in an ordinary gastric 
fever; there is vomiting of bitter and green masses; the liver is somewhat 
swollen, and a light icteroid coloring of the white of the eyes may appear, 
until finally, after a week's duration, the whole train of symptoms is wound 
up with a bilious diarrhoea. In the first days it is often difficult to discern 
between these forms of gastric catarrh and Typhoid fever. However, gastric 
fever is generally preceded by dietetic faults; its temperature ranges never 
very high, nor does it show the characteristic step-like increase of a typhoid 
fever temperature and the typhoid roseola, while the fever blisters around 
the mouth, a frequent occurrence in gastric catarrh, are extremely seldom 
met with in typhoid fever. 

Therapeutic Hints. 

Aeon. After taking cold; stitch-like, burning and pressing pain in the 
pit of stomach, with anguish and fear of death; fever, with great thirst and 
vomiting. 

Ant. crud. Total loss of appetite; tongue thickly coated, yellow or 
white; great thirst at night; nausea; belching, with taste of what had been 
eaten; vomiting; after bad, sour wine; after bathing. 

Apis. Painful sensitiveness in the pit of the stomach, with burning; 
painless, yellow diarrhoea. 

Arnica. After a blow or fall; sense of fullness in the pit of the stomach; 
belching, with taste of putrid eggs; hot head, remainder of body cool. 

Arsen. Nausea and vomiting, worse from rising up; quick prostration; 
anxious restlessness; great thirst, but drinking little at a time; after abuse 



THERAPEUTIC HINTS TO ACUTE CATARRH OF THE STOMACH. 427 

of ice, ice water, ice cream, vinegar, sour beer, tobacco (chewing), alcoholic 
drinks. 

Bel lad. Cutting pain in stomach, worse from motion and pressure; 
vomiting; gagging; hiccoughing; great thirst, but drinking makes it worse, 
consequently the patient abstains from drinking. 

Bryon. Stitching pain in the region of the stomach, worse from motion, 
and especially from a misstep; tongue coated; dry without thirst; or else 
great thirst day and night, and drinking large quantities; constipation. In 
warm weather and after eating of flatulent food. 

Card. veg. Great deal of belching, sour and rancid; burning in the 
stomach; bloatedness of the abdomen; disgust for meat; desire for acids; 
after debauch. 

Chamom. Bitter taste in the mouth; vomiting of bile or green "mucus; 
belching; rumbling in the bowels; hot and red face; much excited, as if 
beside himself; sleeplessness; after offence, vexation, anger. 

China. Feeling satiated all the time; however, when trying to eat, he 
can eat something, but feels bad afterwards and cannot say how; fullness in 
the stomach and bowels; belching; sour rising; cold feeling in the stomach, 
great lassitude and weakness. 

Euphorb. cor. Sudden nausea, vomiting and diarrhoea of watery fluid, 
with sinking, anxious feeling of the stomach; faintness; slow and weak 
pulse; cool skin; cool hands and feet, which become affected with cramps. 

Hydrast. Dull, aching pain in the stomach, which causes a very weak 
faintish feeling, "goneness" in the epigastric region; acidity; constipation. 
''After drugging." (W. Goodno.) 

Ipec. Constant nausea proceeding from the stomach, with empty eruc- 
tations and accumulation of much saliva; easy vomiting; diarrhoea; after 
eating sour, acrid things; sour, unripe fruit, berries, salads, etc. 

Iris ver. Great burning distress in the epigastric region; vomiting with 
diarrhoea, accompanied by great prostration; burning in the mouth, fauces 
and oesophagus; and headache. 

Kali carb. Emptiness and gone feeling in pit of stomach; after eating, 
fullness, heaviness and pressure in pit of stomach; vomiting; dry stool; tur- 
bid urine; constantly chilly. 

Lycop. Great fullness in pit of stomach, after taking the least food. 

Nux vom. Always after the use of tinctures, mixtures, tonics, vege- 
table pills, coffee, wine, condiments; after mental overexertions; in leading 
a sedentary life; bitter or sour taste; sour belching; fullness and pressure in 
the stomach; constipated bowels; dizziness, headache; irritable, cross; all 
worse in the morning, in the open air and after eating. 

Podoph. Food turns sour after eating; belching of hot flatus, which is 
very sour; great thirst; vomiting; the stomach contracts so hard and rapidly 
in the efforts to vomit, that the wrenching pain causes the patient to utter 
sharp screams; vomiting of bilious matter, mixed with blood. 

Pulsat. No appetite; no thirst; bitter taste in the mouth; everything 



428 CHRONIC CATARRH OF THE STOMACH. 

tastes bitter; dizziness when rising from a chair; chilliness; after fatty sub- 
stances — pork, pastry, rancid butter, etc. 

Rum ex. Shootings from the pit of the stomach into the chest in various 
directions; aching pain in the pit of the stomach, and aching and shoot- 
ing above it in the chest; fullness and pressure in the pit of the stomach, 
extending towards the throat-pit; it descends towards the stomach upon 
everj T empty deglutition, but immediately returns; flatulence; eructations; 
pressure and distention in the stomach after meals. 

Sa?igui?i. Xausea, with headache, chill and heat; vomiting, with 
severe painful burning in the stomach, and intense thirst; red tongue; red 
and dry lips; hot and dry throat; tickling cough. 

Sepia. Sensitiveness of the pit of the stomach to touch; bloatedness of 
the abdomen; congestion and heat of the head; headache; tongue coated 
without lustre; often sore and covered with little blisters on the edges and 
tip; sour smell from the mouth, and likewise of the urine, which is clear 
like water, or pale yellowish; constant drowsiness; anxious dreams, and 
great fever heat; especially in children from taking cold when the weather 
changes. 

Chronic Catarrh of the Stomach 

Is, in many cases, only a continuation of an ill-managed, acute attack, but it 
may grow out of too free a use of spirituous liquors, coffee, chewing and 
smoking of tobacco; it may have its origin in gluttony, sedentary habits, 
mental exertions, long-continued mental emotions, etc. 

Secondarily, it has been observed accompanying heart, liver, lung and 
pleural affections; anaemia, chlorosis, Bright' s disease, marasmus, tuberculosis 
gout, cancer, haemorrhoids. 

Its most permanent symptoms are, indigestion or dyspepsia, belching" 
after eating, mostly sour, and attended with heartburn; pressure and full 
feeling in the epigastric region, with actual distention of the same. 

Other symptoms are, nausea and vomiting, loss of appetite, or perverted 
appetite, or ravenous hunger, with gaping and faintness; after eating always 
pain in the stomach. Such patients feel weak; they are morose, irritable 
and quite sleepy through the day. By-and-by their skin becomes pale and 
dry, and they become emaciated. 

Its progress is a slow one, and whether curable or not curable, depends 
entirely upon its combination with other diseases. 

On the authority of Kafka I shall give the following therapeutic re- 
marks : 

Aching or burning pain in the pit of the stomach: increased from palpa- 
tion or pressure of the clothes; and distention of the epigastric region, 
Bel lad. y Phosphor., Arnica, Arsen. 

Aching in the pit of the stomach, not much increased by external 
pressure: Bellad., Phosphor., Hepar, Ignat., Nux vom., Arnica, Calca/., 
Ziiicum. 



GASTRITIS TOXICA SKU CAUSTIC A. 429 

Aching in the pit of the stomach, not increased by external pressure: 
Card, veg., China, Chin, sulph., Capsic, Nat?'. i?iur., Lycop., Sulphur. 

Sour stomach, with sour belching and taste, heartburn; gulping up and 
vomiting of sour matter: Nux vom., Calc. carb., China, Phosphor., Sulphur, 
Kalicarb., Carb. veg. 

Sour stomach always after eating: Nux vom., Kali carb., Natr. mur., 
Sulphur, Phosphor., Sepia. 

Rancid belching: Pulsat., Carb. veg., Magn. mur., Sulphur, Asa/. 

Foul belching: Sepia, Phosphor., Arsen., Arnica, China, Ferr. ac, 
Mercur. 

Much mucus in mouth and stomach: Pulsat., Amm. mur., Natr. mur., 
Arnica, Sulphur. 

Accumulation of bile in the stomach, with bitter taste, bitter belching, 
and vomiting: Chamom., Pulsat., Arsen., /pec, Nix vom., Veratr. 

Much wind in the stomach, with distention: Nux vom., Carb. veg., 
Ig?iat., Ar?iica, Sulphur, Arsen., Phosphor. 

Distention of the abdomen: Carb. veg., Nux vom., China, Arnica, Natr. 
mur., Phosphor., Sepia. 

Relief from Eructations: Laches., Carb. veg., Ignat., Lycop., Tart, 
emet., Nux vom., Sulphur. 

Relief from wind passing down: Nux vom., Carb. veg., Pulsat., China, 
Chamom., Lycop. 

Worse from accumulation of flatulence: Nux vom., Carb. veg., Pulsat., 
Ignat., Natr. mur., Phosphor., Arnica, China, Chamom., Kalicarb., Coloc. 

Slow digestion: Nux vom., Ignat., Phosphor., China, Opium. 

Total loss of appetite: Nux vom., China, Sepia, Natr. mur., A? r sen. 

Feeling of emptiness and hunger in the stomach without desire for food : 
Natr. mur., Opium, Arsen. 

Ravenous hunger: Nux vom., Calc. carb., China, Iodium, Natr. mur., 
Phosphor. 

Worse after eating: Nux vom., Calc. carb., Lycop., Phosphor., Natr. 
mur., Sepia, Sulphur. 

Disgust against meat: Sulphur, Sepia, Petrol., Mur. ac, Natr. mur., 
Carb. veg., Arsen. 

Sleepiness in the daytime: Natr. mur., Pulsat., Sepia, Calc carb., Carb. 
veg., Chinin., Kalicarb. 

Great weakness and loss of energy: China, Chin, sulph , Arsen., Phos- 
phor., Iodium, Ferr. ac 

Gastritis Toxica seu Caustica, Inflammation of the Stomach in 
consequence of Poisoning. 

Such poisoning is caused by concentrated or diluted mineral acids, caus- 
tic alkalies, salts and metals, acrid, vegetable or animal poisons, and ethereal 
oils. 



430 GASTRALGIA. 

Diluted mineral acids change the epithelium and the superficial layers 
of the mucous membrane of the stomach into a soft, brownish, even blackish 
mass. Concentrated mineral acids change all layers of the mucous mem- 
brane into a blackish mass; the other coats of the stomach become softened, 
and, in some rare cases, perforated — eaten through. The blood in the ves- 
sels of the stomach and in the adjoining larger vessels is black and tough, 
like tar. Caustic alkalies — for example, the Kali causiicum or Ammonium 
caustic urn — change the epithelium and the mucous membrane of the stomach 
to a pappy, discolored mass; they destroy and perforate the coats of the 
stomach much more readily than acids do. 

Salts of metals, like verdigris, corrosive sublimate, Argentum nitricum, 
Tartarus cmcticus, likewise Arsenicum and Phosphorus , cause brown scurfs, 
surrounded by injected and swelled portions of the mucous membrane of the 
stomach. Acrid, vegetable and animal poisons, and ethereal oils cause a 
highly inflamed state of the mucous membrane of the stomach. 

Poisoning is characterized by the following symptoms: Violent pain in 
the stomach and bowels; vomiting of slimy or bloody masses; slimy, diar- 
rhceic discharges from the bowels, mixed with blood, and tenesmus; the fea- 
tures of the face become distorted; there is sudden loss of strength; coldness 
of the extremities, and cold, clammy perspiration; the pulse is small and 
thread-like. 

If the patient informs us what he has swallowed, our diagnosis is safe 
enough. If not, the ejected masses will have to be examined. Mineral 
acids and caustic alkalies leave their traces also upon the mucous membrane 
of the mouth and fauces. 

Therapeutic Hints. 

If we see a case soon after the swallowing of poison, this poison must 
be either removed or neutralized — acids hy alkalies and alkalies by acids. 

Chronic consequences require: after acids, Calc. carb.; after alkalies, 
Nitr. ac; after ethereal oils, Nux vom., At sen. \ after metals, Hepar. 

Gastralgia, Oardialgia Nervosa, Cramp of the Stomach. 

This affection is characterized by attacks of great pain in the stomach, 
which come at intervals, leaving the patient free from pain between the at- 
tacks; there is no structural change of the stomach effected by it. We fre- 
quently find this complaint, however, in connection with anaemia, chlorosis, 
tuberculosis or great loss of vital fluids; also with chronic catarrhal affections 
of the stomach, the round perforating ulcer, and cancer of the stomach; also 
with diseases of the womb, as falling or dislocation of the womb; catarrh or 
ulceration of the mouth of the womb; too scant3^ or too profuse menstruation; 
also with diseases of the spine, especially such forms as present an inter- 
mittent character; and finally we observe it frequently in consequence of 
depressing mental emotions; chilling the stomach by drinking ice water or 
eating ice cream while being heated; or after the use of lemon juice, or other 



THERAPEUTIC HINTS TO GASTRAEGIA. 43 1 

acid fruits, coffee, fresh bread and hot cakes, and other things which are 
difficult to digest. 

The attack usually commences with a feeling of pressure in the pit of 
the stomach, frequent yawning, coldness of the extremities, and an uncom- 
fortable feeling in the middle of the spine, which induces the patient to bend 
backwards frequently. Sometimes, without such premonitory signs, a violent 
pain in the stomach sets in at once, which may be various in character — 
pressing, drawing, burning, boring, gnawing, cramp-like, etc., amounting 
sometimes to such a degree of severity that the patient faints away; his face 
appears collapsic, his extremities become cold, and his pulse small and 
thready. The pain seems to radiate from the spine and reflect up to the 
chest, where it causes asthmatic symptoms; or, it reflects up to the oesophagus, 
causing the so-called globus hystericus; or, to the larynx, causing chok- 
ing; or to the sympatheticus, causing spasmodic laughing and crying; or, 
to the nerves of the cranium, causing hemicrania; or, to' the intestines, 
causing pain in the bowels and diarrhoea. The pain is oftentimes relieved 
by hard pressure upon the stomach, but sometimes the patient cannot even 
bear the pressure of the clothing. The pit of the stomach is, in some cases, 
distended, in others it is drawn in; often we observe a pulsation in the 
epigastrium. 

The attack generally ends with belching of wind, vomiting of watery, 
sour fluids, passing of pale urine, and with a gentle perspiration. In some 
cases there is a great accumulation of wind in the stomach, so that the pit 
of the stomach and the bowels are greatly distended, with constant belching 
and rumbling in the bowels. Belching and passing wind generally brings 
relief. 

Therapeutic Hints. 

Abies nigra. Continual distressing constriction just above the pit of 
stomach, as if everything was knotted up, or as if the hard lump of undi- 
gested food remained there. 

Abrot. Feeling as if the stomach were hanging or swimming in water, 
with a sense of coldness. Pains cutting, gnawing, burning, contracting, 
stinging, mostly worse at night. Never entirely free from pain. 

Arg. nitr. Between the xyphoid cartilage and the navel a small spot, 
which is very sensitive to the slightest pressure; from this spot a very se- 
vere pain spreads to the hypochondriac region into the back, up into the 
shoulders, even to the head; gradually increasing in intensity, and as gradu- 
ally leaving again. 

Arsen. Burning pain, as of red-hot coal; pit of stomach sensitive to 
slightest touch; vomiting of ingesta as soon as taken; anguish; restlessness; 
dyspnoea; fainting; pale, earthy face; worse from eating and touching; bet- 
ter from warm applications; brought on by eating ice cream or drinking ice 
water. 

Asa/. Pressing, cutting, stitching pain in spells; eructations of a smell 



432 THERAPEUTIC HINTS TO GASTRALGIA. 

like garlic or feces; accumulation of gas; constantly pressing upwards, none 
downward; gulping up of rancid, acrid fluids; obstinate constipation. Pain 
in paroxysms; better from eating; worse when stomach is empty. 

Bellad. Gnawing, pressing, crampy, drawing, wrenching pain, which 
compels the patient to bend backwards, and to hold his breath; pain extend- 
ing through to the spine, with tired feeling in the spine; great thirst, but 
feels worse after drinking; face hot, red, bloated; pupils enlarged; especially 
for the female sex, when the menstrual period has been disturbed. 

Bismuth. Sense of heaviness like a weight in stomach; intense press- 
ure in a denned spot with pain in the spine, compelling the patient to bend 
backwards. 

Bryon. Pressing pain as of a stone or a load in the stomach; worse 
from eating or drinking; from any motion; better when lying quiet on the 
back. 

Calc. carb. Pressing pain as of a load or stone in the stomach; or from 
the abdomen rising up into the throat; sour belching and vomiting; better 
from motion; too profuse catamenia. 

Calc. hypophosph. Sudden appearance of the attacks; absence of gastric 
catarrh; entirely free at intervals; sensation as if the pain and distress were 
caused by wind; spreading of the pain upwards, never downwards. Attacks 
appear suddenly two hours after each regular meal, and are appeased by tak- 
ing a cup of milk or other food carefully chewed. Without this the pain 
steadily increases, extends to the spine, into the chest and throat, and is 
accompanied hy a rising of clear, white, brackish, sour froth, and a gnawing 
in the stomach. (F. G. Oehme.) 

Carb. veg. After Nux vom., burning pain, extending down to the 
small of the back and up to the shoulders; sour, rancid belching; cold 
limbs; cold sweat; worse from lying down; after rich living; drinking of 
spirituous liquors. 

Chaviom. When sitting or standing the pain doubles him up; in bed 
he tosses about in great agony; hands and feet cold; after anger or vexation. 

Chelid. Gnawing, grinding pain, ameliorated by constantly eating some- 
thing. 

Coloc. Violent cutting, tearing pains, which, from different parts of the 
chest and abdomen, concentrate in the pit of the stomach; relieved by hard 
pressure and bending double; after vexation and indignation. 

Ferritin. Pressure in the stomach; vomiting of ingesta, and better 
afterwards; worse after drinking milk; chlorotic and anaemic individuals. 

Gelsem. Sensation of a heavy load with weight; tension and dull pain; 
sometimes with empty, faint sensations in the epigastrium, and a false hun- 
ger — a kind of gnawing. 

Graphit. Anaemic, chlorotic patients. Dysmenorrhcea; constant yawn- 
ing and bloatedness of the stomach. 

Ignat. Gnawing, cutting pain in the stomach; faint feeling; false hunger; 
collection of water in the mouth; nausea and vomiting of mucus; poor di- 



THERAPEUTIC HINTS TO GASTRALXHA. 433 

gestion; bloated stomach; pale, watery, profuse urine; after grief or poor 
living; habitual smoking. 

Leptand. Sharp, cutting pains at intervals in the lower part of the 
epigastrium; constant aching distress; worse from drinking cold water; after 
rising; great desire for stool, that cannot be retained one moment. 

Lycop. Brought on by eating fruit; flatulency; flowing saliva; con- 
stipation; pain better from bending. 

Nux vom. Pressing, constricting, clawing pain in the pit of the 
stomach, extending into the chest, or towards the small of the back and to 
the anus, which is drawn in; worse after eating and drinking; better from 
belching, after vomiting, from bending forward and rubbing the pit of the 
stomach; great irritability; headache; loss of appetite; or hunger, with fear 
of eating; belching, vomiting and gulping up of sour substances; constipa- 
tion; haemorrhoids; suppressed menstruation; complaints from the use of 
coffee or liquors; sedentary life; night-watchings; anger and worriment; 
always after previous use of nostrums. 

Petrol. Pressing, drawing pain, ameliorated by constantly eating some- 
thing. Compare Chelid. 

Phosphor. A singular rising of the swallowed food by mouthfuls; 
gnawing pain; worse from motion; pain worse after eating; during the pres- 
ence of morbid hunger eating relieves for a short time; decidedly better when 
keeping warm in bed. 

Phosph. ac. Violent pressure in pit of stomach through to the back; 
worse from touch. Urine white and almost as thick as milk. 

Plumbum. The patient bends backwards during the spell; gets better 
from hard external pressure upon the stomach; afterwards yellow appear- 
ance of the white of the eyes; badly-smelling sweat of the feet; during 
paroxysm, abdomen hard like a board; pharynx feels constricted; hands 
and feet cold. 

Pulsat. Dizziness when rising; loss of appetite; no thirst; sour or bit- 
ter vomiting; after eating fat meat, cakes, pastry, and drinking whiskey; 
the attacks are worse in the evening. 

Rumex. "Shootings from the pit of the stomach into the chest in 
various directions; aching pain in pit of stomach, and aching and shooting 
above it in the chest; fullness and pressure in pit of stomach, extending 
toward the throat-pit; it descends toward the stomach with every empty 
deglutition, but immediately returns. Pressure and distention of stomach 
after eating; stitching, cutting pain in pit of stomach; worse on movement." 
(W. K. Knowles.) 

Staphis. After indignation. 

Sulphur. Pain in right hypochondrium extends over stomach to left- 
cannot lie on either side; when lying on back the pain spreads to chest under 
sternum and hinders respiration; must get up and walk about. 

Ver. alb. Pains radiate to back and shoulders; increase slowly and de- 
28 



434 



DIGEST TO GASTRALGIA. 



crease slowly, and are attended with a shaking chill, and cold hands and 
feet. 

Digest to Gastralgia. 



Paroxysms: Asa/. 

, sudden, two hours after each regu- 
lar meal, relieved by taking a cup of 
milk or other food carefully chewed. 
Without this the pain steadily increases, 
extends to spine, chest and throat, and 
is accompanied by a rising of clear, 
white, brackish, sour froth and a gnaw- 
ing in the stomach: Calc. hypoph. 

increase slowly and decrease as 

slowly: Arg. nitr., Stannum, Ver. alb. 

entirely free intervals: Calc. hypoph. 

Never entirely free from pain: Abrot. 

Sensations, aching: Leptand., Rumex. 

, burning: Arsen., Carb. veg. 

, bloatedness: Ignat. 

, , with constant yawning: Graphit 

, clawing: Nux vom. 

, constriction: Abies nigra, Nux vom 

, cutting: Abrot., Asa/, Coloc, Ig- 
nat., Leptand., Rumex. 

, crampy: Bellad. 

, distention after eating: Rumex. 

, drawing: Bellad., Petrol. 

, dull: Gelsem. 

, faint feeling: Gelsem., Ignat. 

, fullness: Rumex. 

, gnawing: Abrot., Bellad., -Calc. 

hypoph., Chelid., Gelsem., Ignat., Phos- 
phor. 

, and grinding: Ignat. 

, hunger, false: Gelsem., Ignat. 

, heaviness, like a weight: Bismuth., 

Gelsem. 

, lump or stone, of a: Abies nigra., 

Bryon., Calc. carb. 

, pressing: Asa/., Bismuth., Bryon., 

Calc. carb., Ferrum, Petrol., Phosph. 
ac, Rumex. 

, shooting: Rumex. 

, stinging: Abrot. 

, stitching: Asa/., Rumex. 

, soreness in a small spot: Arg. nitr. 

, , to slightest pressure: Arsen. 

, tearing: Coloc. 

, tension: Gelsem. 

, water, as if stomach were swimming 

in, with sense of coldness: Abrot. 

, wind, as if caused by: Calc. hypoph. 



Direction of pain, in pit through to the 

back: Phosph. ac. 
with tired feeling in spine: 

Bellad. 
, and shoulders: Arg. nitr., Ver. 

alb. 

, into chest: Nux vom., Sulphur. 

, and throat-pit: Rumex. 

from abdomen into throat: Calc. carb. 

always upwards, never downwards: 

Asa/, Calc. hypoph. 
from pit to hypochondria, up in 

chest, even head: Arg. nitr. 

down to small of back: Carb. veg. 

and anus: Nux vom. 

descends toward stomach with every 

deglutition, but immediately returns: 

Rumex. 
from right hypochondrium over 

stomach to left: Lycop., Sulphur. 
from different parts of chest and ab- 
domen, concentrating in pit of stomach: 

Calc. carb. 
Attended with belching of smell like 

garlic or feces: Asa/ 

, , sour, rancid; Carb. veg. 

and vomiting: Calc. carb. 

gulping up of rancid, acrid fluids: 

Asa/ 
singular rising of swallowed food by 

mouthfuls: Phosphor. 
rising of clear, white, brackish, sour 

froth: Calc. hypoph. 
Nausea and vomiting of mucus: Ig- 
nat. 

vomiting, sour or bitter: Pulsat. 

of ingesta and better afterwards: 

Ferrum. 

, as soon as taken: Arsen. 

flatulency: Lycop. 

constipation: Asa/, Lycop., Nux 

vom. 
great desire for stool that cannot be 

retained: Leptand. 

GENERAL SYMPTOMS. 

Anguish: Arsen. 
Irritability: Nux vom. 
Dizziness when rising: Pulsat. 



ULCUS VENTRICULI PERFORANS. 



435 



Headache : Nux vom. 
Pupils enlarged : Bel lad. 



Yellowishness of white of the eyes: 
Plumbum. 

Face hot and bloated: Bellad. 

pale and earthy: Arsen. 

Collection of water in mouth: Ignat. 

Flowing" saliva: Lycop. 

Pharynx constricted : Plumbum. 

Loss of appetite : Nux vom., Pulsat. 

Hunger, with fear of eating: Nux vom. 

Thirst, but worse after drinking: Bellad. 

Poor digestion: Ignat. 

Abdomen hard like a board during par- 
oxysm: Plumbum. 

Haemorrhoids : Nux vom. 

Urine profuse, pale, watery: Ignat. 

white and almost as thick as milk: 

Phosph. ac. 

Menstruation suppressed: Nux vom. 

Dysmenorrhea : Graphit. 

Catamenia to profuse: Calc. Carb. 



Respiration hindered by lyin< 

back: Sulphur. 
Dyspnoea: Arsen. 



the 



Shaking Chill : Ver alb. 
Cold sweat : Carb. veg. 
Badly-smelling sweat of feet: Plumbum. 
Cold hands and feet: Plumbum., Ver. 

alb. 
limbs: Carb. veg. 



Fer- 



Fainting: Arsen. 

Chlorotic and anaemic individuals: 

rum., Graphit. 
For females with disturbed menstrual 

period: Bellad. 



Worse after eating: Nux vom. , Phosphor. 

and drinking: Bryon., Nux vom. 

and touching: Arsen. 

from drinking cold water: Leptand. 

milk: Ferrum. 

two hours after each regular meal: 

Calc. hypo ph. 



when the stomach is empty: Asa/. 

from lying down: Carb. veg. 

on back: Sulphur. 

on either side: Sulphur. 

When sitting or standing the pain dou- 
bles him up; in bed he tosses about in 
great agony: Chamom. 

Worse from motion: Bryon., Phosphor., 
Rumex. 

after rising: Leptand. 

from touch: Arsen., Phosph. ac. 

in evening: Pulsat. 

Better from belching: Nux vom. 

after vomiting: Ferrum., Nux vom. 

from eating: Asa/. 

taking a cup of milk or other food 

carefully chewed: Calc. hypoph. 

by constantly eating something: 

Chelid., Petrol. 

by eating during the presence of 

morbid hunger: Phosphor. 

from warm application: Arsen. 

when keeping warm in bed: Arsen. 

from external pressure upon the 

stomach: Plumbum. 

and bending double: Coloc. 

lying quiet on back: Bryon. 

motion: Calc. carb. 

must get up and walk about: Sul- 
phur. 

must bend backwards: Bellad., 

Bromium, Plumbum. 

bending forwards: Coloc, Lycop., 

Nux vom. 

Caused by grief: Ignat. 

anger or vexation: Chamom. 

indignation: Coloc, Slap his. 

sedentary life: Nux vom. 

night-watching: Nux vom. 

rich living: Carb. veg. 

poor living: Ignat. 

ice cream or ice water: Arsen. 

fat meat, cakes, pastry: Pulsat. 

spirituous liquors: Carb. veg., Nux 

vom., Pulsat. 

fruit : Lycop. 

smoking: Ignat. 

quack medicines: Nux vom. 



Ulcus Ventriculi Perforans (rotundum, chronicum), the Round 
Perforating Ulcer of the Stomach. 

In four-fifths of the cases the ulcer is situated in a region bounded 
by the posterior wall, the lesser curvature and the pyloric region; the rest of 



436 ULCUS VEXTRICULI PERFORANS. 

the surface of the stomach appears to be affected in only one-fifth of the 
cases; it was also frequently observed in the duodenum, in cases of Chicka- 
hominy diarrhoea. Only one ulcer is usually found; exceptionally there 
are two, three or more. Its size varies: it may be smaller and also much 
larger than a three-cent silver piece; its shape is round, sometimes oval; and 
in cases where several ulcers join, it is irregular. On the inside of the 
stomach it is largest, and grows smaller in its progress of eating through the 
different layers of the stomach, so that it assumes a funnel-shaped appear- 
ance. When it reaches the serous membrane of the stomach it causes peri- 
toneal inflammation and fibrinous exudation, which cause adhesions with 
the adjoining organs, as the pancreas, liver, omentum and colon. When 
even this last or external membrane is eaten through, it causes peritonitis. 

This ulcer ma}' heal in any of its different stages, in which event new 
granulations are formed, and the whole is shut by a flat, radiated cicatrix, 
in consequence of which it sometimes happens that the pylorus becomes con- 
stricted, so that the exit of the food into the intestines is impeded. Such a 
cicatrized induration of the pylorus can generally be detected by palpation 
in the pit of the stomach as a hard swelling. 

In regard to its origin we are quite in the dark. Rokitansky considers as 
the nearest cause hsemorrhagic erosions. They consist, according to Virchow, 
in obstruction of arterial vessels, in consequence of which the mucous mem- 
brane becomes deprived of its necessary nutriment and dies off, and by the 
corroding effects of the acids of the stomach is eaten out deeper and deeper. 
Of special interest is its occurrence after extensive burns of the skin and its 
coincidence with trichinosis. 

The Symptoms are as follows: pain, exactly as in gastralgia, in the pit 
of the stomach, often extending to the spine, coming in spells mostly after 
eating, ameliorated, sometimes ceasing, after vomiting of slimy, tough or 
waterj', clear, tasteless or sour fluid, often containing blackish or brownish 
flakes. 

Vomiting is found not only during cardialgic spells, but also between 
these spells, although in exceptional cases it is not a prominent symptom. 
It generally happens soon after eating, and frequently without previous 
nausea and without great exertion. Acrid, sour, indigestible food causes it 
most frequently. The vomit often contains particles of decomposed blood in 
the form of blackish or brownish flakes and masses, and sometimes even 
clear blood in large quantities. But even this bloody vomit is not a constant 
symptom; in cases of slow bleeding the blood ma}- pass into the intestines 
and be carried off in the form of tarry faeces. 

Indigestion. In some cases the appetite is little or not at all changed, 
but in severer cases it is diminished, or altogether absent. Eating usually 
causes pain and digestion is very slow. Milk and white meat are best 
digested. Eructations, nausea, pyrosis or water brash, are symptoms of the 
chronic catarrh attending the disease; and obstinate constipation is of fre- 
quent occurrence. Sooner or later, the face of the patient assumes a pale, 



THERAPEUTIC HINTS TO ULCUS VENTRICUEI PERFORANS. 437 

sallow aspect, his spirits become depressed, he loses flesh, and grows weaker 
and weaker. 

When perforation takes place, which may happen either spontaneously 
or in consequence of a strong concussion of the body, or from overloading 
the stomach, or during a hard attack of vomiting, we have in a very short 
time all the symptoms of peritonitis. The patient experiences a stitch-like 
or cutting pain, altogether different from that of a cardialgic spell; he is 
seized with a violent chill and vomiting, and his features become collapsie, 
distorted, pale, expressing deep pain and agony. The abdomen distends 
largely and is very painful, especially when touched. Respiration is short, 
superficial, without any respiratory motion of the diaphragm. There is sin- 
gultus; violent action of the heart; frequent, small pulse; fainting; decrease 
of natural temperature; great prostration and collapse. 

Some chronic cases take to the end a latent course, until at last dis- 
covered as cicatrices on post-mortem examination. This surely proves the 
curabilit3 T of this disease. The disposition to it seems to be greater during 
middle life, and is by no means of rare occurrence. 

Differential Diagnosis. — It may be confounded with chronic catarrh 
of the stomach. The round ulcer, however, generally shows a clean, red 
tongue, has much more frequent vomiting; and the vomit is often tinged 
with either fresh or decomposed blood, and the soreness in the epigastrium is 
confined to a circumscribed spot with frequent cardialgic spells. 

It may be confounded with cardialgia. The round ulcer, however, 
has a falling away of flesh and change in features, pale, yellowish face, and 
vomiting between the cardialgic spells, which we do not observe in 
gastralgia. 

It may be confounded with cancer of the stomach; cancer, however, 
comes at a later period of life; its pain in the stomach, although often severe, 
never extends to the spine; it tells much quicker upon the general constitu- 
tion by the wasting away in flesh; it is often marked by a hard swelling in 
the pit of the stomach, which is observed in cases of round ulcers, only when 
the pylorus becomes cicatrized; it commences with feverish attacks and ends 
with a cachetic fever. 

Therapeutic Hints. 

Milk and mutton or beef -broth must be considered as the best diet. 

Arg. nitr. Pain below and to the left of the xyphoid process in a small 
spot extending to a corresponding point in spine, where pressure aggravates 
it. Looks as if dying. 

Arsen. Vomiting of black, decomposed blood; burning pain; always 
worse after eating or drinking; gray-yellowish color of the face. Chlorotic 
patients, with anaemic murmui in the large blood-vessels, and scanty menses. 

A tropin. Pressing pain after eating; and vomiting of acrid, sour masses 
which set the teeth on edge; hard swelling in the region of the pylorus, just 



438 THERAPEUTIC HINTS TO ULCUS VENTRICULI PERFORANS. 

above the navel towards the right, very sensitive to touch; excruciating pain 
in the stomach; constant vomiting; deadly paleness of the face, with cold 
perspiration; hands and feet icy-cold; pulse very small. Peritonitis in conse- 
quence of perforation of the stomach. Compare Be Had. 

Carbveg. Gray, yellowish face; dry tongue; vomiting of sour, bilious 
or bloody masses; burning in the stomach; worse after eating; better from 
drinking cold water; eructations; distortion of stomach and bowels; cos- 
tiveness. 

Conium, co?iiin. Vomiting of black masses like coffee-grounds in clear, 
sour water; violent pain in the stomach, always two or three hours after 
eating, but also at night; somewhat relieved in the knee-elbow position; 
swelling in the region of the pylorus. 

Ferritin. In anaemic and chlorotic patients, with murmurs in the large 
blood-vessels and scanty menses. Haemorrhage from stomach and pain in 
stomach through to the spine. 

Kalibichr. Ulcers are oval; they corrode and become deeper without 
spreading in circumference; pressure and heaviness in the stomach after 
eating; giddiness, followed by violent vomiting of a white, mucous, acid 
fluid, with pressure and burning in the stomach; vomiting of sour, undigested 
food; of bile, with pinkish, glairy fluid; of blood, with close perspiration on 
the hands; burning in the stomach; heat of the face; all of which symptoms 
decidedly suggest its application in the round, perforating ulcer of the 
stomach. 

Lycop. Earthy color of the face; rising ot sour, acrid fluid; vomiting 
of sour water and mucus; fullness of stomach and abdomen; pain in the 
stomach after eating; rumbling and gurgling in the abdomen; constipation; 
scanty urine; worse from sitting bent; better from rising and walking about; 
no pain at night, when warm in bed. 

Mezer. Constant, violent pain and pressure in the stomach after eating, 
no matter what, even simple things like broth, milk, bread; a constrictive 
squeezing pain with much belching from on? to two hours after eating; 
the pain reaches its height and ends with vomiting and gulping up of what 
has been eaten; constipation; circumscribed redness of the face; skin cool, 
pulse very small and frequent; chilliness alternating with flushes of heat. 

Nux vom. Frequently indicated at first when the patient has already 
been drugged. Vomiting in the morning before breakfast. 

Phosphor. Regurgitation of food by mouthfuls without nausea; re- 
gurgitation of cold drinks as soon as they become warm in the stomach; 
excessive acidity; flatulency; constipation. 

Sepia. Yellow bridge over the nose; earth}' complexion; sour taste in 
the mouth after eating; vomiting of mucus; pain in the stomach after 
eating the simplest kind of food; hardness in the region of the pylorus; 
constipation; stitching all over the body, with breaking out of little pus- 
tules; menses scanty. 



CARCINOMA OF SCIRRHUS VKNTRICUU. 439 

Silic. Yellowish complexion; screwing, pressing, twisting pain after 
drinking; pyrosis and vomiting after eating. 

Stannum. The pain commences mildly but increases steadily to an 
almost unendurable height, when again it gradually lessens and dies away 
for a short time. 

Sulphur. Constant pain in stomach and back after suppressed itch; 
sour taste in the mouth and sour vomiting; constipation; piles; cold legs. 

Compare also Gastralgia and Haematemesis. 

Carcinoma or Scirrhus Ventriculi, Cancer of the Stomach. 

According to pathological researches there are three different forms of 
cancer of the stomach: 1. Scirrhus, a fibrous growth in which the connec- 
tive tissue stroma predominates over the cell formation, generally originates 
in the submucous cellular tissue; 2. Carcinoma medullar is, a marrow-like 
growth, in which the cancer-cells predominate over the stroma, forms round 
isolated lumps in the mucous membrane of the stomach, and spreads sponge- 
like upon the inner surface of the stomach; and 3. Carcinoma alveolaris, 
a jelly-like growth, in which we observe a colloid degeneration of the can- 
cercells, invests at first the submucous cellular tissue, but penetrates fre- 
quently to the peritoneum, and forms large tumors upon it. All three kinds 
of cancer may often be seen together; and they mostly invest the pylorus, 
sometimes the lesser curvature, still rarer the cardia, and most rarely other 
parts of the stomach. 

It is often the case, that the diseased pylorus forms adhesions with ad- 
joining organs, such as the pancreas, liver, kidneys and colon, which are 
mostly invested by the same morbid product, keeping the stomach in a fixed 
position. When, however, such adhesions do not take place, the stomach 
sinks, in consequence of its increased weight, lower dowm into the abdominal 
cavity; remaining there, either perfectly free and movable, or adhering to 
organs low r er down such as portions of the intestines, the uterus, or its ap- 
pendages. 

The inner cavity of the stomach is much changed by this disease. It 
becomes greatly enlarged by stricture of the pylorus, or much diminished by 
stricture of the cardia ; there is cancerous degeneration of the coatings of the 
stomach. The mucous membrane, in the neighborhood of the cancer, ex- 
hibits chronic catarrhal inflammation, which is sometimes spread all over it; 
and, in the further progress of the disease, ulceration and erosion of smaller 
or larger blood-vessels w T ith consecutive haemorrhage obtain. 

The causes of carcinoma of the stomach we do not know, just as little 
as the causes of cancer in any other part of the body; heredity seems to 
deserve some amount of consideration. The disease has been observed most 
frequently between the years of fifty and seventy. 

Symptoms. — i. General cancer-cachexia: emaciation; paleness of the 
skin and the mucous membranes; ash-colored or yellowish color of the face; 



44-0 CARCINOMA OR SCIRRHUS VEXTRICULI. 

brittle, dry, harsh and wrinkled skin; peeling off of branny scales, especially 
from the lower extremities. The expression of the face is sad; the eyes are 
fallen in ; the malar bones stick out ; the ankles are cedematous. 

2. Tumor in the pit of the stomach. This is present, however, only when 
the cancer invests the pylorus. In this case we observe a roundish, or oval, 
or irregular lump to the right above the navel under the upper part of the 
right rectus abdominalis muscle. It is always there, and cannot be moved, 
if the pylorus should have formed adhesions with neighboring organs; but it 
changes position and is movable, when those adhesions are not formed. In 
this latter case it gradually sinks down into the abdominal cavity, and may 
appear below the navel, or even but little above the symphisis pubis, either 
as a movable or fixed tumor. But when the pylorus-carcinoma is covered 
by the left lobe of the liver, or by a distended colon, it cannot be felt. The 
same is true, when carcinoma has its seat on the cardia or on the lesser 
curvature. Cancerous degeneration of the anterior wall of the stomach is 
felt as a resisting mass in the epigastrium, changing position, however, ac- 
cording to the position of the patient; and according to the fullness and 
emptiness of the stomach, may be felt more towards the right or towards the 
left side, higher up or lower down, even below the navel. 

3. The stricture of the pylorus causes, further, a sinking in of the ab- 
domen; the intestines are empty, because the food is prevented from going 
through the pylorus; the abdominal walls are thin, wrinkled, like parchment; 
they may be lifted up in folds which remain; the subcutaneous cellular 
tissue is wasted away, and the full percussion sound is wanting. The spine 
even may be felt through the abdominal walls, and the aorta descendens 
pulsates perceptibly. When there is a stricture of the cardia the epigastric 
region is fallen in because not sufficient nourishment is allowed to enter the 
stomach; the intestines are likewise empty, only the ribs and the processus 
xyphoideus protrude. 

4. Vomiting. This happens if there is a stricture of the pylorus, gener- 
ally from four to five hours after eating. The masses which are thrown up 
are digested. In case of stricture of the cardia, the vomiting takes place 
immediately after or even during eating, without nausea or exertion; it is 
only a regurgitation of the swallowed food. If diverticles or widenings of 
the oesophagus exist at the same time, the vomiting follows a little later. 
The masses which are thrown up are the same as swallowed. If the cancer 
has its seat at another part of the stomach, the vomiting may be entirely 
absent; or it may, after having been regular for a time, slacken off and cease 
altogether. So also, the vomiting may cease if the stricture of the pylorus, 
by softening, gets removed, or if the walls of the stomach, by diffused cancer- 
ous degeneration, lose all power of contraction. 

5. Haemorrhages from the stomach. The blood is thrown up either 
decomposed as a brownish, chocolate-like mass, or when larger blood-vessels 
have been destroyed, as clear blood. 

6. The pain in the epigastrium, which has its seat generally in the can- 



CARCINOMA OR SCIRRHUS VENTRICUU. 44 1 

cerous tumor, is worse from eating, usually of a lancinating or burning 
character, and never extending to the spine; it may be absent altogether. 

7. The appetite is generally diminished; in some cases, however, it is 
increased; but the patients are afraid to eat, because of the following pain 
and vomiting. 

S. The stool is usually retarded; but when the cancerous growth 
softens and dissolves, we observe colliquative diarrhoea, and when there is 
haemorrhage in the stomach, bloody evacuations. 

Differential Diagnosis. — At its commencement it can hardly be dis- 
tinguished from a chronic catarrh of the stomach ; but in its progress cancer 
has the following distinguishing features: often a tumor in the epigastrium; 
now and then coffee-ground looking emesis; rapidly developing marasmus; 
asfi5 T or yellowish color of the face ; and the age of the individual — over forty 
3 T ears; all of which is not applicable to chronic catarrh of the stomach. 

The symptoms of cancer are also very similar to those of the perforating 
ulcer of the stomach. Both have pain; both may have coffee-ground emesis; 
both may have haemorrhages from the stomach, and even a tumor in the epi- 
gastrium. But cancer never sets in before the fortieth year of age, lasts on 
an average not longer than one year, shows a steady progress in general 
decay, and its pain does not extend through to the spine, but is often com- 
bined with swelling of the lymphatic glands, especially in the axillae and on 
the neck, and with sleeplessness; while the ulcer befalls persons mostly 
under forty years of age, may last for several years and may be cured, or end 
quickly by perforation and subsequent peritonitis, and does not so rapidly 
develop a cachectic appearance of general decay; its pain usually extends 
from the stomach through to the spine. 

Cancer is distinguished from cardialgia in that it grows uninterrupt- 
edly and gradually, whilst cardialgia comes in spells, with intervals of 
health; further, by the age of the person, and its inroads upon the general 
constitution. 

How can we know what kind of cancer it is ? 

A very slow progress of the disease, together with additional ascites, 
make it probable that it is a jelly-like cancer — carcinoma alveolaris. An 
acute progress and rapid growth of tumor, with frequent and large haemor- 
rhages, point to carcinoma medullaris. A slow progress and considerable 
hardness and nodulated appearance of the tumor indicates a scirrhus. This 
latter is by far of the most frequent occurrence. 

Therapeutic Hints. 

Arsen. Burning pain in the stomach; better from warm applications; 
vomiting of all he takes; vomiting of black substances; prostration; emacia- 
tion; restlessness. 

Arsen. jod. Violent burning in stomach. (E. Huber.) 
Bellad. Cutting, clawing pain; nausea, gagging and vomiting; staring 
eyes; dryness in mouth and throat; fainting. 



442 THERAPEUTIC HINTS TO CARCINOMA. 

Bismuth. Violent, crampy pains; burning and stinging in the region 
of the stomach; stomach enlarged, hanging down to the crest of the ilium; 
hard lump between the navel and the edges of the lower ribs on the right 
side; scirrhus of the pylorus; abdomen bloated in ridges, with great rumbling 
of wind along the colon, which is rarely passed off, but then gives relief; 
vomiting, only at intervals of several days, when the stomach has become 
filled with blood, and then of enormous quantities, and lasting a whole day. 

Card. veg. Burning pain, extending from the pit of the stomach into 
the small of the back; anxiety; cold extremities; cold, stick)' sweat; inter- 
mitting pulse. 

Card. an. Saltish water rises from the stomach and runs out of the 
mouth, accompanied by retching, and followed by violent, empty eructa- 
tion; cold feet and hiccough; pressure, clawing, griping and burning in 
the stomach; scanty, hard stools in lumps; copper-colored eruption on the 
face. 

Conium. Vomiting of chocolate-colored masses, sour and acrid; press- 
ing, burning, squeezing pain, extending from the pit of the stomach into the 
back and shoulder. 

Cundur. A case well diagnosticated by Friedreich improved remarka- 
bly under the administration of the tincture. 

Hydrast. Vomits everything, except water with milk; pain in pit of 
stomach; emaciation. 

Kreos. Painful, hard place on the left side of the stomach. 

Laches. Gnawing pressure, relieved after eating, but coming on again 
in a few hours, and the more violent the emptier the stomach; great sensi- 
tiveness to contact, especially to that of his clothes; drunkards. 

Lycop. After eating or drinking, vomiting of dark, greenish masses; 
bloatedness of the stomach and bowels; rumbling in the bowels; obstinate 
constipation; hard swelling in the epigastric region. 

Mezer. Great emaciation; the muscles of the face are tensely drawn, 
like strings; constant vomiting of chocolate-colored masses, with great burn- 
ing in the throat; violent retching, accompanied with the agon}* of death; 
sleeplessness and exhaustion; obstinate constipation; hard lumps in the 
epigastric region. 

Phosphor. Epigastric region sensitive to the touch; constant nausea 
and fullness in the stomach; after eating, or drinking even a swallow of 
water, vomiting of a sour, foul-smelling fluid, which looks as though it had 
been a mixture of water, ink and coffee-grounds; in the sunken abdomen, a 
circumscribed, hard swelling; pale, earthy complexion; great emaciation; 
sleepiness; peevishness; fine gurgling noise in the abdomen; urine scanty, 
red or brown, with reddish or yellowish red sediment; bowels constipated, 
dry, rumbling stools. 

Sepia. Sour taste after eating; vomiting of mucus, caused by taking 
even the simplest food; the pain in the stomach increases b}* vomiting, and 



HEMORRHAGE FROM THE STOMACH. 443 

extends to the back, with anxiety; oppression of the chest and cold perspi- 
ration; hard places in the region of the pylorus; constipation. 

In addition, compare the Round Perforating Ulcer, Glastralgia, Catarrh 
of the Stomach and Haematemesis. 



Haemorrhage from the Stomach, Haematemesis, 

Consists of an effusion of blood, either from the arteries, veins or capillaries 
of the stomach, and may have two distinct causes, viz. : i. An increased pres- 
sure in the blood-vessels. Such is the case, a. In all congestive, catarrhal 
and inflammatory affections of the mucous membrane of the stomach. The 
bleeding in such cases is not very considerable, and comes from the capillary 
vessels, b. In all those cases in which the free circulation of the blood is 
interfered with, as in diseases of the vena porta, liver or spleen, in conse- 
quence of constriction of the inferior vena cava, in heart and lung diseases, 
all of which cause a mechanical interference to the free circulation, and, in 
consequence, a stagnation and greater pressure of the blood in the mucous 
membrane of the stomach. The bleeding in such cases is mostly capillary 
only; but it may amount to large quantities, if the pressure be great enough 
to rupture larger blood-vessels, c. In cases where habitual bleedings have 
been suppressed, menstrual or hsemorrhoidal. Such bleedings are called 
vicarious. 

The second distinct cause of haemorrhage from the stomach depends upon 
morbid alterations of the coats of the blood-vessels; these may arise — a. From 
chemical or mechanical influences, such as alkaline or corroding substances, 
or pointed objects within the stomach; from violent vomiting, straining, or 
from the effects of a fall or a blow; b. From pathological conditions, such as 
varicose veins, and aneurismal arteries; c. From general diseases, such as 
scurvy, yellow fever, and acute exanthematic fevers; d. From ulcerative pro- 
cesses, such as the round perforating ulcer, hsemorrhagic erosions and cancer 
of the stomach. 

Post-mortem examinations exhibit the mucous membrane of the stomach 
pale and anaemic, especially after capillary haemorrhage. At times we find 
the mucous membrane infiltrated with blue or darkened patches here and 
there, from which the blood oozes on slight pressure. On such places the 
membrane is softened and easily removable, whereby slight depressions are 
formed, called hsemorrhagic erosions. After profuse haemorrhages we find 
clots of blood, after slow bleeding or oozing the blood generally is altered 
by the gastric juice into a substance like coffee-grounds. 

Symptoms. — Slight haemorrhages usually cause no particular signs, ex- 
cept traces of blood in the masses which are thrown up. Profuse effusions 
cause a feeling of warmth and fullness in the stomach, nausea and vomiting, 
and soon all the signs of depletion, such as paleness, small pulse and cold 
extremities, great weakness, anxiety and oppression, singing in the ears, 
flickering before the eyes, dizziness and fainting. 



444 THERAPEUTIC TO HEMORRHAGE OF THE STOMACH. 

The vomiting brings up the blood clear, in lumps, or already decomposed 
into a chocolate or coffee-ground-like substance. After the vomiting there is 
great thirst. Sometimes no blood is thrown up, but it is carried off through 
the bowels, making the feces appear dark, black or tar-like. 

Differential Diagnosis. — It may be confounded with haemoptoe. 
Haemoptoe is preceded by heart or lung affections, attended by cough. We 
hear rattling noises in the chest. Haematemesis is preceded by affections 
of the stomach, liver, etc., and is attended by nausea and vomiting. 

Haemoptoe generally yields bright, froth}- blood; haematemesis mostly 
dark or decomposed blood. 

When the blood is carried off through the bowels, how can we discern 
whether it comes from the stomach or from the intestines ? In the first case 
the blood is always mixed thoroughly with the feces; while in the latter case 
it generally comes without fecal masses. 

Therapeutic Hints. 

Aeon. In congestion and inflammation of the mucous membrane of the 
stomach; in scarlet fever, sometimes during desquamation, with excruciat- 
ing pains in the stomach, gagging, retching, gasping for breath; distressed 
face; anguish; cold sweat on the forehead. 

Arnica. When caused b}^ external injuries; overexertions; soreness all 
over the body. 

Arsen. Headache; roaring in the head; fainting; cold, distressed, 
yellowish or deadly pale, collapsed face; cold perspiration on the forehead; 
constant nausea; retching; great thirst; burning in the stomach; bloated 
abdomen; stitching pain in the spleen; black stools; groaning and moaning 
breathing; quick, trembling, thread-like pulse, 120 to 130 per minute; cold- 
ness over the whole body; great weakness; trembling, anxiety. 

Bellad. Congestion of the head and stomach; singing in the ears; 
flickering before the eyes; red cheeks; feeling of fullness and warmth in the 
stomach. 

Card. veg. Frequent fainting; hippocratic face; icy-coldness of the 
extremities; intermitting, small, scarcely perceptible pulse. 

China. Great loss of blood, and in consequence excessive weakness; 
paleness and coldness of the hands and feet, like marble; sensitiveness to 
touch in the pit of the stomach. 

Colchic. In a case with bloody discharge from the bow T els, and deadly 
nausea from smelling the cooking of food. 

Eriger. Violent retching and burning in the stomach. 

Ferr. ac. Pit of the stomach sensitive to touch, and soreness all over 
the abdomen; pulse full, excited; face pale; greatly exhausted. 

Hamam. Previous fullness and pain in the abdomen; feverishness hy 
spells; bloody vomiting and stools; weak, cold, profuse sweat; weak and 
quick pulse; restlessness; fullness and gurgling in the abdomen. 

Hyosc. Dizziness; stupefaction; eyes red; face bloated; pit of stomach 



GASTROMALACIA. 445 

sensitive; dull aching in the region of the liver; abdomen bloated; limbs 
numb, weak, trembling; during vomiting convulsions, with loud shrieks on 
account of crampj T pains in the stomach. 

Ipec. Sudden attack; blood dark, black, sour; paleness; coldness; pulse 
scarcely perceptible; fainting; anxiety; pressure in stomach; great thirst; 
oppression of breathing; constipation or bloody stools. 

Mosclncs. When the patient becomes pulseless and collapsed. 

Nux vom. Throbbing pain in the head; pale, distressed face; belching; 
constant nausea; stomach full and distended, sore to the touch; burning 
anxiety and pressure in the precordial region; pain in the region of the 
spleen; constipation, with black stools; urine turbid, dark; fainting; weak- 
ness; temperature of the skin increased ; pulse full, hard, quick. 

Phosphor. Bright blood; drowsiness; sleepy; face, lips, gums and 
tongue are pale; thirsty, better from drinking cold water; loathing of food; 
heaviness and heat at the pit of the stomach, which is distended; abdomen 
soft; urine dark; skin warm, with partial perspiration; pulse quick, ener- 
getic. 

Secale. The patient lies still, with great weakness but no pain; face, 
lips, tongue and hands deadl} 7 pale; skin covered with cold sweat; pulse fre- 
quent, thread-like; oppression; abdomen soft, without pain. 

Veratr. Slow pulse; cool temperature of the skin; chilliness; fainting 
fits; inability to stand; moving or rising causes sickness in the stomach at 
once; cold sweat; even fainting. 

When in connection with suppressed menstrual discharges, compare 
Conium, Ipec, Millef., Pulsat., Sulphur ; with suppressed haemorrhoidal dis- 
charges, Carb. veg., Millef., Nux vom., Sulphur ; after mental emotions, 
Aeon., Hyosc, Natr. mur., Phosph. ac. 

When in combination with scurvy, typhus: Alum., Arsen., Carb veg., 
Nitr. ac, Phosph., Phosph. ac, Sulph. ac. 

In consequence of destructive processes within the stomach, compare 
Carcinoma et Ulcus Rotundum Ventriculi. 

Gastromalacia, Softening of the Stomach. 

Post-mortem examination reveals the coats of the stomach softened, 
changed into a kind of pappy mass; it can easily be scraped off. The affec- 
tion is more or less extended and almost exclusively confined to the greater 
end of the stomach, or fundus ventriculi. And, notwithstanding such a 
complete decay, there is never found any sign of any catarrhal or inflamma- 
tory or ulcerative process in the whole mucous membrane of the stomach; 
neither is the decayed portion sharply defined, but passes gradually over 
into the healthy tissues. Its symptoms are such as are described under 
hydrocephaloid, or cholera infantum, the most prominent of which are con- 
stant vomiting and diarrhoea. The latest observations on this disease make 
it more than probable that gastromalacia is no disease, but a chemical process 
of decay after death. The reasons for this opinion are the following: 



446 GASTROMALACIA. 

i . Softening of the coats of the stomach have been found in perfectly 
healthy individuals, who died suddenly or were executed after they had a 
short time previously partaken of food. Elsasser observes that the food 
which had been taken was easily prone to an acid fermentation, or contained 
already a natural acid, as wine, beer, etc. 

2. Experiments which Elsasser made show that substances which easily 
undergo the acid fermentation, such as sugar, milk, starch, etc., bring on 
this softening in a healthy stomach, taken out of a corpse under application 
of the same degree of heat which the bod}' retains for some time after death. 

3. The softening of the stomach is never found in a perfectly empty 
stomach, but always only in the presence of sour contents, and it is almost 
without exception found at the fundus ventriculi, that part of the stomach 
which lies deepest, if the body lies stretched out on its back, on a part, 
therefore, on which the fluid contents of the stomach must collect. Further- 
more, the size of the softened tissue has been found to correspond with the 
surface that has been covered by these contents. Furthermore, Elsasser 
found that, if he brought the bodies of children who died with cholera 
infantum into another position, that then other parts of the stomach were 
softened, and the fundus perfectly free from so-called gastromalacia. 

4. The symptoms during lifetime which are ascribed to gastromalacia 
are so inconsistent and var3 T ing, that it would be almost impossible to make 
a differential diagnosis. Some writers describe it as an acute, others as a 
chronic disease; some under the form of cholera, others under the form of 
gastritis; others under the form of irritation, or congestion, or inflammation 
of the brain. Who is right ? And the most constant symptom ascribed to 
this disease — the constant vomiting — does not very well agree with a softened 
condition of the stomach as is found after- death. For it is almost impossible 
to realize that a stomach so far decayed could bear such contractions and 
revolutions without bursting. 

5. There is one symptom entirely absent during life which we should 
naturally suppose would necessarily occur, if such softening were really 
present during life, viz., the vomiting of blood. Imagine the entire destruc- 
tion of so large a piece of membrane, which is full of blood-vessels, without 
any bleeding! And yet, if this same organ is artificially injected after death, 
the injected matter escapes from all parts of the softened surface, why should 
not the blood during life do the same ? 

6. According to latest observations it appears that in extremely rare 
cases the softening of the stomach may begin before death, and even proceed 
to complete perforation. (Lauber.) 

I will close by simply suggesting that time and research ma)' reveal the 
fact, that many other conditions, now considered to be the result of morbid 
processes in the living organism, are but the products of changes which the 
body undergoes after it has been given over to the sole influence of chemical 
and mechanical agencies. 



DISEASES OF THE INTESTINAL CANAE. 447 



b. DISEASES OF THE INTESTINAL CANAL. 

Catarrhus Intestinalis, Enteritis Catarrhalis, Intestinal Catarrh. 

In its acute form this affection presents the same appearance as that by 
which a catarrhal inflammation of any other mucous membrane is character- 
ized — injection, swelling, infiltration of the submucous tissue; besides there 
is almost always swelling of the solitary and Peyer's glands, also frequently 
hyperemia and enlargement of the mesenteric glands; the serous fluid is 
mixed with epitheial cells changing gradually into a thick, turbid phlegm, 
which adheres to the walls of the intestines. 

Primarily, it may take place after overloading the stomach, the use of 
purgative medicines, taking cold, and after mental emotions. 

Secondarily, it accompanies tuberculosis, cancer, typhus, puerperal fever, 
pneumonia, dentition, and wide-spread external inflammations in consequence 
of burns. 

The Symptoms vary according to the locality of the affection. A ca- 
tarrhal inflammation of the duodenum, is almost always found in connection 
with catarrhal inflammation of the stomach, and is characterized by obstruc- 
tion of the ductus choledochus and consequent icterus. A catarrhal inflam- 
mation of the colon almost alwa} 7 s extends to the rectum, and is characterized 
by colicky pains, also pains in the sphincter ani, tenesmus, and burning at 
the anus. A catarrhal inflammation confined to the rectum alone offers the 
same symptoms. 

In all cases, however, diarrhoea is the most permanent symptoms, except 
where the inflammation is confined to the upper portions of the small intes- 
tines, when there may be no diarrhoea at all. The color of the discharge is 
at first usually green, from an admixture of bile which has not been changed 
by the normal digestive process; later, when the discharges become more 
abundant, the dejections grow pale and whitish. In cases of affections of the 
lower portion of the colon and of the rectum, the evacuations are slimy and 
even bloody. The frequency of stools varies according to the severity of the 
case. The evacuations are usually preceded by sharp, cutting pains in the 
abdomen, which subside after each evacuation. Severe cases are attended 
with fever, headache, delirium, want of appetite, sickness of the stomach, 
and thick coated tongue. 

Secondary catarrh of the intestines, according to its seat, presents the 
same symptoms, but modified by the original affection and sometimes dis- 
guised by it. That which ensues in consequence of severe external burns, 
according to Curling, usually sets in at or about the tenth day after the in- 
jury, and is characterized by a sharp pain in the epigastrium and towards 
the region under the right ribs, and sometimes by a severe diarrhoea. 

In most books we find a chapter on ''enteritis," or inflammation of the 
bowels. The term is too wide. It embraces what we have to diagnosticate 
specially: as dysentery, ulceration of the bowels, peritonitis; in short, any 



448 THERAPEUTIC HINTS TO DISEASES OF THE INTESTINAL CANAL. 

inflammatory affection of the bowels, and is, therefore, worth about as much 
as the enchanting term of "liver complaint.'' 

Therapeutic Hints. 

Aeon. After checked perspiration: frequent, scanty, and loose stools 
with tenesmus: green stools, like spinage; jaundice. 

Aloes. Pain and rumbling in the bowels before stool; escape of large 
quantities of wind with the stool; pain in the small of the back. 

Ant. erud. Disordered stomach from sour wine or beer; white tongue; 
watery discharges; thirst at night. 

Aranea. Colicky pain and diarrhoea daily at the same hour, with a 
feeling as if the arms and legs were asleep. (Nunez.) 

Arsen. After chilling the stomach by taking cold substances; painful 
or painless diarrhoea; worse about midnight; sudden prostration and great 
thirst; also diarrhoea in consequence of severe external burns. 

Benz. ac. Fetid, white, froth}' stools, like soap-suds; urine high-colored 
and very offensive; child weak and very cross; wants to be nursed all the 
time. (A. Korndoerfer. ) 

Bryon. When the weather changes suddenly from cold to warm, or 
from warm to cold; in the summer season; after eating fruit or sour-krout; 
after vexation and anger; painful diarrhoea, worse from motion and in the 
morning. 

Calc. carb. During dentition, with vomiting and diarrhoea, which is 
generally worse in the after part of the day. 

Chamom. Painful diarrhoea of little children; they draw their limbs up; 
their belly is bloated, hard; the discharges are water}', or greenish and slim}', 
or undigested, looking like chopped eggs; there is rumbling in the bowels, 
and soreness of the anus; jaundice. 

China. Frothy diarrhoea, generally painless; after sour beer; with a 
great deal of fermentation in the bowels; worse after eating, and in the night. 

Collin. Diarrhoea of children, accompanied with colic, cramps, flatu- 
lence, etc. 

Coloc. With every pain he doubles up, or presses the belly against a 
hard object. 

Corn. circ. Dark and bilious stools, with griping and tenesmus; gen- 
eral debility and nervous excitability; chilliness, followed by flushes of heat 
and sweat. 

Crot. tigl. Suddenly gushing out of yellowish watery substances, with 
pain before. 

Cupr. arsen. With abdominal pains. 

Dulcam. When the weather changes suddenly to cold; cold, chilly feel- 
ing in the small of the back: griping in the region of the navel, with nausea 
in the stomach. 

Fcrrum. Painless, large, watery discharges, with a good appetite. 

Ipcc. Diarrhoea and vomiting during dentition; in consequence of eating 



CHRONIC INTESTINAL CATARRH. 449 

sweet, fat, or sour things (raisins, pound-eakes, pastry, salad, etc.); accompa- 
nied by pain in the bowels; paleness of the face; cold extremities; even 
spasms. 

Iris vers. Burning in the rectum and anus after a passage; painful, 
green discharges; periodical spells of diarrhoea; always at night about two 
or three o'clock. 

Jatropha. Painless diarrhoea, worse in the morning, thin, watery, with 
loud rumbling, and gushing out of stools. 

Leptand. Profuse, watery stools, followed by severe cutting pains in 
the small intestines; after exposure to wet, damp weather. 

Magn. carb. Stools green, like scum on a frog pond; sour, frothy; or 
with white, floating lumps, like tallow. Colic before, better after stool. 

Mercur. Great straining, cannot get done; discharges slimy, green or 
blood}' ; from taking cold; worse in the evening; jaundice; chafed at anus. 

Nux vom. Always after previous use of quack medicines, teas, lauda- 
num, brandy, lavender, peppermint, etc., frequently worse early in the 
morning. 

Podoph. Diarrhoea, which changes constantly in appearance, now green, 
now yellowish, now whitish, slimy, etc.; always worse in the forepart of the 
day; during teething; rolling the head from side to side. 

Pulsat. Chilliness; thirstlessness, bitter taste in the mouth; coated 
tongue; diarrhoea worse at night; disordered stomach; nausea. 

Rheum. During dentition; the whole child smells sour; sour discharges, 
green, brown, fermented; great pain in bowels and crying; pain worse at 
once from uncovering an arm or leg. ' ' The child asks for many things with 
vehemence and tears; is temporarily satisfied after its whims are gratified, 
attended by pallor of countenance, occasional twitching of eyelids, soreness 
of mouth, lips and fingers; sweat of the hairy scalp asleep or awake; sweat 
sour or not; crying desires for various articles of diet, but quickly satisfied. 
Colic often worse after a diarrhoeic stool; increased urging to stool, when 
moving about." (M. B. Tuller.) 

Rhus tox. Great pain in the bowels before evacuation, which is green- 
ish, and contains jelly-like globules or flakes; worse in the night or when 
keeping quiet. 

Rumex. Diarrhoea in the morning, with cough from tickling in the 
throat-pit. 

Sulphur. Either without pain or with straining; always worse in the 
morning, driving out of bed; excoriating the anus. 

Veratr. In summer season with vomiting, coming on suddenly at night, 
generally painless; white. Great thirst; feels worse after drinking. 

Chronic Intestinal Catarrh. 

Its pathological features differ much from those of the acute form. The 
mucous membrane of the intestines appears livid, brownish-red, or gray, 
slate-colored; it is thickened and swollen; its follicles are hypertrophied, and 
29 



45° THERAPEUTIC HINTS TO CHRONIC INTESTINAL CATARRH. 

the whole surface is covered with a tough, grayish, sometimes transparent 
and jelly-like slime. In some cases all the coats of the intestines are hyper- 
trophied, and polypous excrescences found upon it. Sometimes the mucous 
membrane appears pale, anaemic, and the submucous cellular tissue infiltrated. 
It is usually diffused over large tracts of the canal, but may be confined to 
the lower part of the small intestines or to portions of the colon. 

This form develops itself either in consequence of repeated acute 
attacks, or the frequent use of purgative medicines, or is a concomitant of 
various other complaints, such as cancer, tuberculosis, typhus, obstructed 
circulation in the vena porta, cirrhosis of the liver, organic diseases of the 
heart and lungs, or obstruction in the gut itself. Its Symptoms are the 
following: 

i. Diarrhoea or constipation, frequently in alternation. The diarrhceic 
stools consist mostly of thin, fecal matter, of all colors and consistencies, 
mixed with considerable quantites of slimy, jelly-like matter. The hard 
evacuations are always covered with tough or jelly-like phlegm. 

2. Copious development of gas in the bowels, which causes partial or 
general distention of the abdomen and great distress to the patient. Its pass- 
ing off gives great relief, and for that reason the patients make much account 
of it. 

3. Hypochondriacal mood. Such patients do not think or speak of any- 
thing but their own sufferings; tormenting everybody with the same sorrow- 
ful tale. 

4. Gradual emaciation, and, in severe cases, sinking in of the abdomen, 
in which the thickened intestines can be felt through the abdominal walls. 

As regards its location, we may conceive the inflammation as situated: 
1. In the upper part of the small intestines, if the patient complains of a dull 
pain in the middle of the abdomen and constipation. 2. In the lower part 
of the small intestines — the ileum — if it is attended with greenish-yellow, or 
yellowish-gray, watery stools, which, w T hen left standing, form a sediment. 
3. In the large intestines, if the evacuations contain large quantities of slime 
or pus mixed with blood, and are attended with a great deal of tenesmus. 

Therapeutic Hints. 

Arg. nitr. Diarrhoea, worse at night; watery, slimy; always after 
drinking or eating soup, immediate discharge from the bowels, as though 
the fluid were rolling through without stopping; soreness and burning in 
the region of the sigmoid flexure; fever; emaciation; desire for sugar. 

Arsen. Worse about midnight; burning pain in the abdomen; dis- 
charges burning, cadaverously-smelling, excoriating the anus; thin, lumpy, 
of all colors; great thirst; restlessness; exhaustion and emaciation; old look 
in the face; very cross and despondent. 

B apt is. Stools dark, offensive, exhausting; pain in the liver and region 
of gall-bladder, sweat and urine extremely fetid; little or no thirst; gone 
feeling at pit of stomach; frequent faintings. 



THERAPEUTIC HINTS TO CHRONIC INTESTINAL- CATARRH. 45 1 

Bryan. Pain in the bowels after eating or drinking; slightest motion 
brings on a discharge which looks like dirty water, showing, on standing, a 
whitish, fineh* granulated sediment of undigested food at the bottom of the 
vessel. 

Calc. card. During dentition; scrofulous individuals; diarrhoea, worse 
toward evening; whitish, chronic, soft stools; emaciation. 

Card. veg. Great collection, of wind in the abdomen, frequent dis- 
charges of very fetid flatus without relief; stool, even if soft, is passed with 
great difficulty, similar to. Cinchona. 

Coccul. Diarrhoea ovXy through the day, thin, yellowish, without pain; 
great rumbling in the bowels; hectic fever; general emaciation. 

Coloc. Chronic diarrhoea in the morning; watery; with pain in the 
sides of the abdomen. 

Crot. tig I. Diarrhoea, with nausea; watery discharges gushing out 
forcibly; worse after drinking, and in the summer season. 

Gelsem. When diarrhoea is always brought on by exciting news, fright 
or emotions of the mind. 

Graphit. A quantity of white mucus is expelled with the stool, or the 
hard feces are covered with slime. 

Gummi gutt. Pain in ileo-caecal region, which is sensitive to the touch; 
discharges watery, slimy, undigested, without smell; during stool, bearing 
down and colicky pain, prolapsus ani, and cold sweat on the limbs. Also 
thin, yellow, fecal or watery, frequent, copious stools, coming out all at once; 
worse in the forenoon; sudden urging; after stool great relief in abdomen. 

Hepar. Especially after the abuse of mercury, with longing for sour or 
strong-tasting things; empty, sinking feeling in stomach, relieved by eating. 

Ipec. Cured a chronic diarrhoea with clean tongue and frequent nausea, 
constant pain at umbilicus; miasmatic origin. Aided by milk diet. ( W. L. 
Dodge.) 

Laches. Ileo-csecal region very sensitive to touch; after great strain- 
ing, discharge of a mass of croupous exudation; stools very offensive; heat 
of abdomen. 

Mercur. Discharge mostly slimy and with straining; worse towards 
evening and in the night; gums swollen; teeth loose; sickly smell from the 
mouth; the mere putting the hands upon something cold, causes pain in the 
bowels; debility; sweat without relief. 

Natr. mur. Diarrhoea mostty through the day; greenish, bloody; or 
watery; perceptible falling away in flesh on the neck; the neck becomes 
quite thin . ( Hering . ) 

Nitr. ac. Acute pain in the abdomen during stool; worse in the morn- 
ing; discharge brown and slimy. 

Nuphar hit. Stool liquid, light yellow; the call is urgent, must go 
quick, every morning at six o'clock, and followed by two or four more pas- 
sages in a few hours, and no more until next morning. (J. L. Gage.) 



452 DIGEST TO ACUTE AND CHRONIC INTESTINAL CATARRH. 

CEnoth. bicn. Relieves the melancholy and low spirits which accom- 
pany the chronic form. (J. S. Douglass.) 

Petrol. Slimy discharge; also, brown fluid or pappy evacuations; pain 
in the bowels; before dusk a sensation of unpleasant motion and grasping in 
the bowels; disgust for meat, especially fat; bitter-sour taste in the mouth; 
cold feeling in the abdomen. Diarrhoea, sometimes only during the day. 

Phosphor. Painless, watery discharges; especially in the morning 
after getting up; in debilitated, consumptive patients; lying-in women, etc. ; 
burning of the palms of the hands; great weakness; emaciation. Worse in 
warm weather. 

Phosph. ac. Painless, watery discharges, with great rumbling in the 
bowels; during cholera epidemics. 

Sepia. Jelly-like stools, with colic; debilitating diarrhoea; worse after 
milk; the whole aspect of the patient indicates a deep-seated disturbance in 
the digestive functions. 

Sulphur. Diarrhoea; worse in the night or early in the morning; stools 
yellow or brownish or greenish, mixed with blood, slime or pus; feces pass 
off while the patient intends to relieve himself of flatus; the abdomen is sore 
to the touch; during stool, pain in the small of the back; palpitation of the 
heart; congestion of the head; prolapsus ani; itching, burning, smarting in 
the anus and rectum. 

Frequent alternation of costiveness with diarrhoea suggests: Ant. crud., 
Arg. nitr., Arsen., Bryon., Graphit., Natr. mur., Phosphor., Rhus tox., 
Ruta, Sepia. 

Copious development of gas: Card, veg., Coecul., Graphit., Nib. ac., 
Phosphor., Pulsat. 

The patients think and talk of nothing but their ailments: Arsen., Calc. 
carb., Coecul., Mercur., Nitr. ac, Phosphor., Sepia, Sulphur. 

Emaciation and sinking in of the abdomen: Arsen., Borax, Calc. carb., 
China, Ferrum, Graphit., Iodum, Laches., Lycop., Natr. mur., Nitr. ac, 
Nux vom., Phosphor., Phosph. ac, Pulsat., Silic, Staphis., Sulphur, Veratr. 

Digest to Acute and Chronic Intestinal Catarrh. 

DISCHARGES. Green: Chamom., Iris, Mercur., Rheum. 

Bloody: Aeon., Mevcus., Natr. mur., > like scum on a frog-pond: Magn. 

carb. 

spinage: Aeon. 

and changing constantly in color: 

Podoph. 
Greenish: Chamom., Natr. mur., Rhus 

tox., Sulphur. 
Jelly-like: Sepia. 

globules of flakes: Rhus tox. 

Lumpy: Arsen. 

Offensive, fetid: Baptis., Ben-, ac, 

Laches. 
, cadaverously: Arsen. 



Sulphur. 
Brown: Nitr. ac, Petrol., Rhus tox. 
Brownish: Sulphur. 
Colors, of all: Arsen., Podoph. 
Croupous masses after great straining 

Laches. 
Dark: Baptis., Corn, circ 
Eggs, chopped, like: Chamom. 
Fermented: China, Rhus tox. 
Frequent: Aeon., Gummi. 
Frothy: China, Magn. carb. 
like soap-suds: Benz. ac. 



DIGEST TO ACUTE AND CHRONIC INTESTINAL CATARRH. 



453 



Pappy: Petrol. 

Pus, containing': Sulphur. 

Slimy: Arg. nitr., Chamom., Gummi, 
Mercur., Nitr. ac, Podoph., Sulphur. 

, a quantity of white mucus is ex- 
pelled with the stool, or covers hard 
feces: Graph it. 

Smell, sour: Magn. carb., Rheum. 

, without: Gunnni. 

Thin: Arsen., Coccul.,Jatropha. 

Undigested: Bryon., Chamom., China, 
Gummi. 

Watery: Ant. crud., Arg. nitr., 
Chamom., Color., Crot. tigl., Ferruvi, 
Gummi, Jatropha, Leptand., Natr. 
mur., Phosphor., Phosph. ac. 

Water, like dirty, with whitish, finely 
granulated sediment of undigested 
matter: Bryon. 

White: Ver. alb. 

floating lumps, like tallow: Magn. 

carb. 

Whitish, soft stools: Calc carb. 
Yellowish: Coccul., Crot. tigl., Gummi, 
Nuph. lut. 

PASSAGE. 

Sudden urging: Gummi. 

every morning at 6 o'clock, fol- 
lowed by two, four or more passages in 
a few hours and no more until next 
morning: Nuphar. 

Coming on suddenly at night: Veratr. 

out all at once: Gummi. 

Gush OUt: Crot. tigl., Jatropha. 
Stool is passed with difficulty, even if 
soft: Carb. veg., China. 

involuntarily while passing flatus: 

Sulphur. 

without pain : Arsen., China, Coccul. , 

Ferrum., Iris, Jatropha, Phosphor., 
Phosph. ac, Sulphur, Ver. alb. 

with pain: Arsen., Bryon., 

Chamom., Coloc, Ipec, Ins., Nitr. 
ac. 

and crying: Rheum, Rhus tox. 

Before stool pain: Crot. tigl., Magn. 

carb. 

and rumbling in bowels: Aloes. 

During stool colic: Aranea, Chamom., 

Collin., Coloc, ipec, Gummi., Sepia. 
, with doubling up and pressing the 

belly against a hard object: Coloc. 



, with drawing the limbs up: 

Chamom. 
, daily at same hour, with feeling as 

if arms and legs were asleep: Aranea. 

griping: Corn. circ. 

, pain in the sides of abdomen: Coloc. 

, in small of back; palpitation of 

heart; congestion to head: Sulphur. 
, with bearing down, prolapsus ani: 

Gummi, Sulphur. 
, burning and smarting in anus and 

rectum: Sulphur. 
, with paleness of face and cold ex- 
tremities: Arsen., Ipec. 

cold sweat on limbs: Gummi. 

, rumbling, flatulence: Collin., 

Jatropha. 

, escape of much flatus: Aloes. 

Passage, with straining and tenesmus: 

Aeon., Corn, circ, Mercur., Nux vom., 

Sulphur. 

, cannot get done: Mercur. 

, nausea and vomiting: Crot. tigl., 

Ipec, Ver. alb. 
, during dentition: Bellad., Calc. 

carb. 
After stool, relief in abdomen: Gummi, 

Magn carb. 

, colic: Rheum. 

, severe pain in small intestines: 

Leptand. 
, burning in rectum and anus: Iris 

vers. 

GENERAL SYMPTOMS. 

Patients think, talk of nothing but 
their ailments: Arsen., Calc. carb., 
Coccul., Mercur., Nitr. ac, Phosphor., 
Sepia, Sulphur. 

Low-spirited and melancholy: CEnanth. 
bien. 

Cross and despondent: Arsen. 

, child wants to be nursed all the 

time: Benz. ac. 

, carried about: Chamom. 

, many things with vehemence 

and tears, and is satisfied for a short 
time if its whims are gratified : Rheum. 

Rolling head from side to side: 
Podoph. 

Hairy scalp perspiring; sweat sour, or 
not: Rheum. 

Old look of the face: Arsen. 



454 



DIGEST TO ACUTE AND CHRONIC INTESTINAL CATARRH. 



Pallor of countenance, occasional twitch- 
ing of eyelids, corners of mouth, lips 
and fingers: Rheum. 



Gums swollen, teeth loose, sickly smell, 

from mouth: Mercur. 
Tongue clean: Ipec. 

coated: Pulsat. 

white: Ant. crud. 

Taste bitter: Pulsat. 

bitter sour: Petrol. 

Thirst great: Veratr. 

at night: Ant. crud. 

Thirstless: Baptis., Pulsat. 

Appetite good: Ferrum. 

Desire for sugar: Arg. nitr. 

sour or strong-tasting things: Hepar. 

various things, quickly satisfied: 

Rheum. 

Disgust for meat, especially fat: Petrol. 

Stomach disordered: Ant. crud. , Pul- 
sat. 

Deep-seated disturbance of digestive 
functions: Sepia. 

Nausea: Ipee., Pulsat. 

Empty, gone, sinking feeling in stom- 
ach: Baptis. 

relieved by eating: Hepar. 

Pain in liver and region of gall-bladder: 
Baptis. 

Jaundice: Aeon., Chamom., Mercur. 



Griping about navel with nausea: D id- 
ea m. 

Pain constant about navel: Ipee. 

Soreness and burning in region of sig- 
moid flexure: Arg. nitr. 

Pain in ileo-caecal region, sensitive to 
touch: Gi/mmi, Laches. 

Cold feeling in abdomen: Petrol. 

Burning pain in abdomen: Arsen. 

Heat of abdomen externally: Laches. 

Unpleasant motion and grasping in 
bowels before dusk: Petrol. 

Soreness of abdomen to touch: Laches., 
Sulphur. 

Rumbling in abdomen: Chamom., Coc- 
cul., Phosph. ac. 

Fermentation in bowels: China. 

Copious development of gas: Card. i'eg., 
Coccul., Craphit., Nitr. ac., Phosphor., 
Pulsat. 

Belly bloated and hard: Chamom. 



Frequent discharges of very fetid flatus 
without relief: Card. veg. 

Frequent alternation of costiveness with 
diarrhoea: Ant. crud., Arg. nitr., 
Arsen., Bryon., Graph it., Natr. mur., 
Phosphor., Rhus tox., Ruta, Sepia. 

Emaciation and sinking in of abdomen: 
Arsen., Borax, Calc. card., China, 
Ferrum, Graphit., Iodium, Laches., 
Lycop., Natr. mur., Nitr. ac, Nux 
z'om., Phosphor., Phosph. ac, Pulsat., 
Silic, Staphis., Sulphur, Ver. alb. 

Urine high colored and very offensive: 
Benz. ac. 

fetid: Baptis. 

Chafed, excoriated, sore anus: Arsen., 
Chamom., Mercur., Sulphur. 

Cough from tickling in the throat-pit: 
Rumex. 



Cold, chilly in small of back: Did cam. 
Chilliness: Pulsat. 

, followed by flushes of heat and 

sweat: Corn. circ. 
Hectic fever: Coccul. 
Burning of palms of hands: Phosphor. 
Sweat fetid: Baptis. 
without relief: Mercur. 



Restlessness: Arsen. 

Nervous excitability: Corn, circ, 
Rheum. 

Weakness: Phosphor. 

Debility: Corn, circ , Mercur., Sepia. 

Exhaustion: Arsen., Baptis. 

Prostration, sudden: Arsen. 

Emaciation: Arsen., Calc card., Coc- 
cul., Phosphor. 

, especially of neck: Natr. mur. 



Whole child smells sour: Rheum. 
aspect indicates deep-seated disturb- 
ance of digestive organs: Sepia. 



Worse in the morning: Coloc, Jatropha, 

Nitr. ac, Rumex. 

, early 2 or 3 o'clock a. M. : Iris. 

, early: Nux vom. 

, driving out of bed: Sulphur. 

, after getting up and moving about: 

Bryon., Phosphor. 

in forenoon: Gum mi, Podoph. 

in afternoon and evening: Calc 

card., Mere. sol. 



TYPHLITIS, PERITYPHLITIS AND APPENDICITIS. 



455 



through the day: Coccul., Natr. 

mur., Petrol. 

in the night: Arg. nitr., China, 

Mercur., Pulsat., Rhus tox., Sulphur. 

about midnight: Arsen. 

after drinking: Crotal., Ver. alb. 

Worse after drinking or eating: Bryon. 
or eating soup, as though the 

fluid were rolling through without 

stopping: Arg. nitr. 

after eating: China. 

from slightest motion: Bryon. 

from moving about: Rheum. 

when keeping quiet: Rhus tox. 

from uncovering an arm or leg: 

Rheum. 

Aided by milk diet: Ipec. 
Brought on by disordered stomach, from 
sour wine or beer: Ant. crud., China. 

from sour krout, sour fruit: Bryon. 

from milk: Sepia. 

from sweet, fat or sour things 

(raisins, pound cakes, pastry, salad, 
etc.) : Ipec., Pulsat. 

by chilling the stomach with ice 

cream, ice<water, ice milk: Arsen. 



after previous use of quack medi- 
cines: Nux vom. 

after mercurial preparations: Hepar. 

by exciting news, fright, etc. : Gel- 

sem. 

by vexation or anger: Bryon. 

in summer season: Bryon., Crotal., 

Ipec., Phosphor., Veratr. 

when the weather changes suddenly 

to cold: Bryon., Dulcam. 
by exposure to wet, damp weather: 

Leptand. 

by taking cold: Mercur. 

by checked perspiration : Aeon. 

by putting the hands upon some- 
thing cold: Mercur. 

during dentition: Calc. card., Ipec, 

Podoph., Rheum. 

, lying-in women: Phosphor. 

, debilitated and consumptive pa- 
tients: Phosphor. 

, scrofulous individuals: Calc. card. 

, external burns: Arsen. 

, during cholera epidemics: Phosph. 

ac. 

, miasmatic origin: Ipec. 



Typhlitis, Perityphlitis and Appendicitis. 

Although, anatomically speaking, these are three distinct forms of dis- 
eases, yet, considering them in a diagnostic point of view, their symptoms 
during life are so intimately interwoven, that a differential diagnosis among 
them is rarely possible. 

Typhlitis is an inflammation or catarrh of the mucous membrane of 
the caecum, in consequence either of cold or accumulation of hardened feces 
or foreign bodies, such as cherry-stones, plum-stones and the like. It may 
spread over a considerable portion of the colon ascendens, and to the vermi- 
form process; it may spread to the muscular layer of the gut, cause ulceration 
and even perforation of these parts, and terminate in peritonitis, inflammation 
of the loose areolar tissue around the caecum, and formation of abscesses in 
the right iliac fossa. 

Perityphlitis is an inflammation of the loose areolar tissue around the 
caecum, either in consequence of typhlitis, or starting here independently; it 
is attended with a feeling of numbness and formication in the right limb and 
but little meteorism. It terminates, if not checked, in the formation of 
abscesses in the right iliac fossa, which either discharge into the neighboring 
viscera or break through the abdominal parietes, mostly in the neighborhood 
of Poupart's ligament. As such abscesses, if not originally caused by per- 
foration of the caecum from within, mostly perforate the posterior wall of this 



456 TYPHLITIS, PERITYPHLITIS AXD APPENDICITIS. 

organ, it occasionally happens that the abscess, when it discharges exteriorly, 
contains fecal matter also. 

Appendicitis may be caused, like typhlitis, by hardened fecal matter or 
foreign bodies. It terminates either in obliteration of this process, or, when 
its opening gets closed, in an accumulation of a slimy, serous fluid, by which 
its walls become distended, forming the so-called dropsy of the appendix, or 
in the formation of abscesses in the right iliac fossa, or, lastly, in more or 
less extended peritonitis. 

The Symptoms of these three pathological states we may sum up under 
the following heads : 

i . External swelling. It makes its appearance in :he right ileo-csecal or 
ileo-inguinal region of the abdomen. It is felt directly under the abdominal 
wall, which is moYable upon it except in such cases where a perforation to 
the outside is going to take place, and exhibits in most cases considerable 
heat and redness. The swelling itself is immoYable, its surface feels smooth 
and its consistency Yaries in degree; it may reach sometimes the hardness of 
a stone; fluctuation is seldom perceptible. Its growth is rapid; in a few 
days it reaches its height. The swelling is wanting only in such cases in 
which perforation takes place, before yet exudation and pus formation could 
take place around the caecum, and it is not perceptible, or at least not distinctly 
so, when, in consequence of peritonitis, the fluid exudation or meteorismus 
of the neighboring intestines coYers it OYer. When perityphlitis follows* upon 
typhlitis, and the latter subsides, we find the exterior swelling likewise de- 
creasing while a tumor deeper in still remains. 

2. Pain. It usually commences suddenly, is of a sharp, lancinating or 
boring nature, and increases on motion, especially such which puts either the 
abdominal or the psoas muscle on a stretch. It is worse from touch, and 
confined either to the right iliac fossa alone or extending OYer a larger sur- 
face in accordance to the extension of the inflammation. 

3. Obstinate constipation, which may last for days, although interrupted 
sometimes. 

4. By an intercurrent diarrhoea of a slimy, watery substance. Such diar- 
rhoea, howeYer, is no faYorable sign; only fecal discharges afford relief. 

5. Vomiting may take place at any stage of the disease, but does so most 
frequently at its height. In some cases it is Yery violent, ten to twelve times 
a day, is at first of a watery, yellowish or greenish fluid, which, however, as 
the disease progresses, and the constipation continues, assumes a stercoraceous 
smell, until, by the continued antiperistaltic motion of the intestines, the con- 
tents of the smaller intestines are forced back into the stomach, whence they 
are thrown up, affording temporary relief to the patient. 

6. Belching and meteoristic distention of the stomach and upper part of 
the abdomen. 

7. Singultus or hiccough is a frequent sign, and very distressing to the 
patient, preventing all rest and sleep. 

8. Pain in the genitals, erections of the penis, drawing up of the testicles, 



THERAPEUTIC HINTS TO TYPHEITIS, ETC. 457 

difficulty in urinating, numbness of the right leg, are consequences of the 
swelling, pressing upon the corresponding nerves; while 

9. The (edematous swelling of the right leg is the consequence of its press- 
ure upon the crural and iliacal veins. Such a desperate condition of things 
must necessarily involve the whole system 

10. In fever, which is more or less violent according to the extent of the 
inflammation. 

Differentiae Diagnosis. — It may be confounded with 

1. Abscesses of the psoas muscle. But in this affection the swelling lies 
deeper, nearer Poupart's ligament, and more towards the middle line of the 
abdomen. It makes any motion with the right leg, which is always held in 
a bent position, impossible; it leaves the action of the bowels undisturbed; 
it is associated with caries of the vertebrae or bones of the pelvis. Pus, when 
discharged through the abdominal walls, has no fecal odor. 

2. Tumors or abscesses of the right kidney cause the main part of the swell- 
ing to appear in the loin, or above the anterior termination of the crest of 
the ilium. There is no disturbance in the action of the bowels, but the urine 
contains pus, bloody gravel, pointing at once to a diseased state of the 
kidneys. 

3. Tumors of the right ovary are attended with menstrual disturbance, 
but not with affections of the bowels; they grow slowly, and from below up 
out of the pelvis; where they may be discovered by a per vciginam exami- 
nation. 

4. Cancer of the caecum is a very rare disease, of very slow growth, and 
attended with all the general signs of cancerous diathesis. 

5. Intussusception or invagination of the intestine may be sometimes 
very difficult to be discerned from typhlitis, especially if it should happen to 
cause a swelling just in the right iliac region; but this not always the case; 
and, furthermore, it is preceded by diarrhoea. As soon, however, as in- 
vagination has taken place, there are only bloody, slimy discharges; the 
obstruction of the intestinal canal with all its symptoms — stercoraceous 
vomiting, hiccough, etc. — is at once established, while in typhlitis it sets in 
only during the further progress of the disease. 

Therapeutic Hints. 

Bellad. Great pain in the ileo-caecal region, cannot bear the slightest 
touch, not even the bed-cover; nausea; vomiting; necessity of lying motion- 
less on his back; high fever, increasing during the afternoon with red or 
pale face; slight perspiration during the fever. 

Ginseng. Stinging pain and swelling and gurgling noise in the ileo- 
cecal region; dry tongue; heat and delirium when going to sleep. 

Ifepar. After the abuse of mercury; ileo-caecal region swollen, deep, 
in a circumscribed lump; lying on the back with the right knee drawn up, 
as easiest position; frequent urging to stool and urination. 

Laches. Great sensitiveness to contact of the abdomen; swelling- in 



458 PROCTITIS. 

the ileo-eaecal region ; painful stiffness from the loins down to the os sacrum 
and thighs; constipation; scanty urine, with red sediment; strangury; only 
possible position is that on the back, with the knees drawn up. Fever in- 
creases towards 3 o'clock p. m.; patient feels worse after sleep. 

Mercur. Painful, hard, hot, and red swelling in the ileo-caecal region, 
painful to the touch; face red or pale, sickly; thirst; red, dry tongue; con- 
stipation, or frequent slimy discharges with straining; sweat without relief. 

Plumbum. Large, hard swelling in the ileo-csecal region, painful to the 
touch and least motion; or when sneezing and coughing; the whole abdomen 
sensitive; the navel drawn in; frequent sour belching; nausea; retching; 
constipation; anxious countenance; dry tongue, red on the edges, brown 
coating in the middle; great thirst, lame feeling in the legs. 

Rhus tox. Hard, painful swelling of nearly the entire right side of the 
abdomen; pain worse in sitting or when stretching the right leg; impossibility 
of lying on the left side; better when lying on the back with right leg drawn 
up; and when gently pressing the swelling from below upwards; pale, anx- 
ious face; burning of the palms of the hands; profuse sweat at night; small, 
frequent pulse; after taking cold by getting wet. 

Thuja. Only those parts of the body perspire which are uncovered 
those covered are hot and dry. 

Besides these compare Ammo?i., Arse?i., Cha?nom., Coccul., Colchic, 
Coloc, Lycop., Nitr. ac, Platina, Silic, Sulphur, Veratr., Zincum. 

Stercoraceous smell of the vomit hints to Asa/., Mercur., Opium, 
Plumbum. 

Already formed abscess in the right iliac fossa indicates Hepar, I odium, 
Kali carb. , Laches. , Lycop. , Mercur. , Silic. 

Proctitis, Catarrhal Inflammation of the Rectum. 

This is either of an acute or a chronic nature, and its pathological ap- 
pearance corresponds entirely to a catarrhal inflammation- of an}' other mu- 
cous membrane, exhibiting injection, infiltration, mucous secretion, and at 
last thickening of the membrane, chronic blennorrhcea and ulceration. It 
may be caused by taking cold, purgative medicines, medicated injections, in- 
sertion of pieces of soap to promote evacuations; by worms and hard fecal 
matter. 

It may, secondarily, be a mere continuation of an inflammatory process 
in neighboring organs, such as the hemorrhoidal veins, the bladder, the 
prostatic gland, or the internal sexual organs; or it may accompany tubercu- 
lous, cancerous or syphilitic ulcers, or disorders which cause stagnation in the 
abdominal veins in general, such as diseases of the liver, of the vena porta, 
the heart and lungs. 

Its Symptoms are: pain, tearing, throbbing, burning, or as if some- 
thing were sticking in the rectum which had to be forced out; worse during 
an evacuation; constant desire to evacuate; tenesmus; in severe cases, 



PERIPROCTITIS. 459 

attended with retention of urine and strangury; painful urination or drip- 
pling of urine; erection of penis; drawing up of testicles; leueorrhcea. 

The bowels are mostly constipated, but the stool natural, covered, how- 
ever, with a thin layer of slime, which is colorless or tinged with blood. The 
great straining frequently causes prolapsus ani. In its chronic form the pain 
is more of a dull, heavy nature, and its most prominent symptom is the con- 
stant discharge of a thick, yellowish, even purulent secretion from the 
mucous membrane of the rectum. It covers either the natural discharges 
from the bowels, or it is mixed with the loose stools (if there be such), or 
oozes out of the anus, staining the linen of the patient. This chronic form 
is frequently attended with chronic catarrh of the bladder, the uterus and 
vagina, and especially with hemorrhoidal affections. In both forms the 
inflammation may extend to the cellular tissue about the rectum. 

Therapeutic Hints. 

In ordinary acute cases there will be indicated either Aeon., Bellad., 
Nux vom. or Sulphut . 

When there is tenesmus in the rectum and bladder at the same time : 
Alum., Aloes, Capsic, Hyosc, Lycop., Natr. carb., Merc. subl. 

During stool, discharge of urine impossible: China, Merc, subl.; during 
stool, erections of penis: Ignat., Thuja; during stool, discharge of leueor- 
rhcea: Magn. mur., Thuja, Zincum. 

Drippling of urine: Arg. ?iitr., Bryon., Calc. carb., Laches., Lycop., 
Natr. carb., Petrol., Rhodod., Silic, Staphis., Thuja. 

Slim}-, purulent matter oozing out of the anus: Borax, Coloc, Sepia, 
Thuja. 

Prolapsus ani : Bellad., Calc. carb., Ignat., Lycop., Nux vom., Podoph., 
Sulphur. 

Polypi recti : Calc. carb., Calc. phosph., Phosphor., Silic, Thuja. 

Periproctitis 

Corresponds to Perityphlitis, being an inflammation of the areolar tissue 
around the rectum. 

Primarily, it is of rare occurrence, but may be brought about by falls, 
bruises, riding on horseback, surgical operations, or taking cold. 

Secondarily it is much more frequent, and may be a mere continuation 
of inflammatory and ulcerative processes in the rectum or other neighboring 
organs, the pelvic bones, the prostate gland, the bladder, the uterus ; some 
times, however, it appears as part of a general tubercular process and puer- 
peral inflammation, without any ulcers in the rectum. 

Its most important Symptoms are: 

i. A swelling and hardness around and about the rectum, which appears 
either back of the anus in the coccygeal space, or in front of it, in the peri- 
neal region. Sometimes, however, nothing is seen or felt exteriorly, the 



460 DYSENTERY. 

swelling being higher up; and an examination per anum, by which it might 
be detected, is so painful to the patient that it is seldom practicable 

2. In the course of ten or twelve days, however, the hard swelling is 
converted into an Abscess, which breaks either outside, in the above-named 
regions, or perforates the rectum, and discharges through the anus. In 
rare cases only, does a perforation take place into the bladder, the vagina, 
the uterus, or into an}' other part of the intestines. The first is the most 
favorable. After discharging itself fully, it heals and nothing is left. Per- 
foration of the rectum, however, frequently causes Fistula; and perforations 
into an}- of the other organs are still more serious in their nature. Instead 
of terminating in abscess, however, the exudation is occasionally absorbed, 
leaving a chronic induration of portions of the wall of the rectum. 

3. The pain is mostly of a dull, heavy kind, or darting in the region of 
the rectum; worse on sitting and walking. Sometimes it is throbbing ; 
shaking chills are a sure sign that formation of pus has taken place. 
Tenesmus is also frequently combined with it; also difficulty of voiding urine. 

Therapeutic Hints. 

When brought about by traumatic causes: bruises, falls, riding on horse- 
back: Arnica, Conium, Pulsat., Rhus tox., Sulph. ac. 

For heavy, dull, pressing pain: Bellad., Ignat., Nux vom. 

For darting-, stitch-like pain: Bryon., Kali carb., Phosphor. 

When the swelling is hard and inflamed: Arsen., Bellad., Hepar, Laches., 
Mercur., Pulsat. 

To bring it to a head : Arsen. , Calc. , carb. , Hepar, Kreos. , Laches. , Lycop. , 
Mercur., Sepia, Silic. 

Fistules require : Berber., Calc. sulph., Caustic, Silic. 

Dysentery. 

The pathological character of this affection presents the following fea- 
tures : it is seated almost exclusively in the large intestines, from the valve 
of the caecum down to the rectum; occasionally, however, it passes beyond 
the caecal valve towards the ilium, but is here only seen in its mildest form. 
When commencing, the mucous membrane appears reddened, swollen; the 
epithelium peels off; sometimes it is raised into little vesicles by an exuda- 
tion beneath. Later the mucous membrane becomes covered in patches with 
a dirty- whitish, yellowish-gray, or yellowish-red substance, which, from the 
contents of the bowels or from blood, may assume a greenish or browish 
color, and consists of decayed epithelial cells, slime, pus and blood globules. 
If scraped off by the knife, it discloses the mucous membrane beneath red- 
dened, softened, and uneven in consequence of a serous infiltration into the 
submucous cellular tissue. The solitary follicles are swelled and in a state 
of ulceration. All this causes a collection of putrid, bloody or purulent 
masses within the cavity of the gut. In a still higher degree of inflamma- 
tion the mucous membrane is found decayed or changed into a soft, dark 



DYSENTKRY. 461 

mass, which is thrown off and discharged, giving rise to irregular, larger and 
smaller dysenteric ulcers of the colon which in rare cases may cause even 
perforation of the gut. Besides these grave destructive changes within the 
intestine itself, we also find more or less inflammation of the peritoneum, 
swelling of the mesenteric glands, hyperemia and inflammation of the liver. 

Dysentery generally prevails epidemically, under the influence of a tropi- 
cal climate, or one resembling a tropical climate, on a soil of moist and per- 
haps swampy character. In this form the amoeba coli is found present in the 
base of the ulcers and adjacent tissues. It is found in camps, in hospitals, in 
regions where malaria prevails. Summer heat and in autumn sudden cool 
nights are very apt to cause it. Sporadic cases we find, therefore, occur 
mostly after sudden check of perspiration, or after getting wet; fruit, if ripe, 
will scarcely ever cause it, although some people do assert it. Unripe fruit, 
however, is always hurtful. Virchow -considers the epidemic form of a diph- 
theritic — the sporadic of a catarrhal — nature. 

Dysentery attacks all ages and both sexes. In its epidemic form it is 
believed by some authors to be contagious, especially when large masses of 
excreta become heaped together, as in camps or hospitals, wherefore every 
dejection should be considered as dangerous. Those who deny its conta- 
giousness do it only reservedly. Sporadic cases are generally considered as 
non-contagious. 

Symptoms. — 1. The stools, commencing almost always as diarrhceic, 
change into characteristic dysenteric stools. At first we observe in the liquid 
diarrhoeic stools jelly-like, transparent clots of slime, looking similar to boiled 
sago; they are dotted and streaked with blood and will sink to the bottom of 
the vessel if the evacuation remains standing a while. They soon increase 
and are discharged in larger quantities of jelly-like, transparent masses tinged 
with blood. As they augment, the fecal substance of the stool diminishes, 
until, finally, nothing but slime is discharged. By this time, however, its 
jelly-like character changes into an opaque, dirty whitish, or reddish-gray 
appearance, like scrapings, swimming sometimes in a thin, bloody, watery 
fluid; fecal matter disappears entirely. 

The blood contained in it varies in quantity from merely tinging the 
slime into a reddish color to clear blood. In rare cases only whole shreds 
or pieces of slough from the lining membrane pass away; but when the dis- 
charges assume a brownish, chocolate-like color, and are of a penetrating, 
cadaverous smell, the dysenteric ulcers within have become ichorous and the 
mucus membrane is decaying. When, however, fecal matter again makes 
its appearance, which generally takes place in the shape of hard lumps, it has 
always been to me a sign that the inflammation is gradually subsiding; and, 
although after it many more evacuations of mere bloody slime ma}* take 
place, yet the violence of the disease seems broken; there is, after that, less 
and less slime discharged, until, at length, normal alvine discharges prove 
the restoration to health. 

The frequency of stools varies from four to twenty, thirty or even more 



462 THERAPEUTIC HINTS TO DYSENTERY. 

in the course of twenty-four hours. The smell of the evacuations Yaries also. 
At first, as long as fecal matter is contained therein, the smell is, accordingly, 
stercoraceous; later, when the fecal matter has disappeared, there is either no 
smell, or a peculiar, fleshy, sweatish, nauseating odor. When, however, the 
disease is at its height, and the dysenteric ulcers become ichorous and 
sloughing, the smell is awful, penetrating, cadaverous. 

2. Pain in the bowels and tenesmus. Characteristic of dysentery is the 
colicky, cutting and drawing-together pain in the bowels before and during 
an evacuation, ceasing soon after, to be renewed by another attack, thus 
coming in spells. The evacuations are generally attended by great burning 
pain in the anus and rectum. In fatal cases, where paralysis of the colon 
takes place, the pain ceases altogether. Likewise characteristic is the tenes- 
mus or straining during an evacuation, and continuing some time after, al- 
though not more than a teaspoonful be voided. It is the most painful symp- 
tom of the disease, and may cause fainting, convulsions and prolapsus ani. 
This symptom also ceases if, in fatal cases, paralysis of the colon takes place. 

3. Reflex symptoms. To these belong the vomiting frequently found at 
the beginning, but also during the progress of the disease; singultus (which, 
however, is not so frequent, and then is generally a sign of peritonitis), reten- 
tion of urine and painful micturition. 

4. General symptoms are, more or less fever, but the temperature of the 
skin is usually not as high as in most other inflammatory diseases. The 
skin is mostl}' dry. There is great thirst, little appetite, great loss of flesh. 

5 Complications are, peritonitis, perityphlitis, periproctitis, pneu- 
monia, pleuritis, parotitis, splenitis, hepatitis, erysipelas, haemorrhages, decu- 
bitus, and abscess of the liver. 

6. Unfavorable symptoms are, copious haemorrhages, ichorous, chocolate- 
colored and cadaverous-smelling discharges, great prostration of strength; 
great frequency and smallness of pulse; cold skin; cold, sticky perspiration; 
livid and cyanotic face; collapsed abdomen, with want of elasticity of its 
walls; paralysis of the sphincter ani, so that the anus remains opens; involun- 
tary discharges; peritonitis; perforation of the colon; shaking chills; erysip- 
elas; violent vomiting, with cholera-like S3 T mptoms; obstinate singultus; 
delirium; convulsions and paralysis. 

Therapeutic Hints. 

Aeon. After sudden check of perspiration; chill, high fever and dry skin; 
first very frequent, small, brown, painful and at last bloody discharges. 

Aloes. Violent tenesmus; frequent stools of bloody water or with lumps 
of mucus, like jelly; during stool fainting or screaming on account of vio- 
lent pains in the abdomen, especially right side, ceasing after stool; hunger; 
great rumbling along the colon; large quantities of flatus escape with the 
stools; pains in the small of the back; when urinating, urging to stool. 

Alum. Tenesmus of bowels and bladder; no flow of urine except dur- 
ing an evacuation from the bowels. 



THERAPEUTIC HINTS TO DYSENTERY. 463 

Apis. Great tenesmus, and feeling as if the intestines were bruised. 

Ar sen. Discharges have a fetid, foul smell; consists of fluid feces mixed 
with blood, chocolate-colored; most frequent about midnight; before stool, 
torturing sensation, as if the abdomen were being constricted; at the stool, a 
feeling of contraction in the rectum; after stool, burning in rectum and 
anus; trembling in all the limbs; palpitation of the heart and distention of 
the abdomen; tenesmus with burning in the anus and rectum; great ex- 
haustion, and, lastly, some short relief from pain; great thirst, but drinking 
little at a time; tongue white or brown or bluish; nausea; vomiting; face 
sunken, expressing great anguish; great restlessness; petechial, miliary and 
nettle-rash eruption; cold, dry skin, or else cold perspiration; very frequent, 
weak pulse; fetid urine. 

Baptis. Violent, colic-like pains before every stool and great tenesmus; 
discharges of pure blood, with very little mucus; dry, brown tongue; ty- 
phoid tendenc}'. 

Bellad. Discharges greenish, slimy, bloody, with great tenesmus; bear- 
ing down and shuddering; afterwards burning in the anus and rectum; the 
mucous membrane of the anus appears swollen and is pressed out; urine 
suppressed; abdomen very sore to pressure ; cutting, tearing and constricting 
pains in the abdomen, so violent that the patient screams out; thirst, belch- 
ing, vomiting; starting in sleep; delirium. 

Bryon. During summer heat; pain and discharges are brought on 
from motion, even from turning in bed, raising the arms or bending the 
toes. 

Canthar. Tremendous burning pain through the whole intestinal tract, 
from the bowels down to the anus, with painful sensitiveness of the abdomen 
to the slightest touch; unquenchable thirst, with disgust for all kinds of 
drink; loss of epithelium on the lips, tongue and palate; vesicles and can- 
kers in mouth and throat; collapse, small pulse, coldness of hands and feet. 
Stools bloody and watery, with scrapings from the bowels; frequent urging 
to urinate, with burning after urination. 

Cap sic. Abdomen distended, as though it would burst; very frequent 
discharges, streaked with black blood, with violent tenesmus and burning 
both in the rectum and bladder; thirst after stool, and shuddering after 
drinking; taste like putrid water; pains aggravated by currents of air, 
though warm. 

Carb. veg. After Arse?i., if be there cold breath, cool skin, terribly 
smelling discharges, general collapse. 

China. Discharges chocolate- colored, of a terrible, cadaverous smell, 
worse at night; great general exhaustion. 

Colchic. Discharges of white, jelly-like or bloody mucus; spasm of 
the sphincter ani during a discharge, with a shuddering over the back; such 
spasms occur also without a discharge; oedema of the lower extremities, 
which are cold; ascites; urine dark brown and scanty. 

Coloc. Discharges slimy, bloody, like scrapings; abdomen bloated; 



464 THERAPEUTIC HINTS TO DYSENTERY. 

violent pain in the abdomen, as though the intestines were squeezed be- 
tween stones, which compels the patient to bend double; from the abdo- 
* men rises a shuddering over the body; during stool, sometimes tenesmus, at 
other times not; after stool relief of the pain. After vexation or indignation. 

Diosc. Stools deep yellow, thin, watery; dark green and mucus; 
severe twisting colic with intervals of relief; faint feeling in the abdomen 
after stool. 

Eriger. StOols small, streaked with blood, aqcompanied with tormina; 
burning in the bowels and rectum; hard lumps of feces mixed with the 
discharges; urination painful or suppressed. 

Gummi gutti. Stools water}*, frequent, eopious and offensive, coming 
out all at once and affording great relief. 

Hamam. When the amount of blood is unusual in quantity and 
amounts to an actual haemorrhage, generally of dark blood; or when there 
are clots or patches of blood scattered through the mucus. Soreness of the 
abdomen. 

Ipec. When caused by eating unripe, sour fruit; great disgust and 
loathing of any sort of food; sickness and vomiting of grass-green, jelly-like 
mucus; coated tongue; headache; chilliness; great pressing to stool ; voiding 
slimy, blood}-, offensive discharges, with subsequent tenesmus; worse in the 
evening. 

Kali bichr. Discharges brownish, frothy water, bloody, with gnawing 
pain about the umbilicus; violent painful pressing, straining and tenemus; 
tongue smooth, red and cracked. After Cantkar. 

Laches. Discharges chocolate-colored, of a cadaverous smell; during 
evacuation burning in the anus; cram-like pain in the abdomen; coldness; 
thirst; abdomen very hot; tongue red and cracked at its point, or 'black 
and bloody. - ' 

Magn. carb. Stools green, watery, frothy, with green scum like that 
of a frog pond; bloody mucus. In hot weather; during the day; during 
dentition. Abdominal pain before and during stool; tenesmus. 

Mercitr. Discharges excoriating; before stool: cutting, pinching, and 
twisting pains in the abdomen; anxiety and trembling; during stool: burn- 
ing in the anus; eructation, nausea; faintness, colic, heat and perspiration; 
after stool: great tenesmus; cannot get done; prolapsus ani and trembling; 
the abdomen generally feels cold; bad taste in the mouth; saltish saliva; 
rheumatic pains in the limbs; all worse at night. 

Merc. subl. With almost constant cutting pains in the abdomen, and 
intolerable, painful, almost ineffectual pressing, straining and tenesmus; 
frequent, scanty discharges of bloody slime, da}- and night, with great 
tenesmus of the bladder. 

Natr carb. Straining and tenesmus, with a voluptuous sensation in 
the genitals. 

Nitr. ac. Profuse discharges of blood: before stool: colic; during stool: 
spasmodic contraction of the anus; cutting and straining in the anus and 



DIGEST TO DYSENTERY. 465 

rectum; after stool: burning in the anus; ineffectual straining; colic; ex- 
haustion; anxiety and general uneasiness. Pulse intermits every third beat. 

Nux vom. Always after previous abuse of diarrhoea mixtures, pain in 
the abdomen before and during a discharge, with tenesmus, relieved after 
stool; pressing pain in the back, as if broken, before and during stool; sick- 
ness in the stomach. 

Plumbum. In violent cases with bloody masses of exudation; burning 
in anus during ditcharge and long-lasting tenesmus afterwards. 

Pulsat. Discharges white-slimy; whitish-coated tongue; pappy, sticky 
taste in the mouth, without thirst; great difficulty in breathing; all worse 
at night. 

Rhus tox. Discharges jelly-like; pains in the abdomen and limbs; 
worse when lying still, better from moving about; nocturnal exacerbation; 
after getting wet. 

Staphis. Cutting pain before and after stool; tenesmus in rectum and 
bladder during stool; always worse after drinking cold water. After indig- 
nation. 

Sulphur. When other remedies have failed, when, during stool, burn- 
ing, cutting, pressing and prolapsus recti, cutting in urethra, catching of 
breath, palpitation, chills about the lower pars of the body; and afterwards, 
straining and throbbing in the rectum, bruised pains and pinching in the 
abdomen, chills and lassitude. Worse early in the morning, driving out of 
bed; faintish feeling in pit of stomach about 10 or 11 a. m., etc. 

Thrombid. Tenesmus, prolapsus ani; discharge of mucus, pus, blood 
and occasional fecal matter. Skin dry, tongue coated, thirst moderate. 

Schiissler: Kali mur. Inmost cases; if not, Calc. sulph., especially if 
,t}ie discharges consist of pus-like slime. If the tongue gets dry, with a delirious 
state and distention of the abdomen, and the discharges have a putrid stench: 
Kali phosph. The same, if much pure blood passes off. If it begins with 
violent fever first: Ferr. phosph. In case of spasmodic bellyache, relieved 
from pressure and doubling up: Magn. phosph. If the pain is depending 
on inflammation, making no intervals and increased by pressure, Ferr, 
phosph. 

. Digest to Dysentery. 



DISCHARGES. 

Brown: Aeon., Kalibichr. 
Chocolate-colored: Arsen., China, 

Laches. 
Deep yellow: Diosc. 

Green, watery, with green scum like that 

on a frog-pond: Magn. carb. 
Greenish: Bellad, 
Dark green mucus: Diosc. 
White, slimy: Colchic, Pulsat. 

Bloody: Aeon., Arsen., Ipec. 
30 



Bloody mucus or slime: Bellad., Colchic. y 

Coloc, Ipec, Magn. carb., Merc, subl., 

Thrombid. 
Bloody water: Aloes, Arsen., Canthar., 

Diosc, Gummi., Kalibichr. 
Bloody masses of exudation: Plumbum. 
Streaked with blood: Arsen., Capsic, 

Eriger., Hamam. 
Pure blood, with very little mucus: 

Baptis. 

, profuse: Kali phos., Nitr. ac. 

, , dark in color: Hamam. 



466 



DIGEST TO DYSENTERY. 



Like scrapings from the bowels: Can- 

thar., Coloc. 
Like jelly: Aloes, Colchic., /pec, Rhus. 
Like pus: Calc. sulph., Thrombid. 
Mixed with hard lumps of feces: 

Eriger. 



Offensive. Gummi, Ipec. 

Putrid, foul, cadaverous, terrible smell: 

Arsen., Card, veg., China, Kali 

phosph., Laches. 

BEFORE STOOL. 

Colic: Nitr. ac. 

, great tenesmus: Baptis. 

Cutting in abdomen: Staphis. 

, pinching and twisting in abdomen: 

Mercur. 
Pain in abdomen: Magn. card., Nux 

vom. 
( torturing, as if the abdomen were 

being constricted: Arsen. 
Pressing pain in back, as if broken: 

Nux vom. 
Anxiety and trembling: Merc. sol. 

DURING STOOL. 

Abdominal pain: Magn. card., Mercur. 

Colic: tormina: Eriger., Mercur. 

Gnawing about umbilicus: Kalibichr. 

Violent pain right side of abdomen: 
Aloes. 

Pressing pain in back, as if broken: 
Nux vom. 

Burning in the anus: Eriger., Laches., 
Mercur., Plumbum, Sulphur. 

in the rectum and bladder: Capsic. 

Cutting in rectum: Niir. ac, Sulphur. 

Mucous membrane of anus is pressed 
out and is swollen: Bellad. 

Pressing and straining: Bellad., Ipec, 
Kali bichr., Merc sol., Merc, subl., 
Nitr. ac, Sulphur. 

( with voluptuous sensation in geni- 
tals: Natr. carb. 

Painful stools: Aco?i. 

Tenesmus: Aloes, Apis., Bellad,, Cap- 
sic, Kali bichr., Magn. carb., Merc 
sol., Merc subl., Natr. carb., Nux 
vom., Sulphur, Thrombid. 

at times, at other times not: Coloc. 

in rectum and bladder: Alum., Merc 

subl., Staphis. 



and prolapsus ani: Th?'ombid. 

, , and cutting in urethra: Sul- 
phur. 

Bearing down and shuddering: Bellad. 

Spasmodic contraction of anus: Ar- 
sen., Nitr. ac 

, with shuddering over the 

back ; such spasms occur also without a 
discharge: Colchic. 

Flatus escapes in large quantities: Aloes. 

Catching of breath, palpitation, chills 
about lower part of body: Sulphur. 

Eructation, nausea; faintness, heat and 
perspiration: Merc. sol. 

Fainting and screaming: Aloes. 

AFTER STOOL. 

Burning in anus and rectum: Arsen., 

Bellad., Nitr. ac 
MUCOUS membrane of anus pressed out 

and is swollen: Bellad. 
Excoriating anus: Mercur. 
Prolapsus ani: Mercur. 
Colic: Nitr. ac 
Cutting: Staphis. 
Bruised pain and pinching in abdomen: 

Sulphur. 
Faint feeling in abdomen: Diosc. 
Straining, ineffectual: Nitr. ac. 

and throbbing in rectum: Sulphur. 

Tenesmus: Arsen., Lpec, Merc sol. 

Plumbum. 

, cannot get done: Merc. sol. 

Thirst: Capsic 
Palpitation of heart: Arsen. 
Trembling in all the limbs: Arsen., 

Merc sol. , 
Chills and lassitude: Sulphur. 
Anxiety and general uneasiness: Nitr. 

ac 
Exhaustion: Arsen., Nitr. ac 
Relief: Aloes, Arsen., Coloc, Gummi, 

Nux vom. 

SYSTEMIC SYMPTOMS. 

Delirium: Baptis., Bellad., Kali phosph. 
Anguish and sunken face: Arsen. 
Headache: Ipec 



Lips, tongue and palate lose epithelium: 

Canthar. 
Tongue coated: Thrombid. 
dry: Kali phosph. 



DIGEST TO DYSENTERY. 



467 



Tongue, dry, brown: Baptis. 

whitish: Arsen., Pulsat. 

brown or bluish: Arsen. 

smooth, red, cracked: Kali bichr. 

red and cracked at tip, or black and 

• bloody: Laches. 
Vesicles and cankers in mouth and 
throat; Canthar. 



Saltish saliva: Merc. sol. 

Taste bad: Merc. sol. 

like putrid water: Capsic. 

pappy, sticky, without thirst: Pul- 
sat. 

Hunger: Aloes. 

Disgust and loathing of any sort of food: 
Ipec. 

Thirst: Bellad. 

moderate: Thrombid. 

great, but drinking little at a time: 

Arsen. 

unquenchable, with disgust for all 

kinds of drink: Canthar. 

Belching, Bellad. 

Nausea, sickness in stomach: Arsen. , 

Ipec, Nux vom. 
Paintish feeling in stomach about io-ii 

a. m. : Sulphur. 
Vomiting: Arsen., Bellad. 

of grass-green, jelly-like mucus: 

Ipec. 



Bruised, as if intestines were: Apis. 
Soreness of abdomen. Hamam. 

to slightest touch : Bellad., Canthar. 

Burning from bowels down to anus: 

Canthar. 
Inflammatory pain, worse from pres- 
sure: Ferr. phosph. 
Heat of abdomen: Laches. 
Cold, abdomen feels generally: Merc. 

sol. 
Pains in abdomen and limbs, worse in 

rest, better on moving. Rhus tox. 
, as though intestines were squeezed 

between stones, compelling to bend 

double: Coloc. 
, spasmodic, better from pressure and 

doubling up: Magn. phosph. 

, cramp-like: Laches. 

, cutting, tearing and constricting, 

compelling to scream: Bellad. 
■ , cutting: Merc. subl. 



, twisting at intervals: Diosc. 

Distention: Capsic, Coloc, Kali phosph. 
Rumbling along colon: Aloes. 
Ascites: Colchic 



Urine suppressed: Bellad., Eriger. 

Urination painful: Eriger. 

Urine flows only during an evacuation 
from the bowels: Alum. 

Frequent urging to urinate, with burn- 
ing after: Canthar. 

Urine dark brown and scanty: Colchic. 

fetid: Arnica. 



Difficulty in breathing: Pulsat. 
Pulse frequent, weak: Arsen. 

small, with cold hands and 

Canthar. 
intermits every third beat: Nitr. ac 



feet: 



Pains in the small of back: Aloes. 
Rheumatic pains in limbs: Merc. sol. 
(Edema of lower extremities, which are 

cold: Colchic. 
Cold hands and feet: Caiithar. 



Fever, begins with violent: Ferr. 

phosph. 
Chill, high fever, dry skin: Aeon. 
Skin dry, tongue coated: Thrombid. 
Cold, dry skin, or else cold perspiration 

Arsen. 
Coldness: Laches. 
Chilliness: Ipec 

Shuddering after drinking: Capsic 
from abdomen, rising over the body: 

Coloc 
Typhoid tendency: Baptis. 



Starting in sleep: Bellad. 
Petechial, military, and nettle-rash erup- 
tion: Arsen. 
Restlessness: Arsen. Rhus tox. 
General exhaustion: China. 
Collapse: Arsen., Carb. veg., China. 



Worse after drinking cold water: 

Staphis. 
when urinating urging to stool: 

Aloes. 

from any motion: Bryon. 

from currents of air, though warm : 

Capsic 
in the evening: Ipec 



468 



CHOLERA MORBUS. 



in the night: China, Merc, so/., Pul- 

sat., Rhus tox. 

about midnight: Arsen. 

in the morning, driving out of bed: 

Sulphur. 

during the day: Magn. carb. 

da}- and night: Blerc. subl. 

Caused by vexation or indignation: 

Coloc, Staphis. 

dentition: Magn. carb. 

eating unripe, sour fruit: Ipec. 

sudden check of perspiration: Aeon m 

getting wet: Rhus tox. 



— hot weather, summer heat: Bryon., 
Magn. Carb. 



Carb. veg., after Arsen., if there be cold 
breath, cool skin, terribly smelling dis- 
charges, general collapse. 

Kali bichr., after Canthar. 

Kali mur., in most cases. 

Nux VOm., after previous abuse of diar- 
rhcea-mixtures. 

Sulphur, when other remedies have 
failed. 



Cholera Morbus, or Nostras, or Europaea. 

The attack comes on almost always suddenly, and frequently in the 
middle of the night. It consists of vomiting and purging, spasmodic pain in 
the abdomen, sometimes cramps in the legs, rapid loss of strength, and cold- 
ness of the skin. The thirst is great, the vomiting constant, and the purging 
consists of fetid fluid discharges containing a large quantity of bile at first, 
which, however, gradually diminishes, until, at last, the discharges approach 
the rice-water appearance without smell. The rapid and great loss of fluid 
will naturally cause similar symptoms as we observe in cholera Asiatica, and 
especially in children, old people or debilitated persons it may reach even a 
fatal termination. Then the intestines become paralyzed, vomiting and 
purging cease, yet the transudation continues; the pulsations of the heart 
grow fainter and the radial pulse ceases altogether; the sensorium becomes 
clouded and the patient sinks from sheer exhaustion. Yet such are only ex- 
ceptional cases; as a general event the patients soon revive again. It prevails 
mostly during summer heat, although there are cases in other seasons; and it 
seems to be excited especially by exposure, checked perspiration, drinking 
large quantities of ice water, or imprudence in eating. It differs from Asiatic 
cholera in not being caused by a specific poison — in not being to such a de- 
gree epidemic, violent and fatal. It differs from poisoning with arsenic by 
its purging and vomiting setting in at the same time; while in cases of poi- 
soning the vomiting almost always precedes the purging. 

Therapeutic Hints. 

Compare Cholera and Cholerine. Besides the remedies there character- 
ized may be indicated: 

Ant. crud. Vomiting and diarrhoea, watery or slim}-; great thirst for 
cold water, especially at night; tongue coated white; after sour wine. 

Chamom. After sudden taking cold; severe, cutting pains in the ab- 
domen; vomiting of bile; painful, bilious evacuations; great irritability of 
mind; impatience; restlessness; child wants to be carried about; also after 
chagrin. 

China. Discharges mostly painless, containing undigested food; worse 



SUMMER-COMPLAINT. 469 

in the night, with great fermentation in the bowels, which are bloated ; fullness 
of the bowels; sour eructations, and better for a while afterwards; especially- 
after new or sour beer. 

Diosc. Yorniting and purging of watery stools, with painful cramps in 
the stomach, bowels, and extremities. 

Euphorb. cor. Forcible vomiting and diarrhoea of watery fluid, with 
sinking, anxious feeling at the stomach; faintness; slow and weak pulse; 
cool skin, feet and hands, which become affected with painful cramps; pain- 
ful spasms in the intestines; cold sweat on the body and extremities; death- 
like sensation with anxiety of mind; no desire to live unless relief comes 
soon. 

Ipec. If the vomiting is predominating; from sour, unripe fruit, etc. 

Iris vers. Vomiting and diarrhoea tinged with bile, with violent pain 
in the pit of the stomach, or around the navel, or still lower down in the ab- 
dominal region, at or before every fit of vomiting or purging; burning in the 
rectum and anus; periodical spells of aggravation about two or three 
o'clock A. M. 

Veratr. Is the most important and the most frequently indicated remedy. 
Furging predominates over vomiting; the stools follow in quick succession, 
become watery, lose all coloring matter and are gushing out, with violent 
pain in abdomen, or absence of pain; cold feeling^ great thirst; nausea and 
anxiety. Drinking increases the symptoms. 

Summer-Complaint. 

Under this title two different affections of early childhood are frequently 
confounded, namely, Cholera infantum and Catarrhal inflammation of the in- 
testines. Both are most prevalent during the heat of the summer, and both 
show a high death-rate of infantile life. 

Cholera infantum corresponds to cholera morbus, and is characterized 
by severe vomiting, purging, rapid prostration and collapse. In consequence 
of the rapid loss of fluids through the intestinal canal and the consequent 
suppression of urine, anaemia and uraemia soon result with symptoms similar 
to hydrocephalus. The child grows restless, utters plaintive cries, rolls its 
head, commences to squint and falls into a stupor — a state of things which 
Marshall Hall has designated by the name of "Hydrocephaloid," in con- 
tradistinction to hydrocephalus acutus, which is of an inflammatory nature. 
Compare Anaemia. 

Its Causes are: Extreme summer heat, 90 ° F. and above, for a great 
length of time; crowded cities with their pestilential influences of impure 
air, unclean streets, etc., improper alimentation, the combined influence of 
which the tender age of infants up to two years is frequently not capable of 
resisting. 

Cholera infantum often associates itself with intestinal catarrh, and this 
is no doubt the reason why in common practice both forms are frequently con- 
founded. Still we ought to distinguish those cases with severe vomiting, 



470 THERAPEUTIC HINTS TO SUMMER-COMPLAINT. 

profuse watery evacuations, rapid prostration and collapse, as cholera in- 
fantum. 

The Intestinal catarrh of infants during summer heat, the true 
Summer-complaint, is an inflammatory disease of the intestinal tract, but 
preponderantly an inflammation of t\ie large intestines, though both the 
small and the large may be affected at the same time, hence it is also called 
Entero-colitis. Its pathological changes correspond to those described 
under Intestinal Catarrh. 

Its Causes are the same as those of cholera infantum, to which we must 
add dentition. For it is not without good reason that mothers most dread 
the second summer of their infants, and are loath to wean them, if possible, 
before that period has passed. 

The most persistent of its Symptoms is diarrhoea. The evacuations, 
however, vary greatly. From feculent masses at first, the dejections become 
more liquid, of a whitish or ash-colored, or yellowish tint, changing to green 
or greenish, or leaving a mere greenish or dirty stain on the diaper; or they 
are slimy, at times mixed with streaks of blood. As long as the dejections 
contain feculent matter, they mostly have a very penetrating smell, after- 
wards they assume a peculiar, sweetish, fleshy odor, sui generis of summer- 
complaint. 

Vomiting is a frequent symptom, but it comes and goes. There is gen- 
erally a great deal of thirst, but the liquid taken is not retained. There is 
always more or less fever, and the pulse rises to 120 and 140 or higher. 

Acute cases generally run their course in about two weeks, when con- 
valescence gradually sets in, or they assume a chronic nature with occasional 
improvements and relapses. Unfavorable symptoms are: continued gag- 
ging; great frequency of the stools and the appearance of hydrocephaloid 
symptoms. 

Therapeutic Hints. 

The large majority of people cannot afford to escape the continued and 
excessive summer-heat by going to the seashore or to the mountains. For 
them it will be well to at least avail themselves of the few cool morning and 
perhaps evening hours, to take the child out riding, either in the cars or in a 
children's carriage, or where a river is near, on a steamboat. The riding 
motion, as Dr. Wm. B. Chamberlain has truly remarked, is certainly of 
great benefit to the patient, and, in conjunction with the breathing of a purer 
atmosphere, will surely produce gratifying results. The high temperature 
may also be lowered by sponging the child all over with lukewarm water 
several times a day, and if there be excessive thirst without the ability to 
retain any drink, it will be well to apply a wet compress over the 
epigastrium. 

Alimentation. — The mother's milk is absolutely the best, provided the 
mother be well herself. If the child has been weaned, resort must be taken 
to cow's milk, thinned by adding two-thirds of boiling water. The boiling 



THERAPEUTIC HINTS TO SUMMER-COMPLAINT. 47 1 

water is, at least, partially freed from disease- germs; it raises the tempera- 
ture of the milk to a desirable degree of warmth, and indicates at once 
whether the milk to be used is already undergoing the process of sour fer- 
mentation or not. A little salt may be added. If milk is always rejected, 
barley well boiled and strained may be tried. Of all the artificially pre- 
pared children's food (prepared, of course, always according to some scientific 
reasons, a la retort), I am no great friend. According to recent microscopic 
examinations, assisted by such simple tests as Iodine, which turns starch-cells 
blue, and gluten or (albuminous) granules yellow, Dr. Ephraim Cutter, of 
Cambridge, came to the following results: "There was scarcely a single one 
of the so-called infant-foods that contained a quantity of gluten as large as 
that contained in ordinary wheat flour. That is to say, a well-compounded 
wheat gruel is superior to any of them, particularly when boiled with a little 
milk; and mothers are in error who place the slightest dependence upon 
them. As respects one very expensive article, professing to possess 270 parts 
in every 1,000 of phosphatic salts in connection with gluten, Dr. Cutter was 
unable to find any gluten at all. The thing was nearly pure starch, sold at 
an exhorbitant price as a nerve and brain food and a great remedy for rickets. 
So all through the list. Sometimes a trace of gluten was present; more 
frequently none at all. In one case there were 90 parts of starch to 10 of 
gluten; but this was exceptional, and the majority were less valuable, ounce 
for ounce, than ordinary wheat flour. Considering the semi-philanthropic 
pretensions that have been put forth by the manufacturers of these foods, 
some of them sustained by the certificates of eminent physicians, the report 
of Dr. Cutter is one of the dreariest comments upon human nature that has 
recently fallen under the notice of this journalist. But if the revelations he 
has made of fraud and pretense on the part of manufacturers in this field 
shall serve to protect mothers from further betrayal and to rescue infant life 
from quack articles of nutriment, his work, though giving a tremendous 
shock to our insensibilities and to our faith in medical certificates, will not 
have been done in vain." (Medical Advance, June, 1882, p. 384.) 

Sometimes I have found that a little red wine in water remained in the 
stomach, when nothing else would. Beef -tea I abominate, and for reasons 
already given elsewhere. Simple mutton or beef-broth maybe recommended; 
but at times solid food is absolutely necessary, especially in weaned children 
who have already some teeth. It is the process of mastication which here 
comes into play and which excites the necessary mixing of saliva with the 
food. A mutton chop sprinkled with a little salt and roasted quickly on a 
gridiron, and a pretzel, crisp and fresh from the baker, often do wonders. 

Cholera Infantum. — Ver. alb. and Ipec. are undoubtedly the most im- 
portant of all remedies, but compare also Arsen., Camphora, Cuprum, 
Phosphor. , Secale, Sulphur and Tabac. The special indications for each are 
given under Cholera and Cholera Morbus. 

Summer-complaint, proprie sic dictu. 

Aeon. Teething children with high fever, restlessness, crying, biting 
fists, and frequent green or mucous stools. 



472 THERAPEUTIC HINTS TO SUMMER-COMPLAINT. 

sEtlmsa. Stools water} 7 , greenish, without smell; milk disagrees, is 
thrown up at once, at times in coagulated lumps; vomiting of white, frothy 
matter; after stool and vomiting the child dozes, utters plaintive cries, now 
and then, and again commences to doze; its face is pale, with a painful 
expression around the mouth ; great prostration ; eyes fixed and staring con- 
vulsions with clenching the thumbs and turning the eyes downward. 

Ant. crud. Child cannot bear to be touched or looked at; tongue 
coated white; violent vomiting, renewed after taking food or drink; diar- 
rhoea profuse. 

Apis. vStools of various colors, offensive or odorless, painful or painless, 
usually worse in the morning. Stupor interrupted with shrill shrieks; head 
hot; eyes red; tongue dry; skin dry; hands cold and blue; abdomen 
tender, shrunken; urine suppressed; pulse thread-like; impulse of heart 
violent. 

Arg. nitr. Stools green, like spinach; diarrhoea after fluids, after 
sweet things which he craves. Sopor; large pupils; periodical trembling of 
the body. 

Arsen. Stools green, water y, offensive; vomiting immediately after 
drinking; great thirst, but drinks little at a time; great restlessness; great 
prostration; all worse after midnight. Sopor, or coma vigil, with staring, 
spasmodically moving eyes; dilated pupils; difficult hearing and speaking 
or swallowing; dry tongue; sooty nostrils; sunken abdomen; involuntary 
stool and urine; stiff neck; palsy of the extremities. 

Baptis. Very offensive diarrhoea, day and night; the child can only 
swallow fluids, no solids, even after it has learned to eat. 

Bellad. Stools green, with hot head and cold feet, profuse micturition; 
white tongue with red margin; dry mouth and lips; drowsy with frequent 
starting during sleep. 

Benz. ac. Extremely copious watery stools, flooding everything about 
the child; fetid urine. 

Borax. Constant vomiting and gagging; painless stools, at first froth}', 
thin and brown, later cadaverously smelling, with little bits of yellow feces, 
or colorless and slimy; belly soft, flabby and sunken in; general emaciation; 
sopor; child makes an anxious face when carried down stairs, or put from 
the arms into the cradle. 

Bryon. Any motion brings on diarrhoea; a sudden change to hot or 
cold weather aggravates the symptoms. Great thirst, with drinking large 
quantities; hot head and soporous condition; very fretful and irritable. 

Calc. carb. Stools whitish, watery, most frequent in the after part of 
the day, often of a sour smell; sour vomiting; open fontanelles; sweat of the 
head during sleep; old, wrinkled face; cold face; cold arms up to the 
elbows; retarded dentition; emaciation; bloated, big belly. The child 
makes an anxious face when being lifted up from the cradle, or being car- 
ried up stairs. 

Calc. phosph. Scrawny children, with dirty white or brownish com- 



THERAPEUTIC HINTS TO SUMMER-COMPLAINT. 473 

plexion; skull soft and thin, cracking like paper when pressed upon; old, 
wrinkled looks of the face; dry skin, diarrhoea with much flatulence during 
dentition; greenish thin stools; longing for bacon or ham fat. Hydrocepha- 
loid conditions. 

Camphora. The skin is cold as marble, and yet the child will not 
remain covered; half stupid and senseless; utter prostration. Vomiting 
and diarrhoea may be present or absent. Choleraic symptoms. 

Chamom. Stools water}^ green or like chopped eggs, often from any 
motion of the child, with crying, colicky pains and drawing up the legs. 
Teething; often one cheek red and the other pale; hot perspiration about 
the head. The child is very cross, wants to be carried about. 

China. Painless and often undigested discharges, worse in the night, and 
after eating. Also attended with colicky pains and fermenting in the bowels. 
When the looseness has been brought on by eating fruit; also when the pa- 
tient has become very weak from profuse and long-continued diarrhoea. 

Coffea. During dentition diarrhoea watery and painless, with sleepless- 
ness and threatening convulsions. 

Coloc. Colicky pains relieved by lying on the stomach. 

Crot. tig I. Sudden forcible discharges, after drinking, while nursing or 
eating, during summer. 

Cuprum. Stools green with painful vomiting; spasms preceded by* 
violent vomiting of mucus; convulsions. 

Dulcam. Stools green with mucus from catching cold during hot 
weather. 

Ferr. phosph. Frequent stools, green, watery, or hashed, mixed with 
mucus, scantp; straining at stool, also retching. Child rolls its head, moans; 
eyes half open; face pinched; urine scanty; pulse and respiration acceler- 
ated; starting in sleep. (J. C. Morgan.) 

Helleb. Loose, watery, or jelly-like stools; scanty, dark urine; hydro- 
cephaloid symptoms. 

Ignat. "Sudden metastasis from bowels to the brain during dentition; 
sudden paleness of face, with rolling- tossing motion of the head; difficulty 
of swallowing; delirium, with convulsive motion of the eyes and lips." 
(Ivilienthal. ) 

Ipec. Nausea and vomiting predominate; stools green like grass, or 
fermented like yeast. 

Iris vers. Nausea and vomiting of sour fluid; stools thin, watery, 
copious, tinged with bile; boils about the child's head. 

Kali brom. Frequent, green, watery discharges, with violent abdominal 
spasms, during which the abdomen gets hard; thrush in the mouth; convul- 
sive motion of eyes and limbs. (C. Mohr. ) 

Kreos. Constant vomiting and greedy drinking; stools grayish or 
white, chopped, very fetid; belching or hiccoughing, especially when being 
carried; the child moans constantly, or dozes with half-open eyes; face cold, 
with a pale bluish tinge, especially on the temples and around the nose and 
mouth; rapid emaciation; quick, scarcely perceptible pulse. 



474 THERAPEUTIC HINTS TO SUMMER-COMPEAINT. 

Laches. Most important when the discharges have a penetrating, fetid 
smell and assume a purulent character. Great heat of abdomen. 

Lycop. " Stools of green, stringy, odorless mucus." 

Magn. carb. Sour-smelling discharges up and down; pain in the bowels. 

Merc. sol. Dark green stools, slimy, sometimes bloody with tenesmus; 
cannot get done. 

Natr. mur. Vomiting and diarrhoea, worse during the day; great 
thirst; general emaciation, most conspicuous around the neck, which appears 
thin and shrunken. (Hering.) 

Nux vom. Stools early in the morning; after errors in diet. 

Phosphor. Vomiting as soon as the water has become warm in the 
stomach. (Iyippe.) The anus remains open all the time the child is strain- 
ing. (Boyce.) Hydrocephaloid symptoms from great exhaustion. 

Phosph. ac. Painless, profuse, watery, or whitish stools, not weakening 
for a while, but being followed at last by great exhaustion. 

Podoph. The stools frequently change in character, and are usually 
most frequent during the earfy part of the day; prolapsus ani during stool. 
Dentition, head hot, rolling head from side to side, moaning; flushed cheeks; 
gagging, retching or vomiting of frothy, green mucus, or of food. 

Psorin. Thin watery stools, smelling like carrion; fretful, sleepless; 
the entire child has a disagreeable smell. 

Rheum. Griping, sour stools, the whole child smells sour. 

Sepia. Stools green, smelling putrid or sour; " boiled milk particularly 
disagrees. ' ' 

Silic. in Thin and scrawny children with sweaty head (Boyce), and 
sweat}', offensively smelling feet. 

Stannum. ' ' The child will not be quiet in any other position than carried 
over the point of its mother's shoulder." (Boyce.) 

Sulphur. Stools worse in the morning; psoric patients prone to erup- 
tions here and there, and to excoriations behind the ears and between the 
legs. Hydrocephaloid symptoms. 

Sulph. ac. " Excessively restless children, when Chamom. was of no 
service; aphthous condition; mouth generally dry." 

Ver. alb. Vomiting and purging, the latter predominates; great thirst, 
but drinking increases nausea and diarrhoea. After vomiting or purging 
great exhaustion, cold sweat on forehead; and cold tongue. One of the most 
important remedies in cholera infantum. 

Zincum. "On awaking the child appears frightened and its head rolls 
from side to side; during sleep it cries out, starts and jumps; feet constantly 
fidgety." Hydrocephaloid. 

Hydrocephaloid. 

Compare: Aithusa, Apis, Arg. nitr., A?se?i., Bellad., Borax, Bryon. y 
Calc. phosph., Camphora, China, Cuprum, Ferr. phosph., Helleb., Ig?iat., 
Laches., Lycop., Magn. phosph., Phosphor, Podoph., Silic, Sulphur, Veratr. } 
Zincum. 



DIGEST TO SUMMER-COMPLAINT. 



475 



Digest to Summer-Complaint. 



COLOR OF DISCHARGES. 

Green: Bel I ad. 

or mucous: Aeon. 

like grass: Ipec. 

, like scum of a frog pond: Magn. 

carb. 

, like spinach: Arg. nitr. 

, watery, offensive: Arsen. 

, with painful vomiting: Cuprum. 

, with mucus: Dulcam. 

, watery, or hashed, mixed with 

mucus, scanty: Ferr. phosph. 

, watery: Kali brom. 

, ■ , or like chopped eggs: 

Chamom. 

, stringy, odorless mucus: Lycop. 

, dark, slimy, sometimes bloody, 

with tenesmus: Merc. sol. 

, putrid or sour smelling: Sepia. 

Greenish, watery, without smell: 

j&Lthusa. 
Of various colors, offensive: Apis. 
Change color frequently: Podoph. 
Grayish or white, chopped, fetid: 

Kreos. 
Whitish, watery: Calc. carb., Phosph. 

ac. 

SMELL OF DISCHARGES. 

Odorless: ^Ethusa, Apis, Lycop. 
Fetid, offensive: Apis, Arsen., Baptis., 

Kreos., Laches. 
Cadaverously: Borax. 
Carrion-like: Psorin. 
Putrid: Sepia. 
Sour: Calc. carb., Chamom., Magn. carb., 

Rheum, Sepia. 

NATURE OF DISCHARGES. 

Copious, profuse: Ant. crud., Iris., 

Phosph. ac. 
flooding everything about the child: 

Benz. ac. 
Jelly-like: Helleb., Rhus tox., Sepia. 
Mucous: Aeon., Borax, Dulcam., Ferr. 

phosph., Lycop. 
Purulent: Laches. 
Thin and watery : JEthusa, Arsen., Benz. 

ac, Borax, Chamom., Coffea, Helleb., 

Iris vers., Kali brom., Phosph. ac, 

Psorin. 
Tinged with bile: Iris vers. 



With little bits of yellow feces: Borax. 

Undigested: China. 

Like yeast, fermented: Ipec. 

Frothy: Borax. 

With much wind: Calc. phosph. 

MANNER OF DISCHARGES. 

Painless: At>is, Borax, China, Coffea, 

Phosph. ac, Sulphur. 
Griping: Rheum. 
Painful: Apis, Merc, sol., Sulphur. 
Colicky, with drawing up the legs: 

Chamom. 
Sudden, forcible: Crot. tigl. 
Involuntary stool and urine: Arsen. 

DURING STOOL. 

Colic and fermenting in bowels: China. 

and drawing up limbs: Chamom. 

Straining, with prolapsus ani: Merc, 
sol., Podoph. 

, anus remains open: Phosphor. 

* , retching: Ferr. phosph. 

Much flatulence: Calc phosph. 

AFTER STOOL. 

Great exhaustion and cold sweat on 

forehead: Ver. alb. 
Dozing, with plaintive cries: JEthusa. 

SYSTEMATIC SYMPTOMS. 

Half stupid and senseless: Camphora. 

Stupor: Borax. 

, interrupted with shrill shrieks: 

Apis. 
Delirium, with convulsive motions of 

eyes and lips: Ignat. 
Moaning: Ferr. phosph., Kreos., Podoph. 
Crying: Aeon. 
Biting fists: Aeon. 
Rolls head: Ferr. phosph., Ignat., 

Podoph., Zincum. 
Makes anxious face when being carried 

down stairs and put from the arms into 

cradle: Borax. 
when being taken up or carried up 

stairs: Calc carb. 
Will not be quiet unless carried over 

the point of the mother's shoulder: 

St annum. 
Cannot bear of being touched or looked 

at: Ant. crud. 



476 



DIGEST TO SUMMER-COMPLAINT. 



Wants to be carried about: Chamom., 

Rhus tox. 
Fretful: Psorin. 

and irritable: Br you. 

Cross: Charnom. 

Appears frightened on awaking: Zin- 



Sudden metastasis from bowels to 
brain during dentition: Ignat. 

Hydro cephaloid: sFthusa, Apis, Arg. 
nit v., Arsen. y Bellad., Borax, Bryon., 
Calc. phosph., Camphora, China, Cup- 
rum, Ferr. phosph., Helleb., Ignat., 
Laches., Lycop.. Phosphor., Podoph., 
Silic, Sulphur, Ver. alb., Zincum. 

Head hot: Podoph. 

and cold feet; Bellad. 

and remaining body cool: Arnica. 

and sophorous condition: Bryon. 

Sweat On head in thin, screaming chil- 
dren: Silic. 

during sleep: Calc. curb. 

hot: Chamom. 

Open fontanelles: Calc. carb. andphosph. 

Skull soft and thin, crackling like paper 
when pressed upon: Calc. phosph. 

Boils about the head: Iris vers. 



Eyes red: Apis. 

fixed and staring: AEthusa. 

half open: Ferr. phosph. 

Pupils dilated: Arg. nitr., Arsen. 
Convulsive motion of eyes and lips: 

Ignat. 
Eruption behind ears and between legs: 

Sulphur. 
Difficult hearing: Arsen. 
Nostrils sooty: Arsen. 
Face, cheeks flushed: Podoph. 
One cheek red, the other pale: Chamom., 

Ignat., Sulphur. 
Dirty white or brownish complexion, 

scrawny children: Calc. phosph. 
Sudden paleness, with rolling, tossing 

motion of head: Ignat 
Paleness, with a painful expression 

around the mouth: Aithusa. 
Face cold: Calc. carb. 
, with a pale bluish tinge on temples 

and around nose and mouth: Kreos. 
Anxious look when being lifted up; 

Calc. carb. 
carried down: Borax. 



Old, wrinkled face: Arg. nitr., Arsen., 

Calc. carb. and phosph. 
Face pinched: Ferr. phosph. 
Convulsive motion of eyes and lips: 

I gnat. 



Mouth generally dry; Sulph. ac. 

and lips dry: Bellad. 

, thrush in: Borax, Kali brom. 

aphthous condition: Sulph ac. 

Tongue dry: Apis, Arsen. 

coated white: Ant. crud. 

white, with red margin: Bellad. 

cold: Ver. alb. 

Speaking and swallowing difficult: 

Arsen. 
Dentition, during: Aeon., Calc. carb. 

Calc. phosph., Chamom., Coffea 

Podoph. 
, , sudden metastasis from bowels 

to brain: Ignat. 



Swallowing difficult: Arsen., Ignat. 

, can swallow, only liquids, no solids: 

Baptis. 

Thirst: Laches., Natr. mur. 

, but drinks little at a time: Arsen. 

, drinks large quantities: Bryon. 

, drinks hastily and greedy: Kreos., 

Sulphur. 

drinking increases nausea and diar- 
rhoea: Ver. alb. 

Longing for bacon or ham fat: Calc. 
phosph. 

boiled eggs: Calc. carb. 



Milk disagrees and is thrown up in coag- 
ulated lumps: Aithiisa. 
, boiled, disagrees: Sepia. 



Belching or hiccoughing, especially 

when being carried: Kreos. 
Nausea and vomiting predominates: 

Ipec. 
Gagging, retching or vomiting: Borax 

Podoph. 
Vomiting sour: Calc. carb., Iris vers. 

of frothy, green mucus or food: 

Podoph. 

, white matter, or coagulated 

lumps of milk: A^thusa. 

of mucus, followed by spells: Cu- 
prum. 



DIGEST TO SUMMER-COMPLAINT. 



477 



immediately after drinking: Arsen. 

as soon as the water has become 

warm in the stomach: Phosphor. 

after taking food or drink: Ant. 

crud. 

and greedy drinking: Kreos. 

after drinking milk which comes up 

in coagulated lumps: A^thusa. 

and purging, the latter predominat- 
ing: Ver. alb. 

may be present or absent: Cam- 

phora. 

Pain in bowels: Magn. card. 

Griping". Rheum. 

Colic, relieved by lying on the stomach: 
Coloc. 

Violent abdominal spasms, during which 
the abdomen gets hard: Kali brom. 

Abdomen sunken: Apis., Arsen. 

, soft and flabby: Borax. 

and tender: Apis. 

big and bloated: Calc. carb. 

hard: Kali brom. 

hot: Laches. 



Urine profuse: Bellad. 

scanty: Ferr. phosph., Helleb. 

and stool involuntarily: Arsen. 

suppressed: Apis. 

fetid: Benz. ac. 

dark: Helleb. 



Respiration and pulse accelerated: 

Ferr. phosph. 
Pulse quick, scarcely perceptible: Kreos. 

thread-like: Apis. 

Impulse of heart violent: Apis. 



Neck stiff: Arsen. 

emaciated: Natr. mur. 

Arms cold up to elbow: Calc. carb. 

Hands cold and blue: Apis. 

Feet cold, head hot: Bellad. 

Body cool, head hot: Arnica. 

Skin cold as marble, yet the child will 

not remain covered: Camphora, Secale. 
Feet sweaty, offensively: Silic. 

fidgety: Zincum. 

High fever and restlessness: Aeon. 

Skin dry: Apis, Calc. phosph. 

, eruption behind ears and between 

legs: Sulphur. 
Whole child smells sour: Rheum. 
disagreeably: Psorin. 



Sleep with starting: Bellad., Ferr. 
phosph., Zincum. 

with crying out: Apis, Zincum. 

Drowsy: Bellad. 

Sopor: Arg. nitr. 

, with hot head: Bryon. 

, or coma vigil, with staring, spas- 
modically moving eyes: Arsen. 

Sleeplessness: Aeon., Bellad., Chamom., 
Rhus tox. 



Trembling of whole body, periodically: 
Arg. nitr. 

Convulsions: Cuprum. 

with clenching the thumbs and turn- 
ing the eyes downward: JEthusa. 

Convulsive motions of eyes and limbs: 
Kali brom. 

of eyes and lips: Ignat. 

Palsy of the extremities: Arsen. 

Weakness and prostration: JEthusa, 

Arsen. 
Exhaustion follows after some time: 

Phosph. ac. 
Emaciation: Borax, Calc. carb., Kreos. 



Worse after midnight: Arsen. 

early in the morning: Nux vom., 

Sulphur. 

during early part of day: Podoph. 

after part of day: Calc. carb. 

the day: Natr. mur. 

the night: China. 

day and night: Bap lis. 

after eating: China. 

and drinking, or while mov- 
ing: Crot. tig I. 

after drinking: Veratr. 

milk: JEthusa, Sepia. 

fluids and sweet things which 

he craves: Arg. nitr. 

from motion: Bryon., Chamom. 



Caused by heat of summer: Crot. tigl. 

catching cold during hot weather: 

Dulcam. 

sudden changes to hot or cold 

weather: Bryon. 

errors in diet: Nux vom. 

eating fruit: China. 

or sour things: Ipec. 



Sulph. ac. is indicated when Chamom. 
has not relieved the excessive restless- 
ness. 



478 CONSTIPATION. 

Constipation. 

Constipation has a relative meaning. Some persons feel perfectly well 
if they have a stool in two or three days. I know women who, in perfect 
health, have not more than one evacuation in a week. With most people 
one discharge every day seems to be the normal. Retarded action of the 
bowels is frequently accompanied with dizziness, headache, palpitation of the 
heart, hypochondriacal symptoms, haemorrhoids and flatulency. If long 
continued it ma)^ lead to dilatation and hypertrophy of the intestine and in 
some rare cases, where actual impaction of hardened and dried feces ensues, 
to inflammation, ulceration, and even perforation of the gut. 

Constipation may be brought about: by a diet containing too large an 
amount of indigestible matter (beans, corn and the like coarse food), which 
forms dry feces difficult to evacuate; by diseased conditions of the mucosa in 
consequence of chronic catarrh, which diminishes the peristaltic action of the 
bowels; D3 7 muscular weakness of the intestines in consequence of anaemia, 
chlorosis, long-continued diarrhoea, the use of purgative medicines, or the im- 
proper suppression of the desire for stool at regular hours; by paralytic 
affections of the intestines in consequence of opium, lead or other poisons, or 
cerebral or spinal diseases; by abnormal losses of fluids in diabetes, profuse 
lactation or sweats; by mechanical obstructions outside of the intestines from 
tumors, the enlarged or displaced womb; or by the presence of foreign bodies 
within the intestines, such as biliary stones, fruit stones, etc. 

Retarded action of the bowels in acute diseases, such as typhoid fever, 
scarlatina, measles, etc., is always of benefit to the patient, and should never 
to be interfered with in any crude manner. 

Therapeutic Hints. 

If frequent resort has been had to purgative remedies, this bad habit 
must at once be stopped. A careful regulation of diet, drinking of cold or 
hot water before retiring and after rising in the morning, a strict adherence 
to the rule: ''try to have the bowels moved at a regular hour every day or 
every other day;" the administration of injections of lukewarm water, and 
the occasional kneading of the abdominal walls by the fist will go a good way 
in helping to improve many cases of habitual constipation. But all this will 
not do in all cases, remedial agents will often be required, as may readily be 
inferred from the numerous causes by which constipation may be induced. 
For lazy chaps and wise ones, who either do their whole business with nux 
vom. and castor oil, or sneer at the symptom under Alumina: " the rectum 
is inactive," because they imagine that in constipation the rectum must 
necessarily always be inactive ! — the following special hints are not written: 

s£sc. hipp. Dry, uncomfortable feeling in the rectum, as if it were 
filled with small sticks; very painful haemorrhoids, with little bleeding; 
aching and lame feeling in the small of the back, extending to the sacrum 
"Smd hips; worse when getting up after sitting. 



THERAPEUTIC HINTS TO CONSTIPATION. 479 

Alum. The rectum is inactive, there is no desire for stool; the evacua- 
tion can be effected only try straining the abdominal muscles, even when the 
stool is soft; stools hard, knotty and scanty, or sticking to the anus like putty; 
ailments from lead. 

Amm. mur. Hard stools, crumbling to pieces when evacuated, re- 
quiring great effort to expel them, followed by soft stools; feces covered by 
glairy mucus. 

Anac. Urging without being able to expel anything; the rectum feels 
as if stopped up with a plug; the expulsion not taking place immediately, 
he experiences a painful twisting and turning in the intestines across the ab- 
domen. 

Bryon. Hard, dry stools, as if burnt; of large size and passed with 
difficulty; rheumatic tendency; irritable and prone to fits of anger; after 
castor oil; during hot weather. 

Calc. carb. Hard, large, partially undigested stools; after stool feeling 
of faintness; oozing of a fluid from the rectum, smelling like herring-brine; 
too early and too profuse menstruation; restless sleep after three o'clock A. m. ; 
scrofulous diathesis. 

Capsic. After drinking, urging too stool, but only slime is passed; feel- 
ing of heat in the abdomen. 

Carb. veg. Urging with tingling in the rectum and pressure on the 
bladder; labor-like pain; discharging feces in fragments, which are tough 
and scanty; burning in bowels; tympanitis. 

Caustic. Frequent and unsuccessful urging, causing a good deal of pain, 
anxiety and redness of the face; stool comes off in pieces; at last soft, and of 
the size of a goose-quill; stool passes better while in a standing position. 

Chelid. Stools like sheep's dung; pain in liver and csecal region 
gurgling in abdomen, which is distended; crawling and itching in rectum; 
and reddish urine. 

China. Large accumulation of feces in the intestines, with dizziness and 
heat in the head; difficult stool, even when soft. 

Conium. Frequent urging without stool, or a small quantity being ex- 
pelled at a time; chilliness during stool; palpitation of the heart and tremu- 
lous weakness afterwards; the flow of urine suddenly stops and continues 
after a short intermission; dizziness when turning in bed. 

Ferrum. Flushed head and face with cold hands and feet; anaemia. 

Graphit. Hard, knotty stools, with tenesmus and stitches in the rectum; 
sometimes the stool is only of the size of lumbricoides; a quantity of mucus 
is expelled with the stool, or the hard feces are covered with mucus; itching 
blotches about the body, which secrete a glutinous fluid; erysipelatous or 
ulcerative processes of the legs. 

Hepar. Sluggishness and inactivity of the bowels, in consequence of 
which the abdominal muscles must bear down in order to effect an evacua- 
tion, which is hard or not, but insufficient; after mercurial dosing. 

Hydrast. Constipation, headache and piles; after stools, for hours se- 



480 THERAPEUTIC HINTS TO CONSTIPATION. 

vere pain in the rectum and anus; colic pains with fainting turns and heat 
in the bowels; anaemia; remittent fever; "after purgative medicines." 
(Goodno.) 

Iris vers. Constant nausea, bitter eructations and vomiting; burning 
in epigastrium; colic with cutting pains and piles; hemicrania. 

/odium. Desire for stool, without evacuation; it takes place with great 
facility after taking some cold milk; discharges of thick mucus, or purulent 
matter; part of the feces being retained. 

Kali bichr. Stools dry, scant} 7 , knotty; painful retraction of trie anus; 
debility, headache, coldness of the extremities; tough secretion from any of 
the mucous membranes. 

Kali card. Too large-sized feces; inactivity of the rectum; severe lan- 
cinating, tearing and cutting in the anus; violent pain in the small of the 
back, as if broken. 

Ladies. Constipation of years' standing; the anus feels closed; the 
feces press against it all the time without passing; only single flatus are 
passed; the feces have a cadaverous smell; haemorrhoids, with stitching pain 
in the varices when coughing or sneezing. 

Lycop. Ineffectual urging, owing to contraction of the rectum (sphinc- 
ter ani); distressing pain in the rectum for hours after evacuation; excessive 
and painful accumulation of flatus in the abdomen; red, sandy deposit in 
the urine. Irritable and restless in the afternoon. 

Magn. mur. Stools hard and in large lumps; urgent pressure in the 
rectum, the stool comes out in small pieces and seems as if burnt; shudder- 
ing for a short time after stool. Pain and distress every few days in the hy- 
pogastric region. 

Natr. carb. Insufficient stool, with tenesmus, followed by burning in 
the eyes and urethra, with great sexual excitement. 

Natr. mur. Pressure from the navel downwards into the pelvis, or a 
leaden heaviness through the pelvis and across the bladder; worse when walk- 
ing, and better when sitting in a bent forward position; hard, dry stools As- 
suring the anus, making it bleed; a number of bad feelings in the anus after 
stool ; also cutting in the urethra after micturition. 

Nitr. ac. Hard, scanty stools; long pressing when going to stool; pain- 
ful burning in the rectum, especially after stool; urine emitting an intoler- 
ably strong smell. 

Nux vom. Constant, ineffectual urging to stool; large, hard feces; 
piles; headache; unrefreshing sleep; after previous use of purgative medi- 
cines; coffee and liquor drinkers; use of high-seasoned food; sedentary 
habits. 

Opium. Stools in hard, black, round balls; decided torpor and inertia 
of the rectum ; vomiting of stercoraceous substances in consequence of intus- 
susception; incarcerated hernia; lead poisoning. 

Phosphor. Stools narrow, dry, long, and difficult to expel; exceed- 
ing!}' painful cramps in the rectum after stool. 



THERAPEUTIC HINTS TO CONSTIPATION. 48 1 

Phytol. Constipation of long standing; pain shooting from the anus 
and lower part of the rectum along the perineum to the middle of the penis. 

Platina. Difficult expulsion of scanty stool; adhering to the part like 
soft clay; after poisoning with lead; traveling in railroad cars. 

Plumbum. Stools consisting of small hard balls; constriction and 
drawing up of the anus; frequent, violent colic; drawing in of the abdomen 
in the region of the navel; numb extremities; knife drops from his hands. 

Podoph. Constipation with great difficulty; prolapsus ani; frequent 
micturition; weakness and soreness of the back; especially after washing. 

P?un. spin. Hard stool; intermitting stool, looking like the excrements 
of dogs, in small lumps, with stitches in the rectum, extorting cries. 

Pulsat. With menstrual disorders, or after suppression of intermittent 
fever b} r quinine. 

Ratan. Urging sensation in the small of the back, as if there would be 
stool; hard stool with straining; and sudden stitches in the anus; fissures of 
the anus. 

Ruta. Scanty, hard stool; frequent urging to stool, with protrusion of 
the rectum, also during stool; the rectum protrudes when stooping ever so 
little, and especially when squatting; a considerable quantity of flatulence is 
emitted whenever the urging takes place. 

Sabad. Violent urging to stool, with noise like the croaking of frogs; 
necessity of sitting a long while, then passes an immense quantity of flatu- 
lence, which is followed by an enormous evacuation, after that, burning pain 
in the abdomen. 

Sarsap. Obstinate constipation, with violent urging to urinate; urging 
to stool, with contraction of the intestines, and excessive pressure from 
above downwards, as if the bowels would be pressed out; during stool vio- 
lent tearing and cutting in the rectum; afterwards a repetition of the same 
symptoms. 

Selen. Stool so hard and impact that it has to be removed by 
mechanical aid; the feces contain threads of fecal matter like hair. 

Sepia. Unsuccessful urging to stool, only wind and mucus being passed, 
with sensation in the rectum as of a lump having lodged in it ; contractive 
pain in the anus; thence in the perineum and vagina; oozing of moisture 
from the rectum. During pregnancy. 

Silic. Stools composed of hard lumps; after long straining the protrud- 
ing feces suddenly recede into the rectum. 

Sulphur. Constant urging, pressing on the rectum as if it would pro- 
trude, with pressing on the bladder; prolapsus ani; palpitation of the heart; 
after stool excessive stinging and sore pain in the anus, preventing lying or 
sitting down; rush of blood to the head; cold feet; faintness regularly, 
towards 10 or 11 o'clock A. m. 

Sulph. ac. Hard stool, consisting of small black lumps mixed with 
blood, and with such violent pricking in the anus that she has to rise on ac- 

3i 



482 



DIGEST TO CONSTIPATION. 



count of the pain; climacteric period; constant flashes of heat; tremulous 
sensation in the whole body without trembling. 

Tabac. Constipation; tympanitic bloating of the abdomen; dyspnoea. 

Thuja. Obstinate constipation, fever, inactivity, or intussusception; hard 
balls; violent pain in the rectum, which prevents the passage; offensive per- 
spiration at the anus and in the perineum. 

Verbasc. Scanty discharge of stool, like sheep's dung, with straining. 

Ver. alb. Chronic costiveness with heat and pain in the head; stools 
in black, round balls, or large and hard, or first portion of the stool of large 
size, the latter coming out in thin strings, although of the same consistence 
and color. During stool turning pale and faint, chilly with anxiety and cold 
sweat on forehead. 

Zincum. Dry, hard, insufficient, and difficult stool; afterwards violent 
bearing down in abdomen, relieved by passage of flatus up or down. 

Digest to Constipation. 



Constipation of longstanding: Laches., 

Phytol., Sarsap. 
, with violent urging to urinate: Sar- 
sap. 

, chronic: Ver. alb. 

, obstinate: Thuja. 

Sluggishness, inactivity, torpor of bow- 
els, abdominal muscles must bear down: 

Hepar. 

, of rectum: Alum., Opium. 

, no desire for stool: Alum. 

Large accumulation of feces: China. 
Urging, ineffectual :Anac., Lodium, Nux 

vom. 
, causing pain, anxiety and redness of 

face : Caustic. 
, with contraction of sphincter ani: 

Lycop. 
, with pressing on rectum, as if it 

would protrude, and pressure on the 

bladder: Sulphur. 
, with contraction of intestines as if 

the bowels would be pressed out : Sarsap. 
, only a small quantity being expelled : 

Conium. 

, only single flatus are passed: Laches, 

, only wind and mucus being passed, 

with a sensation in rectum as if a lump 

having lodged in it: Sepia. 
- , large quantity of wind is emitted: 

Ruta. 
, followed by an enormous evacuation 

and burning in abdomen: Sabad. 
, in small of back: Ratan. 



, with tingling in rectum and pressure 

on bladder: Carb. veg. 
, with protrusion of rectum: Podoph., 

Ruta. 
Urging, with noise like croaking of frogs: 

Sabad. 

, i «with labor-like pain: Carb. veg. 

, pressure from navel downwards into 

pelvis: Natr. mur. 
, with sudden receding of feces into 

rectum: Silic. 
, after drinking, but only slime is 

passed: Capsic. 
Evacuation difficult: Am. mur., Podoph. 

, with straining abdominal muscles: 

•Alum., Hepar. 

, followed by soft stools: Amm. mur. 

, even when stool is soft: Alum., 

China, 
, stools stick to anus like soft clay or 

putty: Alum., Platina. 

, part of feces being retarded: Lodium. 

Stool passes easy after taking some cold 

milk: Lodium. 
in a standing position: Caustic. 



Before Stool painful twitching and turn- 
ing in the intestines: Anac. 

During stool, violent pain in rectum, 
preventing passage : Th uja. 

, violent pricking in anus, must rise: 

Sulph. ac. 

, violent tearing and cutting in rectum: 

Kali carb., Sarsap. 



DIGEST TO CONSTIPATION. 



483 



, painful retraction of anus: Kali 

bichr. 
■ , contractive pain in anus, in perineum 

and vagina: Sepia. 

, stitches in rectum: Print, spin. 

, stitches in rectum: Graphit. Ratan. 

, anus feels closed, feces presses 

against it: Laches. 
During 1 stool, Assuring the anus and 

making it bleed: Natr. mur. 

, chilliness: Com' inn, Ver. alb. 

, pale, faint, chilly with anxiety and 

cold sweat on forehead: Veratr. 
After stool, burning in eyes and urethra 

with sexual excitement: Natr. carb. 
, stinging and sore pain in anus, pre- 
venting lying or sitting: Sulphur. 

, pain in rectum and anus: Hydrast. 

, burning in rectum: Nitr. ac. 

, cramps in rectum: Phosphor. 

, distressing pain in rectum for hours: 

Lycop. 
, number of bad feelings in anus: 

Natr. mur. 
, bearing down in abdomen, better 

from passage of wind up or down: Zin- 

cum. 
, palpitation of heart and tremulous 

weakness: Conitnn. 

, feeling of faintness: Calc. carb. 

, shuddering: Magn. mur. 

NATURE OF DISCHARGE. 

Stool of large size: Br yon., Kali curb., 

Ver. alb. 

, later in thin strings: Ver. alb. 

and hard: Calc. carb., Magn. mur., 

Nux vom., Ver. alb. 
, dry and hard as if burnt: Biyon, 

Magn. mur. 
so hard and impact that it had to be 

removed by mechanical aid: Selen. 
scanty, insufficient: Alum., Carb. 

veg., Hepar, Kali bichr., Natr. carb., 

Nitr. ac, Ruta, Verbasc, Zincum. 

knotty: Alum., Graphit., Kali bichr. 

hard lumps: Si lie. 

small, black lumps mixed with blood: 

Sulph. ac. 

small hard ball: Plumbum Thuja. 

round blackball: Opium, Veratr. 

like sheep's dung: Chelid., Verbasc. 

, like excrements of dogs in small 

lumps: Prun. spin. 



narrow, dry, long: Phoshor. 

in pieces: Caustic, Magn. mur. 

, which are tough: Carb. veg. 

, crumbling to pieces when being 

evacuated: Amm. mur. 
Stool containing threads of fecal matter 

like hair: Selen. 
, feces covered with mucus: Amm. 

mur., Graphit., Lycop. 
, consists of thick mucus, or purulent 

matter: Iodium. 

of the size of lumbricoides: Graphit. 

a goose-quill : Caustic. 

, latter portion consisting of thin 

strings: Ver. alb. 
of cadaverous smell: Laches 

Rectum feels as if stopped up with a plug: 

Anac. 
, as if filled with small sticks: JEsc. 

hip p. 

, crawling and itching in: Chelid. 

Anus contracted and drawn up: Plum- 
bum. 
, lancinating, tearing, cutting in : Kali 

carb. 
, shooting pain along perineum to 

middle of penis: Phytol. 
, prolapsed: Nux vom., Pod op h., 

Sulphur. 
protrudes when stooping or squattng 

down: Ruta. 
Piles: Alsc. hipp., Hydrast., Iris, Nux 

vom. 
, stitch-pain in, when sneezing or 

coughing: Kali carb., Laches. 
Fissures of anus: Lgnat., Nitr. ac, Nux 

vom., Ratan. 
Oozing 1 of moisture from anus: Sepia. 
, smelling like herring brine: Calc 

carb. 
Offensive perspiration at anus and in 

perineum: Thuja. 

SYSTEMIC SYMPTOMS. 

Anxiety and redness of face from fre- 
quent and unsuccessful urging: Caustic. 

, cold sweat on forehead, face pale 

and faint during stool: Ver. alb. 

Irritable and prone to fits of anger: 
Bryon. 

and restless in afternoon: Lycop. 



Dizziness when turning in bed: Con i inn. 



4 8 4 



HERNIA. 



and heat in head: China. 

Heat and pain in head: Ver. alb. 
Flushed head and face with cold hands 

and feet: Ferrum. 
Rush of blood to the head: Sulphur. 
Hemicrania: Iris. 
Headache: Hydrast, Kalibichr., Nux 



Tough secretion from any of the mucus 

membranes: Kali bichr. 
Constant nausea, bitter eructations and 

vomiting: Iris. 

Vomiting" of stercoraceous substances: 
Opium. 

Burning' in epigastrium: Apis. 

Abdomen, bloating: Card veg., Lycop., 
Tabac. 

, heat in: Capsic, Hydrast. 

, burning: Carb. veg. 

Colic: Plumbum. 

, with fainting: Hydrast. 

Drawing in of abdomen in region of 
navel: Plumbum. 

Leaden heaviness through pelvis and 
across bladder: Natr. mur. 

Pain and distress every few days in hypo- 
gastric region: 3Iagn. mur. 

in liver and caecal region: Chelid. 



Menstruation too early and too profuse: 

Calc. carb. 
Menstrual disorders: Pulsat. 

Frequent micturition: Pod op h. 
Cutting in urethra after micturition: 

Natr. mur. 
Flow of urine stops and continues again 

after a short emission: Conium. 
Urine of intolerable strong smell: Nitr. 

ac. 

reddish: Chelid. 

makes a red, sandy deposit: Lycop. 

Dyspnoea: Tabac. 



Palpitation of the heart; Sulphur. 
Back, weakness and soreness, especially 

after washing: Podoph. 
Small of back, pain as if broken: Kali 

carb. 
, aching and lame feeling, extending 

to sacrum and hips: A^sc. hipp. 
Extremities, numb; knife drops from 

hands: Plumbum. 

cold: Kali bichr. 

Hands and feet cold: Ferrum. 
Feet cold: Sulphur. 
Rheumatic tendency: Bryon. 
Erysipelatous or ulcerative processes of 

legs: Graph it. 
Itching blotches about body, which emit 

a glutinous fluid: Graphit. 
Tremulous sensation in body without 

trembing: Sulph. ac. 

Sleep unrefreshing: Nux vom. 

restlessness after 3 a. m. : Calc. carb. 



Flushes of heat: Laches., Sulph. ac. 
Fever, inactivity: Thuja. 
Debility: Kali bichr. 
Faintness towards 10 or n a. m. : Sul- 
phur. 

After castor oil: Bryon. 

mercury; Hepar. 

lead: Alum., Opium, Platina. 

quinine: Pulsat. 

purgative medicines: Hydrast., Nux 

vom. 

During hot weather: Bryon. 

traveling in the cars: Platina. 

pregnancy: Sepia. 

climacteric age: Laches., Sulph. ac. 

incarcerated hernia: Opium, PI inn- 
bum. 

intussusception: Thuja. 

Scrofulous diathesis: Calc. carb. 

Anaemia: Ferrum, Hydrast. 



Hernia; Internal and External Strangulation. 

Both consist of a ' ' constriction or nipping of a portion of bowel by the 
edges of some natural or artificial orifice through which it protrudes, with 
consequent arrest of the circulation of blood in it, and impediment to the 
passage of fecal matters along it." (Bristowe.) 

Internal strangulation may take place in the foramen Winslowii or 
the foramen ovale, or in any abnormal fissure or opening which has been 



THERAPEUTIC HINTS TO HERNIA. 485 

formed by inflammation and consecutive adhesion, and formation of bands 
and strings within the cavity of the abdomen. 

External strangulation may take place in the inguinal or in the 
crural canal, in the opening which gives passage to the infrapubic vessels, in 
the sacro-sciatic notch and in the umbilicus. But it does not follow by any 
means, that the displacement of a portion of the bowel in any of these by- 
wa3^s should always be followed by strangulation. If, however, strangulation 
does result, the symptoms are the same whether it be internal or external 
strangulation: there is acute pain in the region of the lesion, which is fol- 
lowed by obstinate constipation and vomiting at first of yellow and greenish 
and later of fecal matter — Miserere. 

The Diagnosis of internal strangulation is obscure, because its symp- 
toms are common to any kind of occlusion of the intestinal tract. External 
strangulation in cases of ordinary herina may always be detected by careful 
examination. 

Therapeutic Hints. 

The first endeavor in any case of hernia, whether strangulated, incar- 
cerated, or merely protruded, must be to reduce it. The manipulations 
used in this endeavor are called taxis, and consist of various procedures. The 
patient is laid on his back, with the shoulders low and the pelvis elevated; 
the leg of the affected side is flexed upon the thigh and the thigh upon the 
abdomen, and then by rotating the limb inward the columns of the ring are 
relaxed. 

Or the patient is raised by his feet, so that by its own gravity the pro- 
truded bowel is retracted into the abdominal cavity. 

Or the patient is placed in a semi-prone position towards the affected 
side with the thigh flexed upon the body; his eyes are covered with a towel, 
and then some cold water is suddenly dashed upon the chest and epigastrium, 
which causes by its shock a quick and deep inspiration, in consequence of 
which the hernia slips back. 

Or, according to Baron Sentin's method, "seek with the index-finger for 
the aperture giving issue to the hernia, pushing up skin sufficiently from below 
in order not to be arrested by its resistance. Pass the end of the finger slowly 
between viscera and herniary orifice, depressing the intestine or omentum 
with the pulp of the finger. This stage demands perseverance. Now curve 
the finger like a hook, exerting enough traction on the ring to rupture some 
fibres, causing a cracking very sensible to the finger, sometimes to the ear. 
When this crack is not produced, submit the fibres to a continuous forced 
dilatation." 

Or place a jar filled with hot air over the abdomen, when, by cooling, 
the contents of the abdomen are drawn up into the jar and the hernia out of 
its enclosure — dry cupping. 

Or draw the hernia gently outwards with the right hand in order to dis- 
engage it from the neck of the sac, and then push gently with left thumb and 



486 THERAPEUTIC HINTS TO HERNIA. 

index-finger upon the upper part of the tumor, thus emptying its upper por- 
tion first, when the rest will follow. A gentle, but persistent, pressure is 
necessary. A peculiar gurgling noise in the abdomen pronounces the reduc- 
tion of the hernia. 

Next to taxis the emptying of the lower bowels is of great importance, 
in order to restore the peristaltic motion of the intestines. Dr. Hensler 
recommends large and repeated injections of sugar- water, as not only soften- 
ing the impacted feces, but also as nourishing to the mucous membrane of 
the gut. 

Dr. Finkelnstein recommends the external application of oil and ether 
in the proportion of 20 parts to 100, every fifteen minutes, which in a number 
of cases will reduce the hernia in one hour. 

Any of these methods may succeed; but the carefully selected remedy 
may do it without them, or at least faciliate our success greatly and diminish 
more and more the necessity of the knife. 

Aeon. Soreness, burning and heat and throbbing in tumor; excessively 
sensitive to touch; after fright and cold. 

Arsen. When the tumor assumes a dark red or livid appearance, with 
great restlessness and prostration. 

Aurum. The testicles are slow in lowering down into the scrotum; in- 
guinal and umbilical hernia in children from crying. 

Bellad. Soon after strangulation, which is caused fry spasmodic action 
of the muscular fibres, and before inflammation has set in. 

Borax. If in children the anxious face is present during any downward 
motion. 

Calc. carb. Rachitic children; big-bellied and prone to diarrhoea. 

Coccul. When the prostration takes place very slowly, as if from a 
paralytic state of the abdominal ring. 

Laches. Livid appearance of the tumor; coughing or sneezing goes 
like a knife through the tumor. 

Lycop. Has been very effective in hernia of right side, with rumbling 
in abdomen and great fullness; also in women of a gentle disposition. 

Magn. carb. Scrotal hernia. 

Nux vom. Sudden violent pain in hernial region; drawing and tear- 
ing, and spasmodic constriction in the abdomen, with nausea, vomiting of 
sour mucus; constipation with constant ineffectual urging to stool; or, similar 
to Coccul. , slow protrusion in aged persons, with squeezing pain in the hernial 
region, fullness in abdomen, periodical nausea; tumor not very sensitive, is 
soft and doughy; later comes pinching and griping in abdomen, periodical 
nausea, gulping up of salty or bitter water, vomiting, etc. Nux vom. is fre- 
quently indicated, and especially if errors in diet have preceded; if it fails 
Coccul. follows well. 

Opium. Soporous condition; red face; distended abdomen with flatus; 
antiperistaltic motion, belching and vomiting; bowels absolutely closed, with 
constant urging to stool and urine. 



TORSION. 487 

Plumbum. Has relieved strangulation where Aeon., Bellad. and Nux 
z'om. failed, in many cases. (Baumann. ) 

jR/ius tox. After straining or lifting heavy loads. 

Silic. " Frequent colic, relieved by the discharge of offensive flatus; 
tenderness about the hernial tumor; vomits much milk after nursing." 
(Guernsey.) Boils; abscesses; offensive sweat of feet. 

Stannum. "Inguinal hernia; the child has curdy stools and much 
colic, which is relieved by laying its abdomen across the nurse's knee, or 
against the point of her shoulder." (Guernsey.) 

Sulph. ac. Left side, in melancholic and phlegmatic persons; after 
carrying heavy loads. Von Bcenninghausen considers it as one of the most 
important remedies in inguinal hernia. 

Thuja. " Sweat only on the uncovered parts, while covered parts are 
dry and hot. ' ' (Von Bcenninghausen. ) 

Vet. alb. Antiperistaltic action, hiccough, cold sweat, nausea, with 
sensation of fainting and violent thirst. 

Torsion or Twisting of the Bowels. 

This takes place most frequently at the sigmoid flexure when, by a dis- 
proportion (mostly congenital) between the length of the S-loop and the 
smallness of its mesenterial root, the overdistended sigmoid flexure, filled 
with gas and feces, is rendered liable of rolling about its axis, and by its 
own w r eight and inactivity is prevented from straightening or untying itself 
again. This occurs most frequently in advanced life. 

Twists also take place not unfrequently when by unusually long mesen- 
tery portions of the ilium are rendered freely movable and are thus made 
liable to twist around their own axis. Peritoneal false ligaments or omental 
adhesions running directly across the pedicle of the twisted loop may fix it 
in its twisted position, causing, by degrees, a permanent occlusion of the 
bowels, which is often preceded for a long time by colic, meteorism and con- 
stipation. " Occlusion itself comes on acutely, with severe symptoms of in- 
ternal incarceration, rapid collapse, vomiting, meteorism, and usually violent 
tenesmus, with frequent, sometimes bloody diarrhoea, followed by death 
within the first twenty-four hours — on the average on the fourth day." 
(Leichtenstern. ) 

A lateral kinking, the result of dislocation, is seen most frequently in the 
caecum and ascending colon, when they are rendered movable by an unusualty 
long meso-colon and become displaced inward or into the left hypochondrium. 
" But the kinking is, in itself, insufficient to produce definite impermeability, 
which requires the addition of some compressing cause, most frequently the 
mesentery of a convolution of the small intestine, which overlies the bent 
point and obstructs it by compression." (Leichtenstern.) 

Intussusception ; Invagination. 

By this is meant ' ' the prolapse or slipping of a tuck of intestine into 



488 INTUSSUSCEPTION. 

the cavity of the portion of intestinal tube immediately below it, wherewith it 
is continuous." (Bristowe.) It takes place in consequence of paresis of a 
limited portion of the intestine associated with vigorous peristaltic action of 
the portion below, just as prolapsus recti may follow violent anal tenesmus. 
It has been observed in all parts of the large and small intestine. The ileo- 
caecalis is the most common form in childhood; in adults, ilium and ileo- 
cecal invaginations occur nearly as often. The ilium invaginations are found 
most frequently in the lower and lowest part of the ilium, while colon invagi- 
nations are more frequent in the descending colon and sigmoid flexure. 

The length of bowel involved in an intussusception varies from two to 
three inches up to three or four feet. The course of these lesions is also va- 
riable. Invaginations may be reduced spontaneously, or by suitable treat- 
ment; or the invaginated portion of the bowel, from being compressed, ma}' 
inflame, die and slough off either entire, or what happens oftener, in pieces 
or in shreds. 

This separation occurs, in the majority of cases, from the eleventh to the 
twenty-first day after the production of the invagination; in chronic cases it 
may not happen until after several months. Or, and this is by far the most 
frequent in chronic cases of ileo-caecal invaginations, the two cylinders be- 
come fixed by a solid union, when after the complete disappearance of the 
swelling the canal of the invaginated portion becomes again permeable; or 
in very acute cases in invagination leads to immediate and permanent oc- 
clusion. The patients die in from three to six days with the symptoms of 
internal strangulation, with or without peritonitis or perforation. 

The Symptoms are ushered in suddenly with violent colic, which is fol- 
lowed by vomiting, especially in children if the lesion be situated high up. 
Now follows diarrhoea, which lasts at least until all the contents below the 
lesion are discharged. These evacuations are always mixed with blood, 
which oozes from the compressed and congested portion of the invaginated 
bowel, and consist at last of mere bloody mucus with violent tenesmus, which 
appears earlier and is the more intense the nearer the intussusception is to 
the* rectum. In this case there frequently follows a paralysis of the rectal 
sphincter and patulence of the anus, through which the bloody passages 
escape involuntarily, a symptom especially found in children. The next and 
quite important symptom is the usually cylindrical, sausage-like tumor, which 
can be felt in the abdomen almost always in colon and ileo-caecal invagina- 
tions, but seldom in those of the ilium. In some cases the intussusception 
extends so low down into the rectum that its lower extremity may be detected 
by the finger inserted into the anus. 

Invaginations, especially in the small intestines, are frequently found 
in the bodies of children, but unaccompanied by any inflammatory changes; 
they seem to be produced during the last struggle, and must therefore be 
considered as mere cadaveric changes. 

Ileus or Miserere are terms which denote stercoraceous vomiting, in 
consequence of any kind of occlusion of the intestine. 



therapeutic hints to intussusception. 489 

Therapeutic Hints. 

Ileus or Miserere hint to: Aeon., Arsen., Bellad., Chamom., Coccul., 
Coloc., Cuprum., Diosc, Lycop., Nitr. ac, Nux vom., Opium, Platina, 
Plumbum, Raplian., Rims lox., Sambuc, Silic, Sulphicr, Thuja, Ver. alb., 
Zincum. 

Aeon. Inflammatory symptoms; restlessness and impatience. 

Alum. Pinching pain in the bowels; obstruction from inactivity and 
dryness of rectum; dry retching, or mucous vomiting; low-spirited, weeping, 
hopeless mood. 

Arsen. Burning pain; restlessness and prostration; better from hot 
applications. 

Bellad. Pain in right ileo-caecal region; cannot bear any touch; claw- 
ing around the navel; vomiting, can keep nothing down, is pale and weak. 
Prolapsus ani; paralysis of the sphincter ani. During teething. 

Carb. veg. In slow 7 cases, when other remedies have failed and the 
pulse is intermitting. 

Coloc. Neuralgic pain in bowels; obstruction, as if from dryness of the 
bowels; serous, bilious vomiting without nausea; angry mood; thrown things 
out of his hands; indignation. (Hayward.) 

Cuprum. Violent pain in iimbilical region; total obstruction of bowels; 
violent, continued convulsive vomiting of blood and feces; singultus; great 
agony. 

Kali bichr. Pain as in enteritis; vomits in rapid succession bilious, 
blood} 7 matter; the blood is bright and clotted. Listless, indifferent, languid 
mood. (Harvard. ) 

Nux vom. Crampy, remittent pain in bowels; contraction or restric- 
tion of bowels; sour, mucous and bloody vomiting; quick, spasmodic pulse 
and hot skin; irritable, sullen, quarrelsome mood. 

Opium. Constipation; vomiting of fecal matter; excessive thirst; dis- 
tended abdomen, painful to touch; crampy motions of the intestine, at times 
like a rolling up of a hard body in right hypochondrium; frequent hiccough; 
small, frequent pulse; cold extremities; distorted face. 

Phosphor. Paralysis of sphincter ani. 

Plumbum. Violent colic in region of navel, with complete obstruction 
of bowels and stercoraceous vomiting; anus feels as if drawn upward; swell- 
ing in the ileo-csecal region; depressed and restless disposition. 

Thuja. Ileus; spasmodic stricture, as if something alive was pushing 
out; ineffectual urging to stool, with erections. Sweats only on the uncov- 
ered parts of the body, while the covered parts are dry and hot. 

Ver. alb. Colic; burning, twisting, cutting pain, with nausea and 
vomiting, worse from food, better after wind passes; cold skin; cold perspi- 
ration; small, spasmodic pulse; restless and anxious. 

As mechanical means to reduce invaginations, injections of air have 
been used by means of an ordinary bellows attached to an oesophageal sound 



490 H.EMORRHAGIA INTESTINALIS. 

until a consideral abdominal tension and the desired effect was produced. 
Dr. W. Danforth procured, in a desperate case, the same effect by injecting 
one ounce and a half of soda, dissolved *in a pint of water, and followed by 
the injection of a dessertspoonful of tartaric acid in a cupful of water. The 
thus suddenly generated gas untied the knot. A copious enema will often 
achieve the same result. 

Haemorrhagia Intestinalis, Intestinal Haemorrhages, Malaena, 

Takes place in consequence of either — i. Obstructed circulation of blood 
through the vena porta, as in the case of cirrhosis of the liver, diseases of the 
heart and lungs, compressions of the blood-vessels by large abdominal 
tumors; or, 2. Erosions or degeneration of the blood-vessels from intestinal 
ulcers during typhus, yellow fever, scurvy, etc.; or, 3. Lesions caused by 
corroding or cutting substances, wounds, etc. ; or, 4. Suppressed normal, or 
habitual, bloody discharges, as menstrual or haemorrhoidal. A copious, 
internal haemorrhage is characterized by sudden paleness, coldness of the 
body, collapsed features, weak pulse, fainting, fits of chilliness, and dis- 
charges of blood from the bowels. The discharged blood, when it comes 
from the upper portion of the intestines, is generally dark and mixed with 
intestinal contents like tar. It is generally red and fluid when it proceeds 
from the lower portions. The exact seat of the haemorrhage, however, can- 
not be determined, as physical examination gives no hint whatever in regard 
to it. The bleeding may occur even within the stomach, as I have men- 
tioned when I spoke of haematemesis; and a black, tar-like appearance of 
stool is not a sign that it contains blood, as it may be colored by bile. This, 
however, may soon be settled. Throwing the passage into water, it colors 
the water red when it contains blood; and when it contains bile the water is 
colored green or yellowish. 

Therapeutic Hints. 

Compare the above-stated morbid conditions, which are the causes of 
the intestinal haemorrhage. ■ 

As generally indicated, the most important remedies are Alum., Arse?i., 
Carb. veg., China, Eriger., Hamam., Ipec, Nitr. ac. } Sulphur. 

Haemorrhoids, Piles, 

Consist of a dilatation of the haemorrhoidal veins, to which belong chiefly the 
plexus of veins lying in the submucous tissue of the lower part of the rec- 
tum, and in the adjoining subcutaneous connective tissue, also the venous 
radicles in the mucous membrane, the perirectal plexus, and the adjoining 
venous plexuses of the bladder, uterus, vagina, and the sacral canal. These 
dilated veins form tumors of different sizes, according to the amount of 
venous turgescence, from the size of a pea to that of a cherry or walnut, 
which sometimes encircle the entire anal opening like a bunch of grapes. 
When thus situated outside the anal margin they are called external, when 
within the anal margin internal haemorrhoids. 



HEMORRHOIDS. 49 1 

There are usually longer or shorter intervals between these spells of 
turgeseence, during which the patient feels comparatively free from hsemor- 
rhoidal inconveniences. However, repeated attacks of turgeseence will 
gradually change either the mucous membrane or the submucous tissue, and 
produce catarrhal swelling of the mucous membrane, or hyperplasia of the 
connective tissue, or atropfty of these tissues under the influence of the pres- 
sure of the varices. The natural rugosities of the rectal mucous membrane 
become permanently thickened and inflamed, polypous growths are formed 
and associated with more or less pedunculated tumors, resulting finally in 
suppuration and consequent purulent discharges — white or slimy hemor- 
rhoids. 

The principal predisposing cause of the piles seems to be the position of 
the hsemorrhoidal veins, as the lowest branches of the abdominal vessels, and 
in their want of valves to sustain the return column of blood in its course 
towards the vena porta. When a retardation or stagnation by some means 
or other in this backward moving column takes place, it is obvious that its 
whole weight must press downwards upon its lowest branches, overfilling and 
dilating them. Such retardation of the refluent stream of blood may arise 
from different conditions: 

i. From tumors within the abdominal cavity, which press upon the 
veins of the rectum; a gravid uterus, etc. 

t>. From diseases of the liver, which obstruct the vena porta. 

3. From diseases of the lungs, by which its capillaries become either 
obstructed or destroyed. 

4. From diseases of the heart, by which the veins become overfilled 
with blood. 

5. From a general relaxation of the abdominal veins, in consequence of 
using too much wine, coffee, tea, or leading a sedentary life. 

The fact, however, that frequently all members of the same family suffer 
with this complaint, seems in favor of the assumption that piles are of a 
hereditary nature, probably consisting of a congenital weakness or yielding 
of the walls of the hsemorrhoidal veins. 

Symptoms. — As forerunners to their local appearance we observe: full- 
ness and pressure in the epigastrium, disturbed digestion, bloating of the 
abdomen, costiveness, dull pain in the small of the back, also in the head 
and nape of the neck, hypochondriacal disposition, disinclination to work, 
and especially to mental occupation, all symptoms which denote a disturbed 
action in the abdominal organs. After a shorter or longer duration of these 
symptoms, we find a gradual development of the local symptoms at the anus 
— the beginning of varicose veins, their gradual growth, their turgeseence 
and their collapse, alternating in longer or shorter intervals. Thus the 
whole complaint is of a slow and tedious nature, changing constantly from 
better to worse. The occasional spells of bleeding are frequently attended 
with a feeling of relief, though they do not better the morbid process itself 
in any way; they become in some cases habitual, assuming a regular type of 



492 THERAPEUTIC HINTS TO HAEMORRHOIDS. 

from three to four weeks intervals. In such eases the organism becomes so 
much accustomed to them, that when they are suppressed in consequence of 
mental emotions, or taking cold, or by external medical applications, etc., 
other disturbances set in, such as congestion of the head, lungs, stomach, 
liver, kidneys, etc., which may result in nosebleed, haemoptysis, bloody 
urine, apoplexy, etc. 

In consequence of thes tagnation of the return stream of blood, which 
is caused by liver, heart or lung diseases, ma}' arise, also, especially in older 
individuals, a varicose state of the veins of the neck of the bladder, of the 
uterus or vagina, causing haemorrhages from these organs, or slim)' dis- 
charges, painful micturition, etc. 

' ' Dilatation of the sacral plexus is revealed by pain and a feeling of 
weight in the sacral region. When the communicating plexus of the spinal 
canal is affected, it may, by compressing the roots of the nerves, give rise to 
sensations of weight, numbness, formication and pain in the lower extremi- 
ties, or in the lumbar region, so as to simulate sciatica or a lesion of the cord 
itself." (Quinke.) 

The Prognosis depends upon its predisposing and proximate causes. 
Actual danger can only exceptionally arise from its local manifestations. 

Therapeutic Hints. 

Aeon. Bleeding piles; stinging and pressure in the anus; abdomen 
feels full, with tensive, pressive and colicky pains; bruised feeling in back 
and sacrum, inflammatory stage. 

sEscul. hipp. Protruding piles, purple, bleeding slightly, attended with 
constipation and a sensation as if sticks were in the rectum; severe fullness 
and bearing down; aching pain and lame feeling in the back. 

Aloes. Protruding piles, like bunches of grapes; hot and sore; relieved 
by cold water; when urinating he has a feeling as though some liquid dis- 
charge from the bowels would take place at the same time; much flatus with 
stool. 

Alum. S'':ool hard, and of the shape of laurel-berries, attended with 
cutting pain in the anus, as if it were too narrow; succeeded by a jet of blood 
from the rectum, followed by soreness in and along the rectum; perineum 
sweats and is tender to the touch. 

Amvi. carb. Varices protrude during stool, and without stool; they 
are moist, and with a pain as from excoriation; discharge of blood during 
and after the evacuation; burning pain in the rectum, itching of anus. 

Ant. crud. Tingling, itching and burning of the varix; mucous secre- 
tion from the rectum, staining the linen yellow; alternate constipation and 
diarrhoea. 

Apis. Small protruding varices, which sting, burn and smart intoler- 
ably, making one very irritable and fidgety; stool constipated, urine scanty. 

Arscn. Varices, which burn like fire, particularly at night; fissures of 
the anus, with impossibility of voiding urine; urine blood)-; small of the 



THERAPEUTIC HINTS TO HEMORRHOIDS. 493 

back feels as if broken; impossibilit3 T of stooping; burning in the skin and 
veins; great weakness and restlessness; useful in case of drunkards. 

Bell ad. Bleeding piles with severe pain in the small of the back, as if 
it would break; incarcerated varices from spasmodic constriction of the 
sphincter ani, with great pain from the slightest touch; on this account the 
patient must lie with nates separated; dysuria; congestion of the head; fever- 
ish restlessness. 

Calc. carb. Profusely bleeding piles; protruding; painful when walk- 
ing, better when sitting; too early and too profuse menstruation; habitually 
cold, damp feet; after suppression of the hemorrhoidal flow, constant giddi- 
ness, especially on going up stairs; heaviness and fullness of the head; 
swelling of the pit of the stomach; palpitation of the heart; offensive sweat 
of the feet, making the soles raw. 

Cap sic. The varices bleed a long time; the flowing blood causes a burn- 
ing pain in the anus; the stool is mixed with bloody mucus; there are draw- 
ing pains in the back and cutting pains in the belly. 

Carb. veg. Protruding piles, blue, even suppurating, emitting a ter- 
rible smell; burning in the rectum ; oozing of humor from the rectum; flat- 
ulence; congestion of the head, and nosebleed; after high living. 

Cascar. Frequent and excessive bleeding from the rectum during and 
after hard, brown stool in large lumps, and without stool. 

Caustic. Varices large, painful, stinging; burning when touched, hin- 
dering stool; increased by walking and reflection; fistula ani. 

Chamom. Bleeding haemorrhoids with colic; frequent urging and 
diarrhoea; pain in the back, worse at night; ulcerating fissures at the anus; 
great restlessness, crying, screaming, tossing; sweating; angry, peevish and 
ill-humored. 

Colchic. With spasms of bladder and discharge of blood from it. 
(Stens, Sr. ) 

Collin. Flowing piles, incessant, though not profusely, or protruding 
piles with bleeding; sensation in the rectum as if sticks, sand or gravel had 
lodged there; growing worse as evening approaches till late at night, better 
in the morning; constipation of the bowels and pain in the epigastrium, with 
loss pf appetite; or diarrhoea. 

Chi?ia. Bleeding piles; burning and burning-itching; tingling in the 
anus, with creeping and itching extending into the urethra, attended with 
burning in the glans. 

Eriger. Bleeding piles; hard, lumpy stools. 

Ferr. phosph. With catarrh of stomach and bowels. 

Graphit. Varices and prolapsus of the rectum, even when there is no 
desire for stool, as if the rectum had lost its contractile power and had be- 
come paralyzed; painful, burning cracks (rhagades) between the varices; 
chronic constipation with hardness in the region of the liver; stool hard, 
knotty with blood and slime; scanty and delayed menses; leucorrhcea like 
water. 



494 THERAPEUTIC HINTS TO HEMORRHOIDS. 

Hamam. Profusely bleeding haemorrhoids, characterized by burning, 
soreness, fullness and weight; at times rawness of the anus; the back feels as 
if it would break off; pricking pain, worse from pressure, from the wrist to 
the shoulder along the course of the superficial veins; the same pricking 
pain in the region of the heart; scanty menses. 

Hcpar. Inflammation and suppuration of the hemorrhoidal tumors. 

Hydrast. When a small loss of blood is followed by excessive weak- 
ness. (H. F. Hunt.) 

Ignat. Bleeding piles; violent, shooting pains high up into the rectum; 
prolapsus recti during stool; cutting, tearing in the rectum, continuing for 
hours after stool; for quiet people, or such as get easily excited and easily 
depressed. After confinement. 

Kali carb. In consequence of constipation with too large stools; the 
haemorrhoidal tumors swell and become large and very painful; they bleed, 
especially during micturition, and emit slime afterwards; riding on horse- 
back ameliorates the pain considerably for the time being. After confine- 
ment. 

Laches. Protruding haemorrhoids, very painful; a stitching pain is 
felt to go through the haemorrhoidal tumors, especially during coughing or 
sneezing; also at the critical age, with scanty menstrual flow. 

Leptand. Frequently bleeding piles; constipation and distressing pain 
beneath the sacrum. 

Lycop. Protrusion of varices; painful when sitting; distention of the 
whole abdomen, and rumbling after stool; cutting in the rectum and bladder; 
long-continued pain after stool; itching eruption around the anus, painful to 
touch; grayish-yellow color of the face; depressed spirits; frequent urging 
to urinate; slim}^ or reddish-sandy sediment in the urine. 

Mercur. Large, bleeding piles during stool, which is watery; haemor- 
rhage from the rectum during micturition; falling of the rectum, which is 
black and bleeding; inflammation and suppuration of the haemorrhoidal 
tumors. 

Mar. ac. Largely protruding piles, which look bluish and are exceed- 
ingly painful to contact — even the sheet is insupportable; prolapsus ani on 
passing loose stool during micturition. 

Natr. mar. Varices, painful, stinging and humid; protrusion of the 
rectum; smarting and beating in the rectum; burning at the anus; herpes 
about the anus; herpes on the boundaries of the hair in the nape of the 
neck; cutting pain in the urethra after micturition. 

Nitr. ac. Bleeding piles, protruding after each stool; the sharp-cutting 
pain in the rectum lasts four hours after an evacuation, and is much worse 
after a loose stool. 

Nux vom . Haemorrhoidal symptoms after purgative medicines and exter- 
nal and internal allopathic treatment; in persons of sedentary habits, or addict- 
ed to the use of coffee, wine, liquors, spices, etc. ; ineffectual urging; constipa- 



THERAPEUTIC HINTS TO HEMORRHOIDS. 495 

tion; headache; sleeplessness early in the morning; hyochrondriac mood; 
fissures of the anus, with great sensitiveness of the rectum. 

Petrol. Burning and stitching in the anus and rectum; scurf on the 
border of the anus; titillating and smarting; itching herpes on the peri- 
neum. 

Phosphor. Varices protrude during emission of flatus; mucous dis- 
charges from the anus, which is constantly open; discharge of dark, coagu- 
lated blood; vertigo, especially on looking up or down. 

Phosph. ac. Bleeding piles, with tolerable pain in sitting. 

Podoph. Piles and prolapsus ani, with diarrhoea of long standing; 
worse in the morning; or constipation with flatulence and headache. 

Pulsat. Blind and flowing haemorrhoids; discharge of blood and slime 
with the stool; colicky pain; painful pressure upon the hemorrhoidal 
tumors; backache; fainting spells; mild, gentle and tearful disposition; dry- 
ness and bad taste in the mouth every morning; no thirst. 

Ratan. Protrusion of the varices after hard stool, with straining and 
violent pressing in the rectum; burning at the anus before and during a 
diarrhoeic stool; fissures of the anus, with great sensitiveness of the rectum. 

Rhus fox. Sore, blind haemorrhoids protruding after every stool; 
drawing in the back from above downwards, with tension and pressing in the 
rectum, as if everything would come out; labor-like drawing towards the 
uterus, when standing; pain in the small of the back, as if bruised, when 
lying or sitting still; going off when moving about. 

Sepia. Protrusion of piles and rectum, even after soft stool; worse after 
drinking milk; continual straining pain in the rectum; difficulty of urinating, 
especially in the morning; a feeling as if drops came out of the bladder, 
which is not the case; heat, burning and swelling of the anus; the varices 
become hardened; oozing of moisture from the rectum; soreness between the 
buttocks. 

S tap his. Intense pain in the back and through the whole pelvis; en- 
latgement of the prostate gland. (Preston.) 

Silic. Inflammation and suppuration of the hemorrhoidal tumors. 

Sulphur. Haemorrhoids; constant ineffectual urging to stool; or thin, 
bloody stool, worse in the morning, with soreness of the anus, or single vio- 
lent stitches in the rectum, also between stools, arresting the breathing and 
causing him to start; prolapsus ani during stool, particularly when hard; 
tensive pain and stiffness in the small of the back, as if the parts were too 
short; inability to stand erect; burning micturition. After suppression of 
habitual bleeding: congestion of the head; dizziness; palpitation of the 
heart; pain in the pit of the stomach, with difficulty of breathing; loss of 
appetite; sudden hunger, with faintness before dinner; sleepiness through the 
day, and sleeplessness at night. 

Thuja. The haemorrhoidal tumors are painful when touched ever so 
slightly; sycosis. 



496 



DIGEST TO HEMORRHOIDS. 



Digest to Hemorrhoids, Piles. 



Bleeding 1 : Aeon., sEsc. hipp., Amm. 

card., Bcllad., Calc. card., Capsic, 
Chamom., China, Collins., Eriger., 
Hamam., Hydrast., Ignat., Kali carb., 
Leptand., Mercur., Nitr. ac, Phosph. 
ac, Pulsat., Sulphur. 

frequently: Lepland. 

during stool, which is watery-: Mer- 
cur. 

during stool, and slime: Pulsat. 

and after: Amm. carb., Cascar, 

during micturition, and emit slime 

afterwards: Kali carb. 

, with colic: Chamom. 

, with pain in small of back, as if it 

would break: Bellad. 

, with shooting pain up into the rec- 
tum: Ignat. 

, with burning, soreness, fullness in 

rectum: Hamam. 

, with burning in anus: Capsic. 

, with burning and burning itching: 

China. 

, with stinging and pressing in anus: 

Aeon. 

• is followed by excessive weakness: 

Hydrast. 

Suppression of bleeding is followed by 
giddiness, worse on going up-stairs: 
Calc. carb. 

Blind or flowing: Nux vom., Pulsat., 
Sulphur. 

, sore, protruding after every stool: 

Rhus tox. 

Moist, with pain as from excoriation: 
Amm. carb. 

Protruding": yEsc hipp., Aloes, Amm. 
carb., Apis, Calc. carb., Carb. veg., 
Caustic, Collins., Kali carb., Laches., 
Lycop., Mur. ac., Nitr. ac, Phosphor., 
Ratan., Rhus tox. 

, like bunches of grapes: Aloes. 

, blue, even suppurating, terrible 

smell: Carb. veg. 

bluish, painful to slightest contact: 

Mur. ac. 

, purple, bleeding slightly: yEsc 

hipp. 

during and without stool: Amm. 

carb. 

after each stool: Nitr. ac, Rhus tox. 

even after soft stool: Sepia. 



after hard stool, with straining: Ra- 
tan. 

during emission of flatus: Phosphor. 

Inflamed: Aeon., Eerr. phosph. 

and suppurating: Carb. veg., Hepar, 

Mercur., Sepia, Silic 

Incarcerated from spasmodic constric- 
tion of the sphincter ani: Bellad. 

The varices become hardened: Sepia. 

Cracks between the varices: Graphit. 

Painful: Kali carb., Laches., Pulsat. 

-, hindering stool: Caustic. 

, from slightest touch: Bellad., 

Thuja. 

in sitting: Lycop., Phosph. ac. 

Hot and sore: Aloes. 

Burning" when touched: Caustic. 

like fire, worse in night: Arsen. 

Stinging, burning and smarting: Apis. 

Titillating" and smarting: Petrol. 

Tingling", itching and burning: Ant. 
crud. 

Stinging: Caustic 

and humid: Natr. mur. 

Stitching" when coughing or sneezing: 
Laches. 

ACCOMPANYING SYMPTOMS. 

Crying", screaming, tossing, restless: 

Chamom. 
Depressed spirits: Lycop. 
Hypochondriac Mood: Nux vom. 

duiet nature, or easily excited, or de- 
pressed: Lgnat. 

Mild, gentle, tearful: Pulsat. 

Irritable and fidgety: Apis. 

Angry, peevish and ill-humored: Cha- 
mom. 



Vertigo: Sulphur. 

, worse looking up or down: Phos- 
phor. 

Congestion to head: Bellad., Carb. veg., 
Sulphur. 

Heaviness and fullness: Calc carb. 

Headache: Nux vom., Pulsat. 

Herpes on boundaries of hair in nape of 
neck: Natr. mur. 

Grayish-yellow color of face: Lycop. 



Dryness and bad taste in mouth every 
morning: Pulsat. 



DIGEST TO HEMORRHOIDS. 



497 



No thirst: Pulsat. 

Loss of appetite: Sulphur. 

Sudden hunger, with faintness before 

dinner: Sulphur. 
Pain in pit of stomach, with difficulty of 

breathing: Sulphur. 
Swelling of pit of stomach: Calc. card. 
Catarrh of stomach and bowels: Ferr. 

phosph. 
Colicky pain: Pulsat. 

and feeling of fullness: Aeon. 

Flatulency: Card. veg. 

Distention of abdomen and rumbling 

after stool: Lycop. 
Fullness and bearing down: ALsc. hipp. 
Ineffectual urging: Nux vom., Sul- 
phur. 
Frequent urging and diarrhoea: Cha- 

mom. 
Constipation: Apis, Kali card., Nux 

vom. 
, with flatulence and headache: Po- 

doph . 
and pain in epigastrium, and loss of 

appetite: Collins. 
, with hardness in region of liver: 

G rap hit. 
and feeling as of sticks in rectum: 

Aisc. hipp. 

and alternate diarrhoea: Ant. crud. 

, and pain beneath the sacrum: Lep- 

tand. 
Stools hard, lumpy: Casear., Eriger. 
, knotty, with blood and slime: 

Graphit. 
, like laurel-berries, with cutting 

in anus, followed by a jet of blood and 

soreness in rectum: Alum. 
thin, bloody, with soreness of anus, 

or stitches in rectum, also between 

stools, arresting breathing and causing 

him to start: Sulphur. 
Diarrhoea: Ant. crud., Collins. 
Flatus with stool: Aloes. 
After stool, cutting, tearing in rectum 

for hours: Ignat. 
, , worse after a loose stool: Nitr. 



cutting pain long continued: Ly- 



cop. 



Anus, burning in: Natr. mur. 
, and swelling: Sepia. 

32 



, before and during diarrhceic 

stool: Patau. 

Rectum, burning in: Card. veg. 

and anus, burning and stitching in: 

Petrol. 

, burning in, and itching of anus: 

Amm. card. 

Cutting in rectum and bladder: Lycop. 

Smarting and beating in rectum: Natr. 
mur. 

Sticking pain in rectum as of sticks or 
gravel: A£sc. hipp., Collins. 

Straining, continual, in rectum: Sepia. 

Tingling in anus, creeping and itching 
extending into urethra, with burning 
in glans: China. 

Prolapsus recti: Nat. mur. 

during stool: Lgnat., Sulphur. 

, with diarrhoea: Podoph. 

during loose stool and during mictu- 
rition: Mur. ac. 

, rectum is black and bleeding: Mer- 

cur. 

, without desire for stool, as if rec- 
tum had become paralyzed: Graphit. 

Oozing of moisture from rectum: Card. 
veg., Sepia. 

mucus from rectum: Ant. crud. 

Discharge of mucus from anus, which is 
constantly open: Phosphor. 

, mixed with blood: Capsic. 

dark, coagulated blood : Phosphor. 

Fissures of ani, ulcerating: Chamom. 

, with great sensitiveness: Nux 

vom., Ratan. 

, with impossibility to void urine: 

Arsen. 

Cracks between varices, burning: Gra- 
phit. 

Eruption around anus, itching, painful: 
Lycop. 

Rawness of anus: Hamam. 

Fistula ani: Caustic. 

Herpes about anus: Natr. mur. 

Scurf on the border of anus: Petrol. 

Sweat on perineum; tender to touch: 
Alum. 

Itching Herpes on perineum: Petrol. 

Soreness between buttocks: Sepia. 

Spasms of bladder, with bloody dis- 
charge: Colchic. 

Urging to urinate, frequent: Lycop. 

Urination difficult: Sepia. 

impossible: Arsen. 



498 



FLATULENCY 



Dysuria: Bel lad. 

Burning during micturition: Sulphur. 

Cutting" in urethra after micturition: 
Natr. mu v., Sepia. 

Discharge from bowels, feeling of dur- 
ing micturition: Aloes. 

Haemorrhage from bowels during mictu- 
rition: Mercur. 

Feeling as if drops came from bladder: 
Sepia. 

Urine bloody: Arsen. y Co l chic. 

scant}-: Apis. 

Sediment slimy or reddish-sandy: Ly- 
cop. 

Prostate gland enlarged: Staphis. 

Labor-like drawing towards uterus, 

when standing: Rhus tox. 
Scanty menses: Hamam. 

and delayed, leucorrhcea like water: 

Graphit. 
Too early and too profuse menses: Calc. 

card. 



Palpitation of heart: Calc. card., Sul- 

phur. 
Pricking pain in region of heart: Ha- 
mam. 
Back, pain in, worse at night: Chamom. 
feels as if it would break off: Bel I ad. , 

Hamam. 

, pain in and through pelvis: Staphis. 

, , and cutting pain in bowels: 

Cap sic. 
, drawing in, from above downward, 

with pressing in rectum: Rhus tox. 
, bruised feeling in, and sacrum: 

Aeon. 
, aching pain and lame feeling in: 

A^sc. hi pp. 
Small of back, as if broken: Arsen., 

Kali card. 

, as if parts were too short: Sulphur. 

, as if bruised, when lying or sitting 

still: Rhus tox. 



Pricking pain in superficial veins from 

wrist to shoulder: Hamam. 
Burning in skin and veins: Arsen. 
Sweat, offensive, of feet: Calc. card. 
Habitual cold, damp feet: Calc. card. 
Cannot stand erect: Sulphur. 



Feverish restlessness: Bellad. 

Sweating: Chamom. 

Sleepy through day, sleepless at night: 

Sulphur. 
Sleepless early in morning: Nux vom. 
Weakness and restlessness: Arsen. 
Fainting spells: Pulsat. 



After constipation with too large stools: 

Kali card. 
purgative medicines, highly seasoned 

food, etc. : Nux vom. 

high living: Card. veg. 

habitual drinking: Arsen. 

confinement: /gnat., Kali card. 

scanty menses at critical age: 

Laches. 

suppression of habitual bleeding: 

Sulphur. 

sycosis: Thuja. 



Worse from evening till late in night: 
Collins. 

on stooping: Arsen. 

on walking: Calc. card., Caustic. 

after drinking milk: Sepia. 

after reflection: Caustic. 

on lying, must lie with nates sepa- 
rated: Bellad. 

Better from cold water: Aloes. 

when moving about: Rhus tox. 

when riding on horseback: Kali 

card. 

when sitting: Calc. card. 



Flatulency, Meteorism of the Abdomen. 

We mean by these terms an abnormal collection of gas in the intestinal 
canal. It may be caused: 

i. By certain kinds of food, such as not well-fermented beer, sweet cider, 
fresh bread, green peas, unripe fruit, cabbage and the like. 

2. By a morbidly changed condition of the digestive juices, which allow 
fermentation of the intestinal contents. 



THERAPEUTIC HINTS TO FEATUEENCY. 499 

3. By a relaxed state of the mnseular coat of the intestines, in conse- 
quence of which the contents of the bowels are not properly moved forwards, 
and become decomposed into gaseous substances. For this reason we fre- 
quently observe meteorism in severe cases of typhoid pneumonia, acute 
exanthematic and puerperal fevers, peritonitis, after the abuse of purgative 
medicines, in diseases of the brain and spine, also in hysteria, and hypochondria. 

4. By mechanical obstructions of the intestinal canal, like strangulated 
hernia, intussusceptions and twistings of the gut around its own axis. 

Symptoms. — The abdomen appears bloated, puffed out, feels either 
elastic, or more or less inelastic and hard, according to the degree of com- 
pression of the gas within. Percussion generally yields a tympanitic sound, 
unless there be a greater tension of the gas within than of the external air, 
in which case the percussion sound is not tympanitic, and may be even dull. 
Auscultation reveals here and there gurgling noises, and even the metallic 
tinkling may be heard when the fluid contents move within the expanded 
gut. 

Such abnormal expansion of the intestines forces the liver, stomach and 
lungs higher up into the thoracic cavity, causing oppression, dyspnoea, palpi- 
tation of the heart, anxiety, fainting and congestion of the head. The ex- 
pansion downwards causes pressure upon the bladder, difficult urination, 
pressure upon the rectum, and frequent desire for stool, and pressure upon 
the uterus. This abnormal collection of gas is frequently associated with 
spells of violent colic, loss of appetite, nausea, etc. Belching, or the passing 
off of flatus, often gives great relief. The gas generated consists mostly of 
carbonic acid, or hydrogen, or sulphurretted hydrogen gas. 

It is obvious that the Prognosis depends entirely upon the cause, of 
which meteorism is the consequence. It is of little consequence if produced 
merely by improper food, or the improper condition of the digestive juices. 
It becomes a more serious symptom when caused by a relaxed state of the 
muscular coat of the intestines, and is most serious in cases of intestinal 
obstruction. 

Therapeutic Hints. 

Carb. veg. Much bleching, sour and rancid; bloatedness of stomach 
and bowels; oppression of the chest; palpitation of the heart; consequences 
of high living. 

China. Distention of the abdomen; oppression of the stomach; eructa- 
tions, especially after eating; great fermentation in the bowels; after new or 
sour beer and fruit. 

Chamom. Attended with severe colic; the abdomen is swollen like a 
drum; the gas passes off constantly, but in small and insufficient quantities. 

Laches. Eructations of gas affording relief; distended stomach; incar- 
ceration of flatulence. 

Lycop. Constant rumbling and gurgling of wind in the bowels, 
especially in the left hypochondrium; incarcerated flatulence, which bears 
•downwards upon rectum and bladder, causing a number of bad feelings. 



500 COLICA, ENTERALGIA. 

Nux vom. Pressure towards the chest and head; oppression of the 
chest; constipation, with constant ineffectual urging; after spirituous drinks, 
coffee, condiments, etc., in consequence of sedentary life. 

Pulsat. Especially in consequence of spoiled stomach from eating fat 
things, pastry, warm cakes, fruits, etc. 

Besides, compare Gastric and Intestinal Catarrh, Constipation and Colic. 

Colica, Enteralgia. 

We understand by this term a paroxysmal pain in the abdomen of a 
purely neuralgic character, without any discoverable pathological change 
within the structure of the intestines, although it may attend different morbid 
processes which consist of such pathological changes. The Causes are 
numerous; they may be classed under the following head : 

i. Such as are dependent upon anomalies of the intestinal contents: ab- 
normal quantity or quality of food, colica saburralis; or abnormal develop- 
ment of gas, colica flatulenta, wind colic ; or accumulation of hard feces, colica 
stercoracea ; or foreign irritating bodies, like worms, colica ferminosa ; or 
metallic poisons, like lead, colica saturnina ; or copper, colica aeruginosa. 

2. Such as are dependent upon a disturbed innervation, either — a. Prim- 
arily within the great centres of innervation themselves, from mental emo- 
tions, in cases of hysteria, hypochondria, and spinal diseases — colica nervosa; 
or, b. Secondarily, in consequence of diseases of other organs, which may 
cause a pain in the bowels sympathetically on the principle of ' 'reflex action. ' ' 
Hence, authors speak of colica hepatica when the liver, of colica uterina when 
the womb, of colica renalis when the kidneys are thought to be the starting 
point of the colic. Still, we ought to remember, that in such cases the 
pain may not be an intestinal colic at all, but merely an irradiation from the 
primarily affected parts. 

3 . Such as are dependent upon structural changes in the intestines, among 
which we may reckon colicky pains in dysentery, catarrhal affections, typh- 
litis, hernia, intussusception, strangulation, twisting, etc. There is also a 
kind of colic produced by taking cold, especially of the feet and abdomen, 
and which is called colica rheumatica. 

Symptoms. — i. Pain. It is of a crampy, severe griping, or twisting 
nature, coming and going in paroxysms, either in the umbilical region or in 
the side of the abdomen; oftentimes shifting from one place to another. Ex- 
ternal pressure sometimes gives relief and sometimes aggravates the pain; in 
other cases it shows no influence. External application of warm things re- 
lieves in a majorit}^ of cases, wmilst cold things almost always aggravate the 
pain. 

2. Rolling and gurgling in the abdomen, occasioned by irregular con- 
tractions of the intestines and the moving of their fluid and gaseous contents, 
which may be felt by the examining hand. 

3. Bloatedness of the abdomen where there is a great collection of gas; 
or contraction of the abdomen, especially in lead colic. 



COLICA, ENTERALGIA. 501 

4. Constipation ; it is only in rare cases that colic is attended by 
diarrhoea. 

5. Nansea, vomiting and belching. 

6. Cold perspiration and extremities; small pnlse. 

7. Anxious, frightened expression of countenance, contraction of eye- 
brows and compression of lips. 

8. Great restlessness ; the patient tries all possible positions to obtain 
relief — now lying on the stomach, now drawing up the limbs, now bending 
and pressing the abdomen against a hard object, a chair, table or bed-post; 
now sitting down, now walking about, now trying to evacuate the bowels, 
etc. In some cases, however, the slightest motion increases the pain. 

The spells usually last some hours, in some cases longer. 

Wind colic ceases as soon as the incarcerated gas finds vent and 
passes off. 

Colic from indigestion is relieved by vomiting or diarrhoea; colic from 
hard feces by a sufficient evacuation from the bowels. 

Colic from taking cold is always relieved by a general warm perspira- 
tion. 

As there are so many causes for, and so many different affections with 
which colicky pains may be associated, it is absolutely necessary in each par- 
ticular case to make as close an examination as possible, in order to find out 
what lies at the bottom of the painful affection. 

Colic from indigestion, or colica saburralis, is brought on either from 
overloading the stomach, or from improper or unhealthy food. 

Here are indicated — 

Nux vom. After coffee, brandy, large meals. 

Pulsat. After fat food, pastry and flatulent food. 

Ipec. After sour and unripe fruits and salads. 

Arse?i. After ice water and ice cream. 

Flatulent colic is characterized by distention of the abdomen, gurgling 
and rolling in the bowels, or pressure upwards towards the thoracic cavity, 
causing pain there and shortness of breath, or pressure downwards upon 
bladder and rectum. 

Here are indicated — 

Bellad. If associated with congestion of the head. 

Carb. veg. When there is a great deal of sour and rancid belching, 
without much relief. 

Chamom. When the abdomen is distended like a drum, and wind 
passes off only in small quantities without relief. 

Lycop. In cases of habitual costiveness and great pressure down- 
wards upon rectum and bladder, and gurgling under the left hypochon- 
drium. 

Nux vom. When there is great pressure upwards toward the thoracic 
cavity. 



502 SPECIAL HINTS TO COLICA, ENTERALGIA. 

Opium. When there is great pressure downwards upon bladder and 
rectum, without any passing off of feces, gas or urine. 

Rheumatic colic follows upon suddenly taking cold, getting wet, etc. 

Here are indicated — 

Aeo?i. After suppresssed perspiration, exposure to sharp northwest 
wind. 

Coloc. Cutting, pinching, contracting pain, with hot or cold skin > 
irritated pulse, and a disposition to double up and press hard upon the 
abdomen. 

Dulcam. After taking cold; the griping is attended wdth nausea in the 
stomach, and followed by diarrhoea. 

Pulsat. After getting the feet wet. 

Rhus fox. After getting wet all over. 

Nervous colic is a consequence of morbid innervation arising suddenly, 
sometimes without any known causes, showing no abnormity in the abdomi- 
nal cavity. 

Here are indicated — 

Bellad. Clawing around the navel; better from pressure. 

Coloc. After indignation. 

Ignat. After grief and fright. 

Opium. After sudden fright. 

Plumbum. Contracted abdomen. 

Lead colic — poisoning by lead. Bluish-gray line along the gums; 
retracted abdomen; pain lessened from external pressure; obstinate costive- 
ness; slow pulse. 

Antidotes. — Opium, Platina, Nux vom., Alum., Ant. crud., Coccul., 
Arsen., Bellad., Podoph., Zincum. 

Copper colic, poisoning by copper. Distended abdomen; pain worse 
from slightest touch; nausea; vomiting; tenesmus. 

Antidotes. — Hepar, Nux vom., Bellad. 

All other secondary forms of colic are mere attendants upon other dis- 
turbances, w T hich either have been considered already, or will be considered 
later. 

Special Hints. 

Aeon. Intolerable, cutting pains in the belly, so violent that he screams, 
tosses about, and is almost beside himself; after taking cold; menstrual colic. 

Alum. Lead colic, with dyspnoea, or pressing down in the groins like 
hernia. 

Arsen. Pains in the whole abdomen, excessive; worse at night, after 
eating and drinking; better from warm application; with vomiting, or diar- 
rhoea, or costiveness; great anguish, lamentations, tossing about; internal 
restlessness, which does not allow one to lie still; despair of life; after the 
use of ice water, ice cream; bad sausages, cheese; lead poisoning. In colic 
after severe burns. 



SPECIAL HINTS TO COUCA, ENTERAI,GIA. 503 

Asa/'. Distention of the abdomen, with severe pain and a feeling as 
though something were rising from below upward into the chest and throat; 
during the height of the paroxysm, fainting; pain better from external press- 
ure; in hysteric and hypochondriac persons. 

Aurum. Painful accumulation of gas below the left ribs, causing a 
stitching pain there; coming on even after eating the simplest food. 

Bellad. During the pain the traverse colon protrudes like a pad all 
the way across the belly; while sitting or standing and walking, much worse, 
with a feeling as though the intestines were loose and dragging downwards; 
external pressure and bending double relieves somewhat; protrusion in the 
inguinal region as thick as a finger, which, when pressed upon, dissappears 
with a gurgling sound; pain below the navel, as though a portion of the 
intestines were seized with the nails, clawing it together; thin purulent stool; 
congestion of the head; copper colic. The pain comes suddenly and dis- 
appears suddenly. 

Bryon. After taking cold; cutting, lancinating pain in the abdomen; 
worse from motion and drinking cold water; bowels constipated; feces hard, 
as if burnt; tongue coated, white, dry, without thirst; or else great thirst. 

Calc. carb. Severe spasms in the intestines, especially in the evening 
and at night, with coldness of the thighs; feeling of coldness in the abdomen; 
enlargement and hardness of the abdomen, particularly in teething children; 
diarrhoeic, clay-like stools, smelling sour or fetid; sweat on the head. 

Carb. veg. Fullness and distention of the abdomen, with a feeling as 
though it would burst; squeezing and pressing in the left side of the epi- 
gartrium, or in the region of the bladder; oppression of the chest; belching, 
tasting sour and rancid; headache; chilliness over the back; hypochondriac 
mood; worse from eating, if ever so little; better from emission of flatus or 
hard stool; colic from riding in carriage. 

Caustic. Crampy colic of a chronic character; pain from the stomach 
through to the back, up into the chest, down into the abdomen; belching; 
rumbling in the bowels; obstinate constipation; tongue coated whitish on 
both sides. 

Chamom. Flatulent colic; the abdomen is distended like a drum, or 
the wind presses here and there against the abdominal walls, with a feeling 
as if it would pierce through; or the patient has a feeling as if the whole 
abdomen were hollow, with continual rolling in the bowels and blueness 
around the eyes; or the excessive pain simulates a sensation as if the parts 
were rolled up into a ball; vomiting; diarrhoea, green and slimy; or continual 
passing of small quantities of flatus without relief; great restlessness, anxiety; 
sticky or hot perspiration; after chargin, or taking cold. Very irritable 
mood. 

China. Distention of the abdomen, with pressing under the short ribs; 
rumbling and cutting pain in the bowels; worse at night; brought on by 
eating fruit or drinking new beer; after exhausting illness, loss of vital 
fluids, profuse perspiration; gall-stones. 



504 SPECIAL HINTS TO COLICA, ENTERALGIA. 

Chin, sulph. Flatulent colic of an intermitting type. 

Coccid. Flatulent colic, about midnight, with incessant formation of 
flatulence, distending the abdomen, going off without relief and obliging to 
turn from side to side; belching relieves; the pain is most severe in the epi- 
gastric, umbilical and right iliac region; nausea, vomiting; yellow face; 
cold perspiration, anxiety and restlessness. 

Coffea. Excessive pains with anguish, great nervousness, loud crying 
and grating of teeth; suffocative fits; coldness of limbs; convulsions. 

Colchic. Great distention of the abdomen; also when the abdomen is 
empty, aggravated by eating; the stomach feels icy cold; after flatulent food. 

Coloc. All sorts of violent pains, mostly in the umbilical region, or 
from the sides concentrating in the middle; the patient doubles up or seeks 
relief by pressing the belly against the bed-post or any other hard object, or 
by lying on the belly; likewise a tight, cramp-like pain in the left iliac and 
inguinal region, which is worse after (not during) external pressure, espe- 
cially observed in women after excess in venere; after indignation; abuse of 
opium; a cup of coffee generally relieves the pain for a while. 

Ctiprum. Violent spasms in the abdomen and in the upper and lower 
limbs, in spells; cutting pain in umbilical region, as if a knife were thrust 
through into tpe back; screams as though he were being killed, throwing 
himself upon the floor; singultus and stercoraceous vomiting. 

Diosc. Remitting, griping pain in the epigastric and umbilical region; 
or severe pain in left iliac region, running upwards to left kidney, better 
from crouching together with the hands clasping the knees; or pain in a 
small spot which feels as if it were drawn forcibly upwards and backwards 
towards the spine. Constant desire to defecate and urinate without accom- 
plishing much. 

Dulcam. Colic when the weather changes suddenly from warm to cold; 
griping in the bowels, with nausea, and coldness in the small of the back; 
diarrhoea. 

Hyosc. Colic as if his abdomen would burst, he presses his fists into his 
sides; spasmodic cutting, vomiting, belching, hiccoughing and screaming. 

Igiiat. Periodical abdominal spasms, particularly at night, waking out 
of sleep, with stitches running up into the chest and to the sides; in sensitive 
and hysteric women. 

Ipec. Colic of children, with diarrhoea, uneasiness, screaming, and toss- 
ing about; after acid or unripe fruit, beer, etc. 

Iris. Colic of infants with flatulency and constipation, where Chamom., 
Coloc. and Nitx vom. had failed. 

Kali carb. Colic, as if the intestinal canal were full of water. 

Lycop. Bloatedness in consequence of incarcerated flatulence and con- 
stipation, with urging to stool; a feeling as if the abdomen must burst; 
belching without relief; passing flatus downwards relieves; renal colic, 
where the pain is felt along the ureters into the bladder, especially in the 
right side. 



SPECIAL HINTS TO COUCA, BNTKRAEGIA. 505 

Magn, phosph. Intermittent pain, relieved by bending double, by 
rubbing, and by external warmth and eructations. 

Mercur. Colic occasioned by the cool evening air, with diarrhoea, 
chilliness and shuddering. 

A T ux vom. Flatulent distention of the abdomen, with pressure upwards 
into the chest, and downwards upon the rectum and bladder; would like to 
belch, but cannot; constant urging to stool without effect, and frequent de- 
sire to make water; wind colic, haemorrhodial, renal and lead colic; "yellow 
color of face and more around the mouth; pinched nose; offensive breath; 
tongue broad and soft, with a dirty white coat of a creamy consistence, and 
a very vivid scarlet redness around the edge of the tip. Thin, yellow, very 
badly-smelling stools." (J. C. Kilgour. ) 

Opium. When flatulence accumulates in the upper portions of the 
bowels, causing a distention of the abdomen, especially in the umbilical re- 
gion, with antiperistaltic motion, belching and vomiting; the bowels seem 
perfectly closed, but there is a constant urging to stool and to urinate; the 
pain is cutting, pressive and twisting; painter's colic. 

Oxal. ac. From eating sugar. 

Piper meth. Agonizing pain, with tossing, twisting and writhing; pa- 
tient driven irresistibly to change position, without relief; better for a while 
when his attention is absorbed by something else. (Hiller.) 

Platina. Painter's colic; pain in umbilical region, extending through 
into the back; the patient screams and tries to relieve the pain by turning in 
all possible positions. 

Plumbum. Frightful pain, particularly around the umbilicus; the um- 
bilicus drawn in towards the spine; obstinate constipation. 

Podoph. Cramps in the bowels, with retraction of the abdominal mus- 
cles, or crampy drawing of the muscles into lumps and knots; lead colic. 

Pulsat. Colic worse in the evening and at night; pale face; white 
tongue; no thirst; wants to uncover; grayish diarrhoea; tearful disposition. 
From eating fat and greasy food. 

Rheum. In infants with sour diarrhoea; the child smells sour all over. 

Rhus tox. Worse at night, and when being quiet; better from moving 
about, or lying on the stomach. 

Sabad. Sensation as if a ball of thread were moving and turning 
rapidly through it. tc Oh, my bowels! it runs like a wheel! " 

Sepia. Boring, burning pain, with great distention and sensitiveness of 
the abdomen; anxiety; typically recurring towards evening; scrofulous per- 
sons. 

Stannum. Stitches from both sides through the abdomen and through 
the hips; worse from slightest motion or touch, and when lying on right side; 
vomiting of water when smelling any kind of cooking. 

Sulphur. Spasmodically contractive colic, extending into the chest, the 
groin, and the genital organs; from piles; from flatulence; from eating 
sweet things; relieved by sitting bent; psoric individuals. 



;o6 



DIGEST TO COLIC A, ENTERALGIA. 



Tart. emet. Violent colic, as if the bowels would be cut to pieces; 
violent cutting and labor-like tearing from above downwards; across the 
groin through the thighs down to the knees; nausea; accumulation of water 
in the mouth; shifting of flatulence, with rumbling in the bowels and diar- 
rhoea. 

Thuja. Hemorrhoidal colic, with very acute and violent pain in the 
lower bowels; much flatus, w T ith or without stool; feces hard or fluid and 
scant}*; when fluid there is a sensation in the rectum as if boiling lead were 
passing through. 

Veratr. Abdomen swollen and very sensitive; violent pinching pains; 
no discharge of flatus either up or downwards; the intestinal canal seems 
closed; nausea; inability to swallow*; cold perspiration; anxiety; restless- 
ness; after eating fruit or vegetables. 

Zincum. Flatulent colic, worse from wine, towards evening, and when 
at rest; loud rolling and rumbling; retraction of the abdomen; hot, moist 
flatus passing off without relief; lead colic. 

Digest to Colic a, Exteralgia. 



Whole abdomen. Aeon., Arsen., Asa/., 
Bryon., Calc. carb. , Carb. veg. , Ckamom., 
China, Colchic, Cuprum, Dulcam., 
Hyosc, Lycop., Nux vom., Podoph, 
Sepia, Tart. emet. 

Umbilical region. Bellad., Coccul., Co- 
loc., Cuprum, Diosc., Opium, Platina, 
Plumbum. 

Below navel, as though a portion of in- 
testines were clawed together: Bellad. 

Epigastric region. Caustic, Coccul., 
Diosc. 

Below left ribs. Aurum. 

Sides of abdomen. Aurum, Carb. veg., 
Coloc, Stannum. 

Inguinal region. Alum. , Bellad. , Coloc , 
Sulphur, Tart. emet. 

Iliac region, left: Coloc, Diosc. 

, right: Coccul. 



— , downwards across the groin, into 
thighs to knees: Tart. emet. 

— into groins like hernia: Alum. 

— left iliac region to left kidney: Diosc. 



From navel to back. Cuprum, Platina. 

sides to navel : Coloc. 

, through abdomen and hips: Stan- 
num. 

stomach to back, chest and down 

into abdomen: Caustic. 

a small spot which seems to be 

drawn upwards and backwards to spine : 
Diosc. 

up into chest and sides: Ignat. 

abdomen up into chest, down in 

groins and genital organs: Sulphur. 

, dragging downwards: Bellad. 



Pain agonizing, with tossing, twisting and 
writhing: Piper meth. 

, cutting: Bryon. 

, , screaming as if beside him- 
self: Aeon. 

, , pressing and twisting: Opium. 

, , as if a knife were thrust 

through into the back: Cuprum. 

, , vomiting, belching, hiccough- 
ing and screaming: Hysoc. 

, and rumbling in bowels: China. 

, , and labor-like from above 

downwards to knees: Tart. emet. 

, stitches, from both sides to abdo- 
men and through hips: Stannum. 

, , up into chest and sides: Ignat. 

griping, remitting: Diosc. 

, , with nausea and coldness in 

back: Dulcam. 

, pinching: Ver. alb. 

, squeezing and pressing in left side: 

Carb. veg. 

, colic, as though bowels would burst: 

Carb. veg., Chamom., Hyosc, Lycop. 

, , would be cut to pieces: Tart. 

emet. 

, , were full of water: Kali carb. 

, crampy, chronic: Caustic. 



DIGEST TO COLICA, ENTERAEGIA. 



507 



— , , in 

gion: Co/oc, 



left iliac and inguinal re- 



, , as if clawed together with 

nails: Bel lad. 

, spasmodically contractive, extend- 
ing np and downwards: Sulphur. 

, spasms: Calc. card. 

, spasms in spells in abdomen and in 

upper and lower limbs: Cuprum. 

, boring, burning with distention and 

sensitiveness of abdomen: Sepia. 

Feeling" of coldness in abdomen: Calc. 
card. 

looseness of intestines, dragging 

downwards: Bellad. 

, as if parts were rolled up into a ball: 

Chamom. 

, as if a ball of thread were turning 

through bowels: Sabad. 

, as if abdomen were hollow, with 

rolling in bowels and blueness around 
eyes: Chamom. 

Pain comes suddenly and disappears sud- 
denly: Bellad. 

Umbilicus drawn in towards spine: 
Plumbum. 

Abdominal muscles retarded: Podoph., 
Zincum. 

Transverse colon protrudes like a pad : 
Bellad. 

Abdominal muscles are drawn into 
lumps and knots: Podoph. 

Protrusion in inguinal region, which dis- 
appears under pressure: Bellad. 

Distention of abdomen: Colchic, 
Opium. 

, like a drum: Chamom. 

with pressing and stitching under 

left ribs: Aurum, China. 

, with feeling as though something 

were rising into throat: Asaf. 

, with pressure upwards into chest 

and downwards upon rectum and blad- 
der: Nux vom. 

, with urging to stool: Lycop. 

, with passing of flatus without re- 
lief: Coccul. 

, with rumbling and diarrhoea: Tart. 

emet. 

, with sensitiveness of abdomen: 

Sepia, Veratr. 

Enlargement and hardness of abdomen : 
Calc. carb. 

Feeling" as if abdomen were hollow with 



eyes: 



Sulphur, 



, Arsen. 
Podoph. 



rumbling and blueness around 

Chamom. 
Wind colic: Chamom., Coccul., Nux 

vom., Sulphur, Zincum. 
, of an intermitting type: Chin. 

sulf. 
Hemorrhoidal: Nux vom. 

Thuja. 
Renal: Lycop., Nux vom. 
Gall-stone colic: China. 
Menstrual: Aeon. 
Lead, or painter's colic: Alum. 

Nux vom., Opium, Platina, 

Zincum. 
Copper colic: Bealld. 

ACCOMPANYING SYMPTOMS. 

Fainting: Asaf. 

Screaming: Aeon., Hyosc. 

, throwing himself upon floor: 

prum. 

, tossing about: Ipec. 

, in all possible positions: Piper 

meth., Platina. 
Loud crying and grating of teeth: 

Coffea. 
Tearful disposition: Pulsat. 
Anxiety: Coccul., Chamom., Sepia, Ver. 

alb. 
Hypochondriac mood: Carb. veg. 

Despair of life, anguish, lamentations, 

tossing about: Arsen. 
Anguish, nervousness: Coffea. 
Irritable mood: Chamom. 
Restlessness: Arsen., Chamom., Coccul., 

Veratr. 
Head, congestion of: Bellad. 
, sweat on: Calc. carb. 



Cu- 



Headache: Carb. veg. 
Blueness around eyes: Chamom. 
Pale face: Pulsat. 

, yellow: Coccul., Nux vom. 

Nose pinched: Nux vom. 



Tongue white: Nux vom., Pulsat. 

on both sides: Caustic. 

, dry: Bryon. 

, broad and soft: Nux vom. 

Offensive breath: Nux vom. 
Accumulation of water in mouth: Tart. 

emet. 
Thirst great: Bryon. 
No Thirst: Bryon., Pulsat. 



;o8 



DIGEST TO COLICA, EXTERALGIA. 



Inability to swallow: Veratr. 
Belching: Card. veg., Caustic, Lycop. 

and vomiting: Opium. 

, cannot: Nux vom. 

Singultus and stercoraceous vomiting : 

Cup) n m. 
Nausea Coccut., Dulcam., Tart, emet., 

I 'cratr. 

and vomiting: Coccut. 

Vomiting and diarrhoea: Arsen., 

Chamom. 
of water when smelling any kind of 

cooking: St an num. 
Stomach feels icv cold: Colchic. 



Gall-stones: China. 

Rolling and rumbling in abdomen: Caus- 
tic, Zincum. 

Flatus, with or without stool: Thuja. 

, passes continually without relief: 

Chamom., Coccut., Zincum. 

, discharges neither ~up nor down- 
wards: Veratr. 

Flatulence: Iris. 

Ineffectual urging to stool and to uri- 
nate: Diosc, Nux vom., Opium. 

Constipation: Bryon., Caustic, Iris., 
Plumbum. 

Feces hard: Bryon., Thuja. 

fluid and scanty, with feeling as if 

melting lead were passing: Thuja. 

thin, purulent: Bellad. 

yellow, badly smelling: Nux vom. 

Diarrhoea: Dulcam., Ipec, Mercur. 

, clay-like: Catc. card. 

, grayish: Pulsat. 

Feces smelling sour, or fetid: Calc card. 



Oppression of chest: Alum., Carb. veg. 
Suffocative fits: Coffea. 



Coldness in back: Dulcam. 

of thighs: Calc. carb. 

of limbs: Coffea. 

Chilliness over back: Carb. veg. 

and shuddering: Mercur. 

Perspiration hot and sticky: Chamom. 

cold: Coccut., Veratr. 

Wants to uncover: Pulsat. 
Child smells sour all over: Rheum. 
Convulsions: Coffea. 

CAUSED BY: 

Indignation, chagrin: Chamom., Coloc 



Cold, taking: Aeon., Bryon. 

Cool evening air: Mercur. 

Sudden change of weather from warm to 

cold: Dulcam. 
Use of ice water or ice cream: Arsen. 

sweet things: Sulphur. 

sugar: Oxal. ac 

acid or unripe fruit, beer: China, 

Ipec. 

fruit or vegetables: Veratr. 

flatulent food: Colchic. 

— — fat and greasy food: Pulsat. 

bad sausages, cheese: Arsen. 

Riding in carriage: Carb. veg. 
Exhausting illness, loss of fluids and 

profuse perspiration: China. 
Severe and large burns: Arsen. 
Sensitiveness, hystery: Ignat. 
Hystery and hypochondriasis: Asa/. 
Excess in venere in women: Coloc. 
Scrofula: Sepia. 
Psora: Sulphur. 
Children: Ipec, Rheum. 
, teething: Calc. carb. 

WORSE. 

Eating, ever so little, or simplest food: 

Aurum., Carb. veg. 
Eating: Colchic 

and drinking: Arsen. 

Drinking cold water: Bryon. 
wine: Zincum. 



Towards evening, typically recurring: 
Sepia. 

evening: Zincum. 

Evening and night: Calc carb., Pulsat. 
Night: Arsen., China, Ignat, Rhus tox. 
Midnight: Coccut. 



At rest, or being quiet: Rhus tox., Zin- 
cum. 

While sitting, standing or walking: 
Bellad. 

Motion: Bryon. 

Slightest motion, touch, or lying on 
right side: Stan num. 

After (not during) external pressure: 
Coloc 

BETTER. 

External pressure: Asa/'., Bellad. 
Coloc 



TUBERCULOSIS IKTESTINALIS. 



509 



Bending double: Bell ad., Magn. 

ph osph . , Su Iph u i : 
Crouching" together with hands clasping 

the knees: Diosc. 
Lying on belly: Coloc, Rhus lox. 
Rubbing: Magn. phosph. 
Moving about: Rhus lox. 



Eructations: Coccul , Magn. phosph, 



Passing flatus downwards: Lycop. 

and hard stool: Carb. veg. 

External warmth: Arsen., Magn. 
phosph. 

Drinking coffee: Coloc 

When attention is absorbed by some- 
thing else: Piper meth. 

Iris helped where Chanwm., Coloc. and 
Nux voni. had failed. 



Tuberculosis Intestinalis, Consumption of the Bowels. 

Tubercles form not only in the lungs; they are as well deposited in the 
mucous and submucous membrane of the ilium, especially in Peyer's patches 
and the solitary glands, in the colon, the caecum, rarely, however, in the 
jejunum and duodenum. The tuberculous material, wherever deposited, 
consists either of yellowish, cheesy masses, or of grayish, half-transparent, 
so-called miliary granules, which, by a gradual dissolving process, produce 
tuberculous ulcers. 

Intestinal tuberculosis is rarely a primary disease, but generally part 
and portion of — 

1. Pulmonary consumption, to which it adds the finishing blow. In 
some cases, however, intestinal tuberculosis seems to so predominate over the 
pulmonary complaint that the latter is overshadowed by the abdominal 
trouble. 

2. In other cases intestinal tuberculosis attends acute miliary tubercu- 
losis, a form of blood-poisoning, which, under the symptoms of typhus, 
deposits a great number of fine granules in different organs and tissues. It 
cannot be distinguished from typhus by its symptoms. 

deposition inflames the pia mater. 

Lastly, intestinal tuberculosis may be part and portion of the tubercular 
formations in the peritoneum, the mesenteric glands, and the retro-peritoneal 
glands, all of which are difficult to define. 

The Symptoms are not very prominent or characteristic, only when the 
tubercles commence to soften in the. last stage, an obstinate diarrhoea is one 
of the most prominent symptoms. With it are associated great loss of 
strength, night-sweats, and partial oedema; the patients finally die with the 
signs of marasmus. 

Obstinate diarrhoea, in conjunction with pulmonary tuberculosis, sug- 
gests the following remedies: Arg. nitr., Arsen., Bryon., Bar. carb., Calc. 
carb., Calc. phosph., Carb. veg., China, Ferruni, Hepar, Mercnr., Nitr. ac, 
Phosphor., Phosph. ac, (Plumbum), Pulsat., Sulphur. Compare Con- 
sumption. 

Cancer of the Intestines, 

Appears either in the form of scirrhus, or fibrous cancer, or as medullary 
cancer (which is of a softer, marrow-like growth), or as alveolar cancer 
(which is of a jelly-like nature, but of rare occurrence). [Compare Cancer of 



5IO POLYPUS OF RECTUM. 

the Stomach.] It originates primarily in the submucous and mucous coats of 
the intestines, or reaches over secondarily from a cancer of the stomach, or 
of the peritoneum, the liver, ovaries, uterus, or other neighboring organs. 

Primary cancer is found most frequently in the rectum, also often in 
the flexura sigmoidea, very rarely in the remaining parts of the intestinal 
tube. As it grows, it causes a swelling or tumor from the size of an egg to 
that of a fist; and by its growth gives rise to intestinal obstruction. Never- 
theless its diagnosis may, in certain cases, be one of great difficulty. It may 
be suggested by partial intestinal obstruction; rarely by total obstruction; 
also by the general symptoms of cancer, cachexia. Or in younger indi- 
viduals it may cause intestinal obstruction alone, without these general 
symptoms of cancer-cachexia. Or it may produce merely the general cancer- 
cachexia without any sign of intestinal obstruction; but in place of it diar- 
rhoea, colicky pain, flatulency, etc., the dejections containing blood, a gan- 
grenous, stinking fluid, and pus. 

The main points of diagnostic importance are these: The presence of an 
uneven, potato-like tumor; the slow but steady development of intestinal 
obstruction; the peculiar dry and ash-colored skin; the fast wasting away in 
strength and flesh; and the age of the patient, as cancer very rarely appears 
before the age of forty. 

Cancer of the rectum is the most frequent in occurrence. In the begin- 
ning of its development, when it causes a pressure upon, and a consecutive 
swelling of the haemorrhoidal veins, with occasional bloody discharges, and 
pain from the os sacrum down into the thighs, it is most easily confounded 
with haemorrhoids. Later, however, the obstruction of the rectum becomes 
more apparent by the form of the discharged feces, which appear pressed, 
flattened, angular, or pass off in small, hard nuts, like sheep-dung. Manual 
examination reveals now a knotted tumor, which encircles the gut like a 
ring. In its still further advanced stage this tumor suppurates, and the 
bursting of blood-vessels may occasion profuse haemorrhages. We some- 
times observe in combination with it indurated inguinal glands; and I have 
seen a case where hard scirrhous infiltrations existed disseminated through 
the glutaeus muscles. # 

Its Prognosis is, like that of all cancers, very discouraging. Death 
occurs either in consequence of ileus, or peritonitis after perforation of the 
gut, or exhaustion. 

By means of the following remedies we ma}' succeed in alleviating much 
suffering: 

Apis, Arsen., Bellad., Cannab., Card, an., Card, veg., Clemat., Graphit., 
Hepar, Hydrast., Kreos., Laches., Phosphor., Phosph. ac, Rhus tox., Sepia, 
Silic., Sulphur, Thuja. 

Polypus of Rectum. 

The follicular or soft polypus occurs generally in childhood, very rarely 
in the adult, is attached to the mucous membrane by a narrow peduncle 



FISSURA ANI. 511 

and usually protrudes in children after a stool, resembling a small straw- 
hern' ; it causes no pain but may produce bleeding sufficient to weaken the 
patient. 

The fibrous or hard polypus is pear-shaped, with a peduncle more or less 
long and thick, protrudes if low down or attached to a long peduncle, causes 
some slimy discharge, but rarely bleeds, produces frequently the sensation of 
unrelief after stool, and its peduncle may be strangulated by the sphincter, 
which causes great pain. 

Therapeutic Hints. 

Calc. carb. and Phosph. are the main remedies. Ligature is the best 
surgical means. 

Fissura Ani. 

An anal fissure consists of an abrasion or ulcer usually at the posterior 
part of the lower circumference of the rectum, although it may occur in any 
other part of this portion of the anal mucous membrane, which here forms 
folds or pouches. When looked at without distending the rectum, the lateral 
edges onl} T being presented to view, the ulcer appears like a fissure, but is in 
reality an abrasion or a superficial ulcer. On defacation its surface is irri- 
tated, exciting spasm of the sphincter muscle, and causing sharp, cutting, 
burning and straining pains which last at times for two or three hours after 
stool. This trouble occurs usually in middle life and is more frequent in 
women than in men. 

Therapeutic Hints. 

Aloes. When complicated with piles. 

Alum, P. S. Ulceration of rectum, even fistula. 

Arum triph. With retention of urine. 

Coloc. Burning, sticking and excoriated pain in the anus, with dis- 
charge of moisture from the rectum; frequent pressure at the anal sphincter, 
which ceases on the escape of some mucus. 

Graphit. Severe cutting pain during evacuation, followed by constric- 
tion and aching contraction for several hours, especially severe at night. 

Ignat. Haemorrhoids; moderate effort at stool causes prolapsus recti; 
after stool stitching pain upward into the rectum; recurring pains in the 
anus of soreness and constriction. 

Nitr. ac. Very painful, especially after loose stool. 

Nux vom. With constipation and great sensitiveness of rectum. 

Pcson. off. Burning and biting several hours after stool, preventing 
sleep; must walk the floor nearly all night; exudation of offensive moisture. 

Platina. With crawling and itching in anus every evening, frequent 
urging with scanty stool, painful sensation of weakness. 

Ratan. Burning in ano before and several hours after stool with pro- 
trusion of varices; burning in urethra during urination. 



512 FISTULA RECTI. 

Rhus fox. With periodical profuse bleeding from anus. 
Silic. Great pain half an hour after stool, lasting several hours. 
Besides compare: Amm. card., Caustic, Gratiola, Mezcr., A T atr. mur. 9 
Phosphor., Plumbum, Sabad., Sepia, Thuja. 

Fistula Recti 

Is produced by the forming of an abscess in the loose areolar tissue around 
the lower part of the rectum. After bursting outside near the anus its walls 
contract and become fistulous, forming a blind external fistula. If the sup- 
purating process has at the same time opened a way through the rectal 
parietes into the bowel, it is a complete fistula. Blind internal fistulae, in 
which an opening leads into the bowel without an external orifice, are rarely 
met with, though it ma)' happen that the original ulcerated opening in the 
rectum is so large as to allow the matter from the abscess in the areolar tissue 
to escape readily into the bowel without the necessity of burrowing its way 
through to the outside. Sometimes the sinuses are tortuous or pass in differ- 
ent directions and there may be more than one internal opening. At other 
times there is an external orifice on each side of the anus which leads to the 
back of the rectum and communicates with the gut at this part by a single 
orifice, so as to form a sort of horse-shoe fistula. In phthisical subjects a 
fistula ma}' originate in consequence of tubercular ulceration and perforation 
of the bowel. 

The forming of a fistula is always attended with pain, heat, redness and 
swelling before it breaks externally. Later, after the subsidence of inflam- 
mation and tenderness, it remains a constant annoyance by its discharging, 
more or less copiously, a thin purulent fluid when coming from a blind 
external fistula, or a brownish fluid from an admixture of feculent matter, 
when it issues from a complete fistula. At times the discharge becomes so 
thin and scant}' that it appears as if the sinus were healing, when a fresh 
irritation again disappoints the sufferer. 

Therapeutic Hints. 

The old school knows nothing but the knife, and the modern view that 
all such affections are but of a local nature, does not make them hesitate in 
using it, notwithstanding the fact that a large percentage of those operated 
on in a short time after succumb to tuberculosis of the lungs. 

Man}' anal fistulas have been cured by the sole use of internal remedies, 
and others have been so decidedly relieved, that so doubtful a relief as 
operation could afford, was never afterwards craved for. The remedies here 
needed are: 

Alum. P. S. Ulceration of the rectum, with painful excrescences and 
fetid, ichorous discharges. 

Arscn. Despondent; chilly up and down the back; relief from heat; 
large purple swelling on right gluteal muscle. 



PROLAPSUS RECTI. 513 

Berber. Great soreness and pain throughout the entire back, from the 
sacrum to the shoulders, worse from exertion. 

Calc. sulph. (Schiissler.) 

Hydrast. With constipation, piles and ulceration. 

Silic. Aching, beating, throbbing in lumbo-sacral region; occasional 
swelling in perineum discharging blood and pus; constipation, stool slips 
back after much effort. 

Thuja. Blind external fistula with cauliflower excrescences at the verge 
of the anus; offensive perspiration around the parts affected. 

Besides, compare: Calend., Caustic., /gnat., Nux vom., Petrol., Sepia, 
St aphis., Sulphur. 

Prolapsus Recti. 

The protrusion of the hypertrophied mucous membrane, often observed 
in haemorrhoids, is not a true prolapsus. This, on the contrary, consists of a 
real falling down and out of all the coats of the rectum, is in fact an ever- 
sion of the gut, similar to intussusception, with this difference: that the 
falling portion of the intestine becomes uncovered and projects externally, 
while in intussusception it becomes invaginated into that portion of the 
intestine which is just below it. The extent of the protrusion varies greatly, 
from an inch to six inches, or even more. When not constricted by the 
sphincter it has the usual florid appearance; when strangulated it appears 
livid, purple and tumid from congestion. After long exposure the mucous 
membrane becomes thickened and granular and sometimes ulcerated. 

Prolapsus recti is most frequently observed in children in consequence 
of protracted diarrhoea; less often is it found in adults, and then oftener in 
women than in men, in consequence of a weakened state of the sphincter, 
after child-bearing, etc. The protrusion takes place usually during stool, 
sometimes after any movement, even when standing. The gut may remain 
constantly protruded, being fixed so as not to admit of replacement. In 
some cases the protruded portion has even sloughed off. 

Therapeutic Hints. 

Bel lad. The protruded bowel looks bright red; during dentition. 

Ferrum. (R. T. Cooper.) 

Ignat. Has helped most frequently. 

Indigo. (Schiissler.) 

Mercur. When there is great straining. 

Mur. ae. When urinating. 

Nux vom. Frequently in children. 

Podoph. With morning diarrhoea. 

Ruta. Frequent, lumpy, slimy stools, at times bloody; feces often 
escape while bending over; much flatus; prolapsus always at stool, sometimes 
without stool. (Mera. ) When stooping or squatting down. 
33 



514 INTESTINAL WORMS. 

Sulphur. Worse on standing; morning diarrhoea; after easy stool; 
weak, scrofulous children. 

Besides: Apis, Arsen., Calc. card., Carb. veg., Ha??iam., Lycop., Mezer. y 
Phosphor., Sepia, Silic, Thuja. 

Proctalgia, 

Or neuralgic pain in the rectum, here oftentimes as violent as in other places, 
is relieved by Kali carb. , when the pain is stitching and pressing. Phos- 
phor. , in violent spasmodic pains, driving the patient about. 

Intestinal Worms, Entozoa, Helminthes. 

Of the twent}~-one intestinal parasites, three are infusoria, nine belong 
to the tape-worm class, two to the leech tribe and seven to the round worms. 
Of these only the following deserve a closer mention in this place: 

1. Oxyuris vermicularis, the thread, seat, or pin- worm, is found in the 
intestine, from the jejunum down to the anus; the young animals in their 
various stages of development, and the mature males chiefly inhabit the 
small intestine; the pregnant females seem to prefer chiefly the caecum as 
their habitat, until their uteri are filled to bursting with eggs, when they 
gradually descend the large intestine and deposit the chief part of their eggs 
in the rectum, and occasionally even leave the latter and creep about on the 
moist skin around the anus. All eggs, males and females, are finally ex- 
pelled mechanically with the feces. New crops of oxyurides can originate 
only if ripe eggs are being introduced again into the stomach where, by the 
action of the gastic juice and the heat of the stomach, they are hatched in a 
short time, and the young, very small, fine delicate worms betake themselves 
at once to the upper portion of the small intestine, increasing rapidly in size 
to their full maturity. 

The ripe eggs may be brought to the mouth of infants even during birth 
and later, b} 7 the dirty hands of the mother or nurse, or in larger children 
and grown persons hy their own hands, as a kind of self-infection; they may 
be imparted by bakers, fruit dealers, cooks, waiters, etc. This is the view 
taken by Leuckhaj't, Zenker and others, resting on numerous experiments, 
while Vix conceives " that all the transformations from the embryo to the 
adult form take place within the intestine of the infested persons without any 
necessary migration," a view which is not in accord with the general law of 
development in parasitic animals, nor does it explain all the known facts. 

Symptoms appear not until the ox3 7 urides come down to the rectum, 
where they, by their active boring movements, cause an intolerable tickling 
and painful itching just within the sphincter and within the folds of the anus, 
which sometimes, especially at night, becomes almost unbearable. In the 
female it is particulatly distressing, from the habit which the worm has of 
wandering into the vagina; it may produce inordinate sexual excitement in 



INTESTINAL WORMS. 515 

both sexes by sympathetic irritation, and cause erections, pruritis, even 
nymphomania with consequent masturbation. 

Cleanliness of the most scrupulous kind, and injections of cold water 
are generally sufficient for the removal of these parasites, which have not a 
very long life. The nightly restlessness and intolerable itching which they 
produce as long as they exist, is mostly always relieved by Aeon. 

2. The Ascaris lumbricoides, round worm, is of a cylindrical form, 
tapering at both extremities. The female reaches, according to I^euckart, 
15 inches in length by \ inch to \ inch in breadth, and the male 10 inches 
b}~ \ inch. It is of a light brownish or dirty reddish-yellow color. Its head 
consists of three semi-circular lips, the bases of which are separated from the 
remainder of the body by a well-marked circular furrow. The mouth con- 
sists of the triangular opening formed by the three lips. The tail of the 
male is always bent towards the abdomen like a hook, on which is seen the 
cloacal aperture with two spiculae, which frequently project. The female 
sexual organs open in a vulva externally at the termination of the anterior 
third of the body. The ova have a conical form when unripe and are oval 
when ripe, and have a dark, tough, double shell, and very dark granular 
contents; they measure 3^0 inch by -^-$ inch, and their number has been 
calculated by Kschricht and I^euckart at about sixty millions in a single 
female, of which over 160,000 are daily discharged into the intestines of its 
bearer. If now a person is the possessor of several of these worms, it can 
easily be seen that his evacuations must become so thoroughly charged with 
these eggs, that their discovery by the microscope cannot be of any difficulty. 
But their further development is not yet fully understood. It may be that 
the ova hatch in the stomach after being conveyed there directly; it may be 
that an intermediate host be necessary for their development. However this 
may be, the development of the worm, once introduced, must be very rapid, 
for it is quite seldom that very young animals are found in the intestine. 

The round worm normally inhabits the small intestine, but has a marked 
tendency to wander and creep into small apertures, so that it is led sometimes 
through fistulous channels to quite remote cavities or organs; it has been 
found in the pleural sac, the gall-bladder, the biliary ducts, the spleen, the 
kidney, the bladder, the muscles of the loin or neck, the spinal cord, the 
lung, the glottis, the trachea and the Eustachian tube. In the Surgical 
Museum, at Washington, I have seen the preparation of a larnyx, into which 
a round worm had entered and caused death by suffocation. 

Symptoms. — When this worm is present in moderate numbers, and oc- 
cupies its normal habitation in otherwise healthy persons, there is often no 
disturbance discoverable; but when present in greater numbers or infecting 
a delicate person it may give rise to abdominal griping, increased secretion of 
mucus, diarrhoea, vomiting, irregular appetite ; or, they cause reflex or sym- 
pathetic symptoms, as, itching of the nose, anus, genitals ; enlargement of the 
pupils, squinting, increased flow of saliva, restless sleep, with frequent start- 
ing and grating of teeth. 



516 TAPE -WORMS. 

Symptoms like the following: Cachectic countenance; blue rings around 
the eyes; enlarged abdomen, fever, irritation of the brain, fits, convulsions, 
etc., which have been ascribed to worms, are rather doubtful. In such cases 
a careful examination will, no doubt, lead to other exciting causes. 

Therapeutic Hixts. 

Symptoms of irritation are easily subdued if we choose homoeopathically 
between Bellad., China, Spigel., Sulphur, and other remedies. Cina or its 
alkaloid will often exterminate round worms; Teucrium is recommended for 
thread worms. 

Tape-Worms. 

1 1 The tape-worm must be looked upon as a colony of animals having an 
alternation of generation. The so-called head is the larva-like nurse; the 
segments of the worm — the proglottides — are the animals with sexual organs. 
From the head (scolex), without any mingling of the sexes, are produced the 
segments by a process of budding. The segments remain joined together for 
a considerable time, but, after they have come to maturity, they separate 
from the rest of the colony. The head is provided with either two or four 
suckers, and very frequently with a circlet of numerous small hooks. By 
means of this apparatus it fastens itself to the mucus membrane of the in- 
testine of its host. As the segments of the chain, the sexual animals, increase 
the distance from the head, by the development and insertion of fresh seg- 
ments, the}* become sexually more developed, increasing at the same time in 
size. They are hermaphroditic, and generate eggs, in which a six-hooked 
embryo becomes developed. If eggs containing these embryos find entry into 
the stomach of a suitable animal, their envelopes become softened or undone, 
and the embryos are set free. By some way or other they leave the digestive 
canal and make their way to different parts of the body. If the}- now meet 
with conditions favorable to their further growth, ' ' nurses ' ' are developed in 
them. Should these again happen to be introduced into the intestinal tract 
of another animal, they fasten themselves on, and another tape- worm colony 
becomes developed by budding. The time required for the development of 
the tape- worm colony, viz., till the sexual organs are fully developed and 
segments are given off, is from eight to twelve weeks. The tape- worm in- 
habits the small intestine, where, folded into many coils, it lies surrounded 
with chyme; it can move but little from its original position. Its muscular 
system seems, in the total absence of anything like an alimentary canal, to 
serve chiefly as a means of imbibing nourishment, the alternate contraction 
and relaxation of several groups of muscles having an effect similar to 
that produced by a force-pump." (Heller.) This is charactersistic of all 
kinds of tape-worms, of which we have separately to consider: 

1. Taenia solium, or the Armed tape-worm, which attains a length 



TAPE- WORMS. 



517 



of from 7 to 10 feet, seldom much more. Its head is about the size of a 
small pin's head, somewhat quadrilateral, owing to the four prominent suck- 
ing discs. On the top front is a moderately prominent rostellum, on which 
is placed a coronet of small hooks arranged in two circles, an outer and an 




(After Kuchenraeister.) 
a. Taenia Solium, b. Natural size. 
c. Taenia Mediocanellata, or Saginata. 

inner one. Its slender neck is nearly an inch in length, but exhibits to the 
naked eye no segmentation, it only gradually passes into distinctly visible 
segments, which at first are so much shorter than broad, that one-half of the 
whole are found in the anterior ninth part of the entire worm. From this 
point the segments gradually increase in length more than in breadth, so that 
finally mature segments, Proglottides or Cucurbitina measure about one- 
half inch in length and one-quarter inch in breadth. From this point also 
the sexual organs are distinctly visible, and in about another ninth lower 
down, the impregnated eggs enter the uterus. The taenia solium being her- 
maphroditic, both male and female sexual organs are present in the same 
joint, and open by a common aperture on the margin and a little behind the 
middle of each segment, alternating irregularly from one side to the other. 
The uterus forms a straight line passing down the centre of the segment, 
from which seven to twelve branches are given off on each side. Running 
along the whole length of each side of the worm is a vessel, with transverse 
communicating branches, which contains a liquid. 

The eggs are roundish, and measure when free about yi-g- inch. The 
ripe egg encloses the embryo, a delicate mass of protoplasm, armed with 
three pairs of fine, glistening hooks. After the ripe segments with their 
eggs have separated and been discharged with the feces — it has been calcu- 
lated that one moderate sized tape- worm contains about five millions of ripe 
ova — the free joints move about for a time, especially in moist and warm 
situations, and disseminate their ova widely. No doubt the vast majority of 
them perishes, but those which happen to be taken with the food into the 
stomach of a pig, or much more rarely into that of a man, are hatched 
under the action of the stomachic juices, and the freed embryo (pro-scolex), 
by a diligent use of its armature perforates the tissues of its present location, 



518 TAPE- WORMS. 

and ultimately settles, most generally, in the cellular tissue of the muscles, 
or in rare cases in the liver or brain. Here it remains and gradually 
develops into the well-known cysticercus cellulosoe of measly pork. This 
metamorphosis requires about two months and a half for its completion. In 
this condition the animal remains unchanged for a period not yet certainly 
known, but which has been estimated at from three to six years. If during 
this time one or several of the cysticerci happen to be transplanted into the 
stomach of man, which only can take place by the eating of raw or imper- 
fectly cooked measly pork, it or the}' are developed into the taenia solium, 
which takes its abode in the small intestine, and may infest the bearer for 
man}* years. 

2. Taenia saginata (Goeze), Taenia canellata (Kiichemneister), the 
unarmed or fat tape-worm, is much larger, when fully developed, and much 
stronger, thicker, fatter and less transparent than the taenia solium. Its 
head measures about -^ inch and has neither rostellum nor coronet of hooks, 
but four powerful and prominent suckers. Its larval form, the cisticercus 
taeniae saginatae, infests the flesh and organs of the ox, a fact which at once 
points out the chief difference between its life history and that of the taenia 
solium. It abounds in Abyssinia and South Africa, and is also common in 
Europe and in this country, and fully as frequent as taenia solium. 

3. Bothriocephalus latus (Bremser), the broad tape-worm, is the 
largest of all the tape- worms and commonly reaches a length of 17 to 26 
feet, and sometimes 60 feet or more. Its head is oblong, or club-shaped, 
measures y ¥ inch by 2V inch, and has on each side a fissure-like groove in 
which its suction apparatus is placed. When fresh, the worm has a dull 
bluish-gray color. Its joints are much broader than long, until towards the 
end of the chain they become square. The genital pores are situated in the 
centre of the segments, and all are on the same side. 

"The ovum, after a prolonged sojourn in water, develops a ciliated 
embryo, which escapes through the aperture in the shell, by forcing open 
the lid, and is furnished with three pairs of hooklets. On analogical 
grounds, it is very probable that it enters into the body of some aquatic 
animal, possibly a fish, but probably a mollusc, and then assumes the larval 
form, which is at present unknown. The intermediate bearer is probably 
eaten by man, and the larva assumes the adult form in his intestine. Of both- 
riocephalus latus there are usually several together; it has a somewhat limited 
geographical distribution; never having been found beyond the limits of 
Europe, in some countries of which only it is indigenous. It is common in 
the western cantons of Switzerland, Northwestern Russia, Sweden, Poland, 
Holland, Belgium and Eastern Prussia; it is less often met with in other 
parts of Germany, and has occasionally been imported into Britain. Low- 
lying damp regions near the borders of seas and lakes are those in which it 
is most often abundant. It is found in persons of all ages and sexes, even 
children at the breast are not free from it." (W. H. Ransom.) 

Symptoms. — Some individuals experience not the slightest inconveni- 



TRICOCEPHAIvUS DISPAR. 519 

ence from tape-worm. Others complain of pain in the stomach and bowels, 
especially after certain articles of food, nausea, variable appetite, slight 
diarrhoea or constipation. As reflex phenomena are mentioned: itching of 
the nose, headache, dizziness, getting dark before the eyes, noises in the ears, 
palpitation of the heart, even chorea and epilepsy. All, or at least many of 
these symptoms may as well arise from some hysterical or hypochondriacal 
affection of the patient. However, in the case of taenia solium, which in its 
embryonic state may infest the most different organs of the human body, 
it is clear that such and other serious disturbances may arise from its 
presence. 

Hahnemann says: "Two symptoms I have often observed to attend 
worms: the deeply wrinkled countenance and the sensation of a cold stream 
winding itself towards the back immediately after a meal. ' ' 

Thkrapkuttc Hints. 

If no offence is given, why should we use the cudgel ? The above- 
mentioned symptoms are often relieved by a well-selected remedy, which 
may even cause the parasite to leave. But at times persons have made up 
their minds to get rid of the "critter," no matter what it costs. As the 
safest and most expeditious of all the numerous tapeworm remedies, many 
have recommended — 

Koicsso, or the flowers of Bray era anthelmintica, 2 or 3 drachms put 
into a tumblerful of water well stirred, so that none of the flowers swim on 
the top. This done in the evening, let it stand over night. Administer a 
cup of coffee before taking it in the morning, to prevent nausea. Then one- 
half of it is taken, and the other half, half an hour later. If inclination to 
vomit should set in, it is best subdued by lemon juice. The taenia saginata 
requires a larger dose. 

Often tapeworms have been removed by the seeds of the common pump- 
kin, mashed up to a mush, or by the use of the cocoanut. The male shield- 
fern (Aspidium filix mas), or the bark of the Pomegranate root (Punica 
granatum), are other remedies frequently and often successfully applied. 

The surest prevention consists in avoiding the use of raw or not well- 
cooked pork and beef. 

Tricocephalus Dispar, 

Or the whip-worm, is from one to two inches long, thin in front, like a 
thread, while its posterior portion is thicker. Its chosen residence is the 
caecum. There are no symptoms known by which it could be diagnosticated 
during life. Its life-history, as far as known, is similar to that of the seat- 
worm. 

Anchylostomum Duodenale, Dochmius s. Strongylus Duodenalis. 

It is a small, cylindrical worm, with its anterior portion, in which the 
head is situated, curved backwards. Its mouth is provided with a bell- 
shaped capsule and at its anterior margin with four strong, claw-like hooks 



520 TRICHINA SPIRALIS. 

and two smaller ones at the opposite side. The males measure T \ inch, and 
the females T % inch in length. The tail of the male terminates in a three 
lobed bursa, in which are placed two thin spicula. The female's extremity 
is pointed, and their genital opening lies somewhat behind the centre of the 
body. The eggs are oval, and measure -^ inch by T oVo inch. They prob- 
ably under favorable circumstances hatch, and the embryo enjoys a free 
existence, for a time, in mud and muddy warer. If taken into the stomach 
it grows and passes down to the duodenum or jejunum, and attaches itself 
by its powerfully armed mouth to the villi of the mucous membrane, and 
sucks the blood of its host. It has been found only in Italy, in Egypt, in 
the countries bordering the Nile, on the Comoro Islands, in Madagascar, in 
Brazil and Cayenne. It produces dangerous haemorrhages in the bowels, 
followed by an anaemic condition, which is often fatal, and is the cause of 
the so-called Egyptian chlorosis, the true nature of which was pointed out 
by Griesinger. Griesinger recommends turpentine against them. 

Trichina Spiralis. 

Only within the last twenty years trichinas have become an object of 
pathological researches, although they had already been discovered by Hilton 
in the year 1821 as numerous white specks visible to the naked eye, in the 
muscles of the human body, but considered by him as cisticerci. Later, 
under the microscope, they proved to be calcined trichinae capsules, and 
about 1835 Paget detected in them a minute round worm, which was accu- 
rately described and named by Owen Trichina spiralis, on account of its form 
being like a hair and of a spiral shape. However, everything concerning 
the life-history of these animals remained unknown until Zenker, of Dresden, 
in the year i860, called public attention to the fact that this little parasite 
was the cause of a very painful and even fatal disease. - Since then by the 
labor of numerous investigators the following has been brought to light: 
"The trichina spiralis is met with under two forms, the intestinal-trichina 
and the muscle-trichina. The former or mature trichina is an extremely 
fine, round, thread-like, slightly coiled worm, with a still finer head, which 
gradually decreases in thickness towards its point; its hinder extremity is 
rounded off rather abruptly. " (Heller.) The males are from one-half to 
one-third smaller than the females, and are furnished at the caudal extremity 
with two pointless, lobular appendages and a genital opening. The females 
have their vulva at about the termination of the anterior fourth part of their 
whole length; their eggs after being fructified develop in the uterus to 
embryos which are born free and living. The birth of the embryos begins 
on the seventh day after the introduction of muscle-trichinae into the stomach, 
and may continue, as it appears, for weeks. Soon after birth the embryos 
commence to migrate, piercing either, as some assume, through the intestinal 
wall and wandering from thence through the loose connective tissue towards 
the muscles; or they enter, as others suppose, the blood-vessels — either 
directly or by way of the lymph current, in which they are carried to the 



TRICHINA SPIRALIS. 



521 



different muscular parts of the body. As soon as they reach the muscles 
they force themselves into the primitive fasciculi, cause disintegration of the 
same, increase in length and thickness, and finally roll up in coils of greater 
or less size and become encapsuled. After a time a deposition of lime-salts 
takes place in the capsules, by which they become opaque and visible to the 
naked eye as little white specks; previous to this calcification only experi- 
enced observers can detect them. Under certain circumstances the muscle- 
trichinae die and may decay, or they petrify, break into pieces, and their 
former nature can be recognized only by the peculiar position occupied by 
the fragments. But as a general thing the vitality of the muscle-trichinae is 
almost unlimited and ends even not with the death of their host, while the 
intestinal trichinae very rarely live longer than from five to eight weeks, 
when their propagation has been finished. 

If it happens that the muscle-trichinae, by eating the meat of its host, be 
introduced into the stomach of a man or a proper animal, they will be freed 
from their capsules, become sexually mature within about two and a half 
days, copulate, and after five days more the females will bring forth living 
embryos, which soon commence to migrate as above described. Trichines 




Trichinae. (After Heller.) 
Muscle-trichinae, magnified. 
Capsulated and calcified muscle-trichinae, sli 
Calcified and broken. 
Capsulated, magnified. 



rhtly magnified. 



are found especially in swine, but have been observed also in the cat, rat, 
mouse, marmot, polecat, fox, marten, badger, hedgehog and raccoon, and 
have successfully been bred in rabbits and guinea-pigs, but exceptionally 
successful only in sheep, calves and dogs. 



522 TRICHINOSIS. 

From this it can be seen that the infection of man is principally carried 
on by the eating of raw or not thoroughly boiled pork. 

The disease caused by the propagation of the trichina in man has been 
called 

Trichinosis, 

Which commences, as a rule, with disturbances of the digestive apparatus, 
sometimes a few hours, at other times not before several days after the in- 
fecting meal, with variable symptoms, such as: uneasiness, fullness, nausea, 
retching, vomiting, diarrhoea, or constipation. In most cases there is an un- 
pleasant and pasty taste in the mouth, and in many a loathsome, putrid odor. 
The muscular symptoms are the most important and painful. A constant 
symptom from the outset is a flabby condition of the muscles and painful 
sensation on motion, a muscular lameness. After the invasion of the muscles 
the symptoms ma}' be trifling, even absent in light, or extremely violent in 
moderate and severe cases. Commencing seldom later than on the tenth day, 
they consist of various degrees of swelling and hardness and extreme sensi- 
tiveness to pressure of the muscles in general, or, a permanent contraction of 
the flexors of the extremities, or a difficulty of chewing and swallowing in a 
degree that only fluid nourishment can be taken, or a hoarseness when the 
muscles of the larynx, and a difficulty of breathing when the diaphragm and 
the respiratory muscles are invaded. The fever in light cases is insignificant, 
in severe forms resembles that of an ordinary case of typhoid fever, or pre- 
sents in lighter cases almost an intermittent type. There is seldom a chill 
at the onset, oftener slight shivering. The pulse varies at the beginning be- 
tween So and 90, and rises later to 100 or 120 beats in a minute. The tem- 
perature ma}* rise to 105 ° F. Perspiration is usually very profuse, and 
continues throughout the whole disease. The nervous symptoms consist 
especially of sleeplessness, neuralgic attacks in the bowels, hyperaesthesia of 
the skin in the form of pruritus or formication, either extending over the 
whole body or limited to single portions of the lower extremities, and in some 
cases of loss of hearing. The circulatory symptoms consist of cedematous 
swelling of the eyelids and face, which is the most characteristic sign of 
trichinosis, setting in most frequently on the seventh day, and at times dis- 
appearing after from two to five days, and reappearing again in some cases 
after a few weeks. CEdema of the extremities is often quite marked and 
lasting. 

The incubation varies from a few hours to several weeks, and it appears 
that some persons can tolerate a considerable number of trichinae without 
experiencing any special disturbance. The muscle-trichinae must have 
attained a certain maturity in order to be capable of sustaining themselves 
in the stomach and of developing and reaching the muscles, their ultimate 
abode. If transplanted too young into the stomach, they will be either de- 
stroyed by digeston. or will have to make up their deficiency in the intestine 
and require therefore a longer time for the development of embryos. Also, 



THERAPEUTIC HINTS TO TRICHINOSIS. . 523 

if the capsulated trichinae are much calcified, it will take a longer time to 
set them free. Just such uncertainty exists as to the duration of the disease 
itself. In some very light cases the whole course of trichinosis passes over 
in two or three weeks without even confining the patient to bed; while in 
somewhat severer cases convalescence begins in the fifth or sixth week, and 
grave cases take some four months, and even then the convalescent frequently 
do not regain their full strength for a long time. A fatal termination occurs 
most frequently in the fourth, fifth or sixth week, and generally as a conse- 
quence of paralysis of the respirator}^ organs. The percentage of deaths has 
been as high as thirt3 7 in a hundred. 

The Diagnosis in single cases is very difficult in the beginning of the 
disease, easier when several persons become diseased at the same time. The 
onset resembles closely a gastro-intestinal catarrh, from which it differs, how- 
ever, by a constantly increasing perspiration. 

The oedema of the face and eyelids, appearing on the seventh day, is 
another important feature, inasmuch as other diseases in which this symptom 
occurs (morbus Brightii, diseases of the heart, lungs or pleura) can easily be 
excluded. The urine in trichinosis is always free from albumen. But the 
diagnosis becomes indisputable on the discovery of single trichinae in the 
stools, or upon the observation of muscle -trichinae in excised portions of 
muscle, or also in the proven fact that the patient has partaken of trichinous 
pork. 

Therapeutic Hints. 
\ 

The best prophylaxis is not to eat any pork, ham, sausages, etc., which 
is not well boiled or roasted. The old school has ordered laxatives, turpen- 
tine, kali picroniticum and benzine, but without any marked effect. 

Dr. Hering has recommended the Tellurite of Potassa in half grain 
doses. For in accordance with the provings of Hansen and Mohler, this 
substance caused at once such a strong, garlic-like odor of the breath, that 
the prover had to withdraw from society for several weeks. This odor is 
owing to a volatile organic compound, or perhaps telluretted hydrogen, into 
which the tellurite of potassa is converted, and may, by its pervading the 
whole system, be the means of destroying the intruders. 

There are a few cases on record which have been treated homcepathi- 
cally by Apis, Arsen., etc., but likewise without any striking effect. Al- 
though I have never treated a case of trichinosis, yet, considering the totality 
of the symptoms of trichinosis, I feel strongly inclined to recommend Z^w 
palustre. For in the first place the herb has been used successfully to 
keep insects away from clothing. Secondly, it has been given successfully 
for insect stings and wounds caused by needles, and what can the wandring 
trichinae be better compared to than millions of the finest needles piercing the 
muscles ? And lastly, Ledum has the following s3'mptoms which correspond 
to trichinosis: Bloated face; want of appetite; nausea; constipation; violent 
tension in the hypochondriac region during inspiration and retention of breath ; 



524 SPECIAL HINTS TO HELMINTHIASIS. 

oppressed painful breathing; pain and drawing in the outer parts of the chest, 
especially during inspiration, accompanied by single stitches. Painful stiff- 
ness of the muscles; sensation as if the muscles had not their proper length, 
with pain as if sprained in every position, but especially when touching the 
parts and when walking. 

Swelling, with tension and stinging hardness of the whole leg. Swelling 
of the leg extending to beyond the calves, with tensive pains; swelling of the 
feet; inflammatory or cedematous swelling of the feet and legs. Pain in the 
soles of the feet when walking, as if ecchymosed. Pressure in the soles of the 
feet, more violent during a walk. Bruised pain in the heel when walking. 
The limbs of the whole body are painful, as if bruised and contused. Chilliness. 
Languor and weariness when sitting, standing or walking; fainting. Pimples 
and boils, pustules on the forehead and other parts. CEdematous swelling, 
also of the skin of the whole body. 

Special Hints to Helminthiasis. 

Aco?i. Pain in the bowels; the umbilical region is hard and the whole 
belly bloated; urging to stool without discharge, or slime only; nausea; ac- 
cumulation of water in the mouth; or restlessness at night on account of 
intolerable itching and tingling at the anus, throwing the child into fever 
(seat-worms). 

A?-g. nitr. Periodical pain in the region of the liver and around the 
navel, with sickness at the stomach, retching, vomiting of tough mucus; 
menses irregular, but always discharge of thick, black, coagulated blood; 
gray-yellowish color of the face. 

Bellad. Drowsiness; starting in sleep, grating of teeth, involuntary 
discharge of feces and urine, or dysuria; squinting. 

Calc. cai'b. Headache, dark rings around the eyes; pale, bloated face; 
thirst; thick, bloated belly; aching about the navel; diarrhoea; easy per- 
spiration from motion; scrofulous diathesis. 

China. Pain in the belly, worse at night, after eating; fullness of the 
abdomen, pyrosis, pressure in the stomach and retching; tremulous weakness 
all over. 

Cicuta. Frequent hiccough and crying; pain in the nape of the neck; 
spasmodic drawing of the head backwards, and tremor of the hands. 

Cina. Restless sleep with rolling of the eyes, dark rings around the 
eyes; squinting; enlarged pupils; constant rubbing the nose; bleeding of 
the nose; face pale, cold or red and hot; loathing of food, or great hunger; 
nausea; vomiting; pain in the umbilical region; belly hard and distended; 
constipation; dry, hacking cough at night; feverishness ; convulsive motions 
of head and limbs. 

Euphorb. Loss of appetite, or voraciousness at times; furred tongue, 
feverishness; fetid breath; bloated stomach; constipation or diarrhoea; ema- 
ciation, peevishness, wakefulness. 



SPECIAL HINTS TO HELMINTHIASIS. 525 

Ferrum. Pale, wretched complexion, easily flushing; itching at the 
anus from seat-worms at night; involuntary micturition. 

Filix mas. Frequent pain in the bowels, a kind of gnawing and boring; 
constipation; loss of appetite; furred tongue; pale face; blue rings around 
the eyes; itching of the nose; irritable and cross. 

Ignat. Itching at the anus from seat- worms; convulsions, with loss of 
consciousness and temporary inability to speak afterwards. 

Konsso. Indigestion; loathing; sleeplessness; weakness with fainting; 
profuse and cold perspiration; emaciation; dull pain in the bowels; bloated- 
ness; constipation, tape- worm and other worms. 

Lycop. Arthritic pain and stiffness; chronic eruptions; wretched, dirty, 
pale, earthy complexion; flatulence; bloating the stomach and abdomen; 
sensation of something crawling and moving in the bowels and stomach up 
and down; constipation. 

Mercur. Continuous greediness for eating; he becomes weaker and 
weaker withal; bad smell from the mouth; itching of the anus; inflamma- 
tion of the vulva; seat and round- worms. 

Punica granatum . Vertigo, wavering before the eyes, enlarged pupils, 
yellow complexion; grating of teeth; accumulation of water in the mouth; 
changing appetite; gulping of watery fluid; vomiting; sensation of some- 
thing moving in the stomach; bloated bowels; colic; palpitation of the 
heart; spasms; syncope. 

Sabad. Vomiting of round- worms, or nausea and retching, with a sen- 
sation of a worm in the pharynx; or, in case of tape- worm, burning, boring 
and whirling in the umbilical region; accumulation of water in the mouth; 
chilliness and sensitiveness to cold; sensation as if the abdomen were sunken in. 

Spigel. Nausea every morning before breakfast, always better after 
breakfast; dilated pupils; squinting; pale face; smarting in the nose; sen- 
sation of a worm rising in the throat, better after eating; or vomiting of all 
she takes, with sour rising like vinegar from the stomach; pain in the bowels; 
dry, hard cough at night; palpitation of the heart. 

Silic. Colic in children from worms. 

Sulphur. After A co n. or Mercur. \ creeping in the nose; creeping and 
biting in the rectum; passage of lumbricoides, ascarides and taenia; nausea 
before meals and faintness before dinner; restlessness at night. 

Stannum. Hahnemann and others have mentioned it as palliating the 
symptoms caused by tape and round- worm. 

Tereb. Burning and tingling in anus and rectum, lessened by applying 
cold water; hunger after a square meal; foul breath; choking sensation; 
dry, hacking cough; spasms and convulsions; wakeful at night; screaming 
as if frightened; staring look, clenching of fingers; twitching of different 
parts of the body. 

Teucrium. Is said to be specific against the terrible itching in the anus 
from thread- worm. 

In addition the following remedies may be merety mentioned as vermi- 



526 PERITONITIS. 

fuges: Apocyn. andr., Asclcp. syr. and tuber., Chclone, Dolich. pruriens, 
Ge/sem., Gnaphal., Helon., Podoph. 

Peritonitis. 

Its pathological character is like that of pleuritis or pericarditis — injec- 
tion of the capillary vessels followed by exudation. This exudation is 
either — 

ist. Of a serous nature, and then generally profuse, distending the ab- 
domen to a considerable extent. Owing to its serosity it is easily absorbed. 
Or the exudation is — 

2d. Of a fibrous nature, coagulable lymph, at least predominantly so. 
This is apt to cause adhesions, not only between the layers of the peritoneum 
at different places (thus forming sacs wherein the remaining fluid is retained) , 
but it may create, also, strings or bands of fibrin, which fasten one portion oj 
the intestine to another, and which may give rise to strangulation of a por- 
tion of the intestines. Or the exudation is — 

3d. More or less mixed with blood globules, called hemorrhagic, mostly 
found in diseases which predispose to bleeding in different organs, as for in- 
stance scurvy, typhus, delirium tremens, exanthematic fevers, etc. Or the 
exudation consists 

4th. Of pus or ichor, when it is called purulent or ichorous. The latter 
takes place only under the most unfavorable conditions, when there is an in- 
fection of the blood, as in puerperal fevers, pyaemia, or when urine passes 
into the cavity of the abdomen. 

It is thus clear that a peritonitis is not necessarily cured simply because 
the inflammation has passed away; its product, the exudation, may yet give 
considerable trouble before it is removed. 

Peritonitis does not always involve the whole peritoneum, is not always 
general or diffused, but much oftener only partial or circumscribed, attacking 
only single portions, for instance those which cover the liver, spleen, kidneys, 
uterus or some parts of the intestines, being more or less complicated with 
inflammations of these organs. 

Its Causes are various. Primarily, it is most frequently brought on by 
external injuries; a blow, a fall, a penetrating wound, or by surgical opera- 
tions, or by exposure to cold and wet. 

Secondarily, it may be a mere continuation of an ahead}' existing in- 
flammatory process of the liver, spleen, womb, bladder, caecum, etc., or it 
may arise in consequence of ulcerative processes within the intestines and 
subsequent perforations; also childbed fever and metritis are frequent causes 
of peritonitis. 

Symptoms. — Owing to these diverse causes peritonitis, considered as a 
general form of disease, it exhibits a great variety of manifestations which 
will change in individual cases. Indeed, this is so with all forms of disease. 
I can point out only those symptoms which are most apt to occur in all 
forms. 



PERITONITIS. 527 

i. Pain is never absent and always severe; it is described as sharp and 
lancinating, and is increased by the slightest motion or touch. Therefore the 
patient lies quietly on his back with his thighs flexed, breathing only with 
the thorax, instinctively avoiding all action of the diaphragm. The slightest 
pressure increases the pain; even that of the bedclothes seems at times un- 
bearable — a distinctive sign between peritonitis and colic. 

2. Vomiting; at first, of the usual contents of the stomach, then of 
slimy and bilious, and lastly of green masses, as though verdigris had been 
taken into the stomach. It becomes stercoraceous only when peritonitis is 
associated with obstruction of the bowels. The vomiting never relieves, but 
increases the pain considerably. 

3. Singultus sets in especial^ when the serous covering of the diaphragm 
becomes involved in the inflammatory process. 

4. Constipation — owing to the paralyzed state of the intestines — is a fre- 
quent symptom; but in cases of peritonitis puerperalis, or in combination 
with catarrhal inflammation, or ulceration within the intestines, there is 
almost always diarrhoea. 

5. Great distention of the abdomen in consequence of accumulation of 
gas and fluid. This causes the diaphragm to rise into the thoracic cavity 
and to compress the lungs, producing congestion, short breathing, 40 to 60 
times a minute, and a disturbance of the circulation which may bring on 
cyanosis of the face. 

6. Constant desire to urinate; painful micturition or retention of urine; 
always where the serous covering of the bladder is involved. 

7. Fever; more or less intense according to the extension of the inflam- 
mation. The temperature may rise to 104 or 105 F., and higher, and the 
pulse from 120 to 130 in a minute. Gradually, however, as the disease pro- 
gresses, the pulse becomes small and flickering; the extremities cool and 
covered with cold sweats; the features collapse. 

8. Physical signs are not very readily elicited; as the patient can bear 
neither touch nor motion; although, of course, we may expect a dull sound 
on percussion where there is effusion, and a tympanitic sound where there is 
meteorism. Auscultation gives no signs, except rumbling in the bowels, 
which may be heard at a distance. 

That it is a dangerouse disease we may conclude, if we consider for one 
moment its nature, and again, that this danger varies according to cause, 
complication and extension of the disease. Simple idiopathic cases, with- 
out other complications, are the least dangerous. Those caused by wounds 
are more or less dangerous, according to the nature of the wound. And 
the danger of those which are the secondary result of other inflamma- 
tory processes depends upon the nature of these processes. 

It is a good sign when, in the progress of the disease, the pain gradu- 
ally abates and the pulse rallies. It is a bad sign when the pain abates and 
the pulse gets weaker and quicker. It is a sign of imminent danger when 



528 THERAPEUTIC HINTS TO PERITONITIS. 

the pain suddenly subsides and the pulse becomes flickering and the features 
collapse. 

Cases which have become chronic terminate frequently in marasmus and 
a variety of consecutive sufferings. It is possible that in such cases the 
purulent exudation perforates either some part of the intestine, or discharges 
outside through the abdominal wall. 

Therapeutic Hints. 

Aeon. Hot, dry skin; quick, hard, small pulse; high, inflammatory 
fever; mouth and tongue dry; great thirst; bitter taste; vomiting; no stool; 
urine scanty, red and hot; lower extremities cool; short, quick breathing; 
very restless; anxious expression in the face; burning, cutting, darting pain 
in the bowels, worse from slightest pressure, motion and lying on the right 
side; abdomen hot to the touch. After taking cold, drinking cold water 
when being heated. 

Apis. Burning, stinging pain in the bowels, very sore to the touch; 
when exudation has taken place; urine scanty, dark; oedematous swelling of 
the feet; burning, stinging in the region of the ovaries; metritis. 

Arnica. After contusion. 

Arsen. Later, when there is a sudden sinking of strength, cold, clammy 
perspiration, anxious, internal restlessness, insatiable thirst with drinking but 
little at a time; constant vomiting; burning in the bowels; all worse in the 
middle of the night. 

Bellad. After A con., great congestion to the head; strong^ pulsating 
carotid arteries; light and noise unbearable; colicky pains in the bowels; 
painful retching and vomiting, worse from motion and contact; great anxiety 
and d3 T spncea. Especially when in complication with metritis or perityphlitis. 

Bryon. Stitching pain or pressing, lancinating in the bowels, worse 
from slightest motion; when exudation has taken place; tongue white and 
dr}'; great thirst; bowels constipated; the patient lies perfectly still, don't 
want to move. Especially in complication with diaphragmitis. 

Calc. carb. When about the seventh day a red rash appears; also when 
the pain is alleviated by cold water applications, so that the patient wants 
them renewed constantly. Abdominal tuberculosis. 

Canthar. Abdomen burning hot; tympanitic distention in its upper 
region; lower portion yields a dull sound; bloody, slimy stools; painful, ex- 
torting cries; tenesmus of the bladder; strangury; great anguish and rest- 
lessness; distressed face; sunken features; cold extremities. Especially 
when the serous covering of the bladder is the seat of inflammation. 

Carb. vcg. Excessive tympanitis with paralysis of the bowels. 

Laches. Abdomen hot and sensitive to touch; painful stiffness from 
the loins down into the thighs; scanty, turbid urine with reddish sediment; 
strangury; constipation; necessity of lying on the back with drawn-up 
knees. Especially in complication with typhlitis. 

Lycop. In complication with diaphragmitis or hepatitis; when lying 



ASCITES. 529 

on the left side, a feeling as if a hard body were rolling from the navel to 
that side; or when after three or four days the face assumes a yellowish 
color; troublesome flatulence and constipation; sleeplessness and constant 
distress. 

Mercur. At a later period, if the exuded fluid becomes purulent, with 
frequent starts; creeping chills; perspiration without relief; pale, wretched 
complexion, foul smell from the mouth; vomiting of slime and slimy stools, 
with straining; cedematous swelling of the feet; great weakness and emacia- 
tion. Especially when in complication with typhlitis and the formation of 
abscesses. 

Nitrnm. Stitching and sticking pains; predominating coldness of the 
lower extremities; kind of numb and stiff feeling in the affected parts, as if 
they were made of wood. 

Nux vom. Belching, vomiting and constant pressure upon the rectum, 
as if urging to stool. 

Oputm. Distention of the abdomen; anxiety, with a feeling of flying 
heat internally, and stupefaction of the head; somnolence; antiperistaltic 
motion of the intestines; constant vomiting and belching; retention of stool 
and urine; complete inactivity of the lower bowels. 

Rhus tox. Great restlessness; changing position, notwithstanding the 
pain it causes; tongue red at the tip; pressive cutting pain in the abdomen; 
typhoid symptoms; febris lente; metritis. 

Sulphur. After Aeon, and Bry on.,, or when the disease takes a pro- 
tracted course. 

Veratr. Vomiting and diarrhoea; coolness of the skin; sunken features; 
pulse small and weak; thirst great; restlessness and anxiety. 

Ascites, Dropsy of the Peritoneum. 

Its pathological character is like that of hydro thorax, a collection of 
fluid within the peritoneal sac, which is of a yellow, or yellowish-green, or 
(if blood be mixed with it) of a reddish color, and contains a great deal of 
albumen, saline constituents, and flakes of coagulated lymph. The quantity 
of fluid sometimes exceeds forty pounds. The peritoneum is opaque, with- 
out lustre, and thickened, but without any signs of inflammation. Liver and 
spleen are pale, sometimes smaller than normal; the kidneys appear anaemic, 
and the diaphragm is pushed upwards into the thoracic cavity. 

Dropsy of the belly is never a primary disease, but always the con- 
sequence of some morbid action, such as diseases of the lungs, heart, larynx, 
blood-vessels, liver, spleen, kidneys, of intermittent fever and cancer- 
cachexia. 

It may result from mere local troubles, such as impediments of circula- 
tion within the peritoneum by obstructions of the vena portae, cirrhosis, and 
tumors of the liver, tubercular and carcinomatous degeneration of the peri- 
toneum. Frequently several of these causes are in operation, and sometimes 
it may be difficult to find out the true cause. If it develops without any 
34 



530 ASCITES. 

oedema of other parts, we may conclude that it is caused either by an ob- 
struction of the portal circulation, or by a degeneration of the peritoneum. 
If by disturbance of the portal circulation, we generally find signs of a dis- 
turbed action of the liver, and the urine containing bilious coloring matter; 
if by degeneration of the peritoneum there are signs of cancer-cachexia, or 
tumors in the abdomen, the urine usually retaining its natural color. 

Symptoms. — i. Swelling of the abdomen. This alters its form accord- 
ing to the position of the patient. When standing, the hypogastric region 
swells out the most; when lying, the most dependent portion of the abdomen 
bulges out. This distinguishes ascites from any other swelling within the < 
abdominal cavity. 

2. Fluctuation, which is easily discovered by palpation. 

3. Diminution of urinary secretion and alvine evacuations (the latter -ex- 
cepted, where there is an intestinal catarrh co-existing). 

4. Dull percussion sound, also variable according to the patient's position. 

5. Pressure towards the thoracic cavity, with dyspnoea and palpitation of 
the heart. 

6. Enlargement of the veins in the lower extremities,, and dropsical 
swelling of the external genital organs and lower extremities, in consequence 
of the pressure which the accumulation of fluid within the abdominal cavity 
exercises upon the vena cava and venae iliacae, causing obstruction of circu- 
lation in these parts. 

The Prognosis depends entirety upon the nature of its cause. If that 
is not removable, it is hardly to be expected that its consequences will be. 
The patient does not die in consequence of dropsy, but in consequence of the 
primary disease, if that be fatal, although dropsy by impeding the respira- 
tion, or by excoriations or superficial gangrene may hasten this result. 

Ascites differs from dropsy of the ovaries by its causes, which close ex- 
amination must elicit; by its form, being a uniform distention of the lower 
abdomen, rising gradually upwards. In dropsy of the ovaries, the swelling 
is more on the one or the other side, exending gradually sideways over the 
whole abdomen; by its changing form by change of position, which never oc- 
curs in dropsy of the ovaries, where the fluid is encysted. 

In our Therapeutic management of each individual case, therefore, 
we shall have to select remedies from those which are indicated for dropsical 
affections in general; as Apis, Arsen., Bryon., China, Dulcam., Ledum, 
Lycop., Phosphor., Pulsat., Rhus tox., Sepia, Strontium. 

Vomiting and diarrhoea suggests: Ant. crud., Apis, Apoc. cann., Ar- 
gent., Arse?i., Asar., Borax, Chamom., Cuprum, Ipec., Mercur., Phosphor., 
Senega, Sulphur, Ta?'t. emet., Veratr. 

Ulcers on the legs: Arse?i., Graphit., Helleb., Lycop., Mercur., Rims 
tox., S cilia, Sulphur. 

(Edema of the lower limbs, with constant oozing out of the water from 
sore places without formation of pus: Rhus tox., afterwards Lycop. 

Cough, with dropsy: Amm. card., Apis, Arsen., Colchic, Helleb., 
Nit. ac. 



special hints to ascites. 53 1 

Special Hints. 

Apis. Urine scant}*, dark, like coffee-grounds; thirstlessness; great 
soreness of the abdominal walls; stinging, burning pains in different parts of 
the body; can't get breath, except when sitting; even leaning backwards 
causes suffocating feeling; in complication with scarlet fever, uterine tumors, 
and inflammatory processes of the bowels. 

Apoc. cann. Has heen given abundantly by western physicians for 
11 drops}*" of all kinds; seems to be indicated by a sinking feeling at the pit 
of the stomach; an irritable condition of t>he stomach, that cannot retain 
even a draught of water; muddy urine; diarrhoea; bloatedness of the face 
after lying down, passing off after sitting up; dropsy after scarlatina. 

Arsen. Complexion pale and earthy, or greenish; great weakness, ex- 
haustion; faint feeling from slight motion; tongue dry; great thirst, with 
frequent drinking, but only little at a time; suffocative spells, especially at 
night; great anxiety; must jump out of bed; skin cool; burning heat inside; 
post-scarlatinal dropsy; in complication with heart diseases. 

Aurum. Has been recommended when ascites is the consequence of 
functional disturbance of abdominal organs, in combination with albuminuria. 

Bryon. Congestion of the head; giddiness when rising after stooping; 
loss of breath when moving in the least; lower eyelids cedematously swollen; 
lips bluish; great thirst and scanty urine, with burning in the urethra, pass- 
ing off drop by drop; obstinate constipation; after scarlet fever. 

Canthar. Cured many cases according to Faivre. 

China. Indicated in organic disturbances of liver and spleen, and after 
loss of blood. 

Colchic. Palpitation of heart, and dyspnoea from n to 3 o'clock in 
the night, burning in pit of stomach, afterwards nausea, finally vomiting with 
subsequent weakness and sometimes ravenous hunger. Skin dry and pale. 
(F. Pollock.) Urine scanty, looking like bits of decomposed blood, with 
offensive smell. (W. McGeorge.) 

Convulvulus arv. Constipation; abdominal disturbances, weakness, 
appetite good; he would eat more if there were more room, the abdomen 
being filled with water; urine almost entirely suppressed. 

Digit. Difficult micturition; pale face; intermitting pulse; cold skin; 
doughy swelling, which easily yields to the pressure of the finger. 

Fluor, ac. Enlarged and indurated liver, in consequence of drinking 
whiskey. 

Graphit. Great oedema of lower extremities with profuse watery exu- 
dation below knees; exudation gelatinous. (H.V.Miller.) * 

Helleb. In acute cases; after scarlet fever; drowsiness; slow in 
answering questions; griping in bowels, with jelly-like discharges; frequent 
but scanty micturition; great thirst; fever; sympathetic neuralgia of face 
into teeth on left side; preventing chewing. 

Kali card. In complication with liver and heart affections. 



532 TYMPANITES ABDOMIXALIS. 

Laches. In complication with liver, heart and spleen diseases, scarlet 
fever; black, scanty urine. 

Lycop. Liver affections; abuse of alcoholic drinks; after venesection, or 
intermittent fever; oozing out of water from sore places in the lower extrem- 
ities, without formation of pus; urine scant)*, with red sediment; upper 
portion of the body emaciated, lower enormously swollen; one foot cold, the 
other hot; restless sleep; cross w T hen getting awake. 

Mangan. ox. Intermittent fever; cachexia; palpitation of the heart, 
strong, irregular, tumbling, without abnormal sounds. 

Mercur. In consequence of organic lesions of the liver and other ab- 
dominal viscera, the swelling of the abdomen is tense, hard; thirst not 
prominent. 

Senec. Abdomen very tense; lower extremities cedematous; urine 
scanty and high-colored, or alternating with profuse and watery discharge; 
pain in the lumbar region and in the ovaries. 

Sulphur. After suppressed eruptions, rough skin; bluish spots; sleep, 
with moaning; quick pulse; cold feet; easily sweating, especially in the face; 
painless diarrhoea; drawing together of the fingers; very forgetful; inclina- 
tion to sit still and to lie down. 

Paracentesis with the usual trocar causes adynamia, rapid return of the 
fluid and often peritonitis. 

Capillary punction allows a slow withdrawal of the fluid, causes less 
adynamia and less frequently peritonitis. (L,eudet.) 

Tympanites Abdominalis 

Corresponds to Pneumothorax, and consists of a collection of gas within the 
peritoneal sac. It is caused by ruptures or perforations of the stomach or of 
the intestines, in consequence of which the gas which is contained therein 
diffuses itself within the peritoneal sac. More rarely the air finds its way 
into the abdominal cavity from out of the lungs (in consequence of abscesses 
and pneumothorax); and still more rarely it enters from the uterus or the 
vagina in consequence of destructive processes in these organs. Cases have 
been observed where the gas originates within the peritoneal sac itself, in 
consequence of a decomposition of ichorous fluids contained therein, especially 
in combination with puerperal peritonitis. 

Symptoms. — Swelling of the abdomen. Its development is rapid if it 
be caused by perforation; slower, if by gradual decomposition. 

Full tympanitic sound all over, even in the region of the liver. This or- 
gan is pressed backwards, if it be not adherent to the diaphragm; this is 
quite characteristic and serves to distinguish tympanitis from meteorism, i. e. y 
a collection of gas within the intestines. 

All signs of peritonitis, which develops itself soon after the entrance of 
air into the peritoneal sac. 

Therapeutic Hints. 

Compare Peritonitis and those other affections of which it is a mere 
consequence. 



DISEASES OF THE LIVER. 533 

DISEASES OF THE LIVER. 

Physical Examination. — The upper border of the liver extends into the 
space between the fifth and fourth, sometimes even to the edge of the fourth 
rib. Being, however, overlapped here by the lower edge of the right lung, 
which reaches down to the sixth rib, we find on percussion the perfect, dull 
liver-sound commencing onfy from the sixth rib, while above it to the fourth 
rib the dull sound can be elicited only by hard strokes, sounding through 
the layer of the lung tissue that covers the liver. Inferiorly the liver reaches 
to the tenth rib in the right hypochondrium, whence it ascends in a some- 
what semi-lunar line across the epigastrium, midway (or often a little higher 
than midway) between the ensiform cartilage and the navel, towards the left 
hypochondrium. Percussion in a horizontal line from the ensiform cartilage 
towards the left, a little under the region where the apex of the heart strikes, 
tells us how far into the left hypochondrium the left lobe of the liver 
reaches. 

This normal position, however, may be changed without indicating any 
disease of the liver itself. The liver is dislocated downwards by emphysema, 
pleuritic effusions, pneumo-, pyo- or hydrothorax of the right lung; it is dis- 
located upwards by fluid or gaseous collections, or tumors within the ab- 
dominal cavity, or in consequence of a shrinking of the right lung. Its sur- 
face becomes grooved by tight lacing of corsets and waists of petticoats in 
females, and of pantaloons in males. Part of the right lobe may, by this 
long-continued process, be brought down to the anterior superior spinous 
process. 

Pigment Liver, Melanaemic Liver resulting from Malarial Fevers. 

The liver presents a steel-gray, or blackish, or chocolate color, in con- 
sequence of an accumulation of pigment matter in its vascular apparatus. 
These deposits are either uniformly distributed, or limited only to certain 
portions. Similar appearances are constantly found also in the spleen, fre- 
quently in the capillaries of the lungs, also in the brain, especially in its 
cortical substance, and in the kidneys. Even the other organs and tissues, 
such as the external integument, the mucous membranes, the muscular tissue, 
etc., remain by no means exempt, as may be seen by their gray tint. The 
pigment seems to be carried everywhere by the blood, and the effects upon 
the system of this morbid process in consequence of malarial fevers will, of 
course, vary according to the organs which are most specially attacked. We 
will find cases with predominant brain symptoms, others with predominant 
symptoms of the kidneys, others with predominant derangements of the 
gastro-intestinal tract and the liver, and others where anaemia and hydremia, 
resulting from affections of the spleen, constitute the most important morbid 
conditions. 

Hyperemia, Congestion of the Liver. 

One of the most frequent causes is obstruction to the circulation of 



534 HYPEREMIA. 

blood in consequence of valvular diseases of the heart, such as constriction of 
the left auriculo-ventricular opening, insufficiency of the mitral and still more 
of the tricuspid valves, and further, affections of the lungs, such as emphy- 
sema, extensive induration or atelectasis, great pleuritic effusions, etc., which 
all give rise to accumulations of blood in the venae cavae, by which the 
branches of the hepatic vein continue permanently distended, and cause a 
general enlargement of the liver. On section, the organ presents a nutmeg- 
like appearance. The dark spots correspond to the situations of the hepatic 
veins, and the light colored portions of the parenchyma, exhibiting upon 
closer inspection pale, delicate ramifications, correspond to branches of the 
portal vein, and constitute the so-called Nutmeg liver. From the persist- 
ence of this obstruction the hepatic parenchyma gradually atrophies and at 
last acquires a finely-granular structure, which frequently has been con- 
founded with cirrhosis of the liver. This is the atrophic form of nutmeg liver. 
Besides the symptoms of the cardiac or pulmonary disease, which constitutes 
the primary cause of the circulatory obstruction, we observe derangements 
of digestion, pains and tension in the epigastrium, nausea, etc., and occasion- 
ally haemorrhoids. Sooner or later it leads to death from pulmonary oedema, 
apoplexy, general dropsy, etc. 

Congestion of the liver may be induced also by rich living, especially 
in persons of a sedentary habit. Stimulants and irritants, such as alcoholic 
drinks, pepper, mustard, coffee, etc., in large quantities frequently give rise 
to this trouble, and quite marked is the influence of hot climates and of 
miasmatic effluvia. The hepatic hyperaemias of the tropics are often associated 
with d3 r sentery or malarious fevers. In the latter case there is also swelling 
of the spleen or kidneys. 

Its acute form is characterized by more or less painful distention of the 
region of the liver, with dyspnoea and pain stretching towards the right 
shoulder, by headache, nausea and vomiting of mucous or green matter; by 
constipation or diarrhoea, which is bilious or even bloody. This state of 
things, by proper treatment, may entirely subside; if neglected, it ma}' give 
rise to a chronic form which shows more or less periodical exacerbations of 
these symptoms, and finally runs into structural changes of the liver, such as 
softening, or pale and jaundiced or fatty degeneration, or induration, cir- 
rhosis and abscesses. 

In temperate climates this affection is much less violent than in the 
tropics, but may also assume a chronic form and produce enlargement of the 
liver by fatty deposits, or infiltration of its parenchyma with albuminous 
substance, which gradually passes into colloid degeneration, and in rare cases 
becomes cirrhosed. 

A hyperaemia of the liver in consequence of the suppression of habitual 
haemorrhages, for instance during the climacteric period of life, has frequently 
been observed; it usually does not give rise to any serious derangement in 
the nutrition of the liver. 



therapeutic hints to hyperemia. 535 

Therapeutic Hints. 

In acute cases : 

Bcllad. High fever; congestion of the head; severe headache; vomiting 
of the wate*ry, slimy and bilious fluid; great thirst; region of the liver pain- 
ful and sore to the touch. 

Bryon. Bilious vomiting; bitter taste; white tongue; great thirst or 
only dryness in the mouth; inclination to keep still; soreness of the liver to 
pressure; costiveness. 

Card. mar. When constipation frequently alternates with diarrhoea; 
liver sensitive to pressure; pressing, drawing, stitching pain in liver, worse 
on lying on left side; catarrh of gall-passages; swelling and induration of 
left lobe, with dyspnoea and cough; jaundice. 

Chamom. After anger or chagrin; very annoying pressure in the 
region of the liver; colicky pains in the bowels; vomiting of bile; feverish 
restlessness; crossness; icteric color of the face. 

China. Pale, wretched complexion; diarrhoea, worse at night or after 
eating; sensitiveness to external cold; great weakness and lassitude; after 
severe illness, loss of vital fluids, or abuse of mercury. 

Ignat. After grief or fright, especially in the female sex; menstruation 
profuse and irregular; leucorrhoea, with bearing-down pain. 

Mercur. Bad taste; bad smell from the mouth; tongue white, flabby, 
showing the imprints of the teeth; feverishness; sweating without reiief. 

Nux vom. Fullness; pressure; stitches in the liver, worse from motion 
or contact; swelling of the liver; yellow color of the face, especially if the 
color of the face is florid with a yellowish tinge; all worse in the morning; 
great irritability and hypochondriac mood; costiveness. 

Ptelia trif. ''Anorexia; sleeplessness; frequent emissions at night of 
small quantities of perfectly colorless urine; yellow coated tongue; nausea; 
sour taste and constant thirst; constipation, the feces discharged every fourth 
day consisted of dark colored, hard, irregular lumps. Swelling of the liver, 
most exquisite tender to jar or pressure, which caused nauseating pains 
shooting towards epigastrium. Worse from motion; cannot turn in bed, must 
lie on right side with abdomen supported by a pillow. Circumscribed flushing 
of cheeks in the afternoon; no perspiration at any time. Jaundice sets in 
on second day of attack. Menstruation had ceased three years previous. 
Mental condition was one of quiet resignation. Has received at various times 
the following remedies: Arnica, Arsen., Bryon., China, Hepar, Kali carb., 
Laches., Lauroc, Nux vom., Sulphur, with rarely any relief of any of the 
symptoms. Ptelia trif. was given on account of the symptoms detailed in 
Allen's Materia Medica under Abdomen -H}q?ochondria, Nos. 471-486, 
with entire success." (F. Preston, Weekly Medical Counselor, May 31, 1882, 

P- 133.) 

In chronic cases: Calc. carb., Carb. veg., Graphit., Lycop., Magn. mur., 
Natr. mur., Natr. sulph., Sepia, Sulphur. 



53^ PERI-HEPATITIS. 

Compare also the diseases of the heart and lungs, of which congestion 
of the liver is more or less a consecutive symptom ; also the chapters on acute 
and chronic catarrh of the stomach and intestines. Besides all this, the 
following require special study — 

Card. mar. Swelling and hardening of left lobe; sensitive to pressure; 
painful on lying on left side; oppression of chest with cough and expectora- 
tion, sometimes bloody; urine scanty, dark red and yellowish, with bile satura- 
ted; jaundice; dropsy. (Wolf.) 

Laches. Cannot bear tight clothes around the waist; has even to 
loosen the night- jacket to relieve the oppression, which is occasioned even 
by lying the arm on the bod}-; tension; contractive tightness in the region 
of the liver. 

Lauroc. Distention of the region of the liver, with pain as from sub- 
cutaneous ulceration, or as if an abscess would burst; earth}' complexion; 
yellowish spots in the face. 

Lycop. Tension around the hypochondria as from a hoop; sore aching 
in the region of the liver, as if caused by a shock, worse from contact. 

Nux viosch. Feeling of heaviness in the region of the liver; swollen 
liver; blood}' stools. 

Podoph. Fullness, with pain or soreness in the right hypochondrium ; 
chronic hepatitis, with costiveness; the patient is constantly rubbing and 
stroking the region of the liver with his hands. 

Quassia. Gastric catarrh and liver complaint with diarrhoea and dropsy ; 
spasmodic cough, like whooping-cough; rapid sinking of strength; spleen 
affection. (Wolf.) 

Peri-Hepatitis, Inflammation of the Capsule of the Liver and of 

Glisson's Capsule. 

It may be part of a general peritonitis, or the consequence of an abscess 
of the liver, of simple, or cirrhotic induration, of cancer, or of echinococci 
in the liver; it is at times the result of external violence, or a mere extension 
of an inflammatory process of some neighboring organs, such as right-sided 
pleurisy, and simple and cancerous inflammation of the stomach. 

Its most characteristic symptom is, tenderness of the hepatic region on 
pressure, motion and deep inspiration, without any change in the volume or 
situation of the liver. In itself it is not a dangerous disease, but may pro- 
duce thickening of Glisson's capsules and of the portal vein. Its treatment 
compare under peritonitis and the diseases of which it may be the conse- 
quence. 

Hepatitis vera circumscripta, seu Suppurativa. 

This is an inflammation of the hepatic tissue limited to one or several 
isolated patches, without implicating the remaining portions of the gland to 



HEPATITIS VERA CIRCUMSCRIPTA, SEU SUPPURATIVA. 537 

any great extent. In their centre these inflamed spots are soft and yellow- 
ish, at their periphery they show hyperemia, swelling and softening of the 
liver tissue. In the progress of the disease pus corpuscles form in the 
middle of the inflamed spot, they increase in number, unite and form a small 
abscess, which again unites with other small abscesses, and thus, in the course 
of time, the greater part of the liver may become an irregular cavity filled 
with pus. 

Such abscesses are found in the posterior portion of the right lobe. 
When they reach the surface of the liver they break through and discharge 
their contents into the abdominal cavity; or, if the surface of the liver has 
formed adhesions, in consequence of previous inflammation, with neighboring 
organs — either with the abdominal walls, the diaphragm, the stomach, the 
gall-bladder, or a part of the intestines — it perforates these organs, and dis- 
charges itself either through the abdominal walls, or into the thoracic cavity, 
stomach, gall-bladder, or intestines, according to its situation and adhesion. 

Hepatitis is primarily a very rare disease, and is mostly brought on by 
external injuries — a fall, a blow, a wound, etc. 

Secondarily it is caused by the irritation of hardened concrements within 
the gall-ducts, or by ulcerative processes within the stomach and the intestines, 
which perforate and spread upon the surface of the liver. In tropical climates 
it has most frequently been found in connection with dysentery. Pyaemia, 
in consequence of wounds on the. head or any other part of the body, is also 
cause of it. 

Symptoms. — A primary hepatitis caused by a blow, fall, or other 
mechanical injury occasions pain in the right hypochondrium; frequently 
very acute, as its lining portion of the peritoneum is likewise inflamed; it is 
worse from any motion. There is also a pain in the right shoulder, and on 
tension, in the right straight abdominal muscles. The liver is swollen; the 
skin more or less yellowish discolored (icterus); fevers alternate with rigors. 

A secondary hepatitis, in the course of ulcerative processes in the stomach 
and intestines, manifests itself by shaking chills, pain in the liver, swelling 
of the liver and icterus, though the latter is not always present. 

Hepatitis in consequence of pyaemia manifests itself likewise in swelling 
of the liver, icterus and shaking chills. Formation of abscesses on the con- 
vex portion of the liver often bulge out, and may be detected by palpation. 
Those on its concave side compress the portal vein, and cause swelling of the 
spleen and ascites. 

Small abscesses may pass over without any marked symptoms. Large 
abscesses cause fever, shaking chills, wasting away, cachectic appearance. 

Perforation through the abdominal walls, after previous adhesion of the 
inflamed portion of the liver with the abdominal parietes, is the most favor- 
able, as in this case, the pus is discharged outside. 

Perforation into the pleural sac causes pleuritis; a perforation into one 
of the larger bronchi causes the pus to be expectorated; a perforation into 
the pericardial sac causes pericarditis, which is fatal. If the perforation 



53 8 SPECIAL HINTS. 

takes place into the stomach, it is thrown up; and if into the intestines, it is 
discharged through the bowels. A discharge into the abdominal cavity pro- 
duces fatal peritonitis. 

All this shows that hepatitis and its consequences must cause quite a 
variety of symptoms; that its prognosis generally is unfavorable; and lastly, 
that a successful treatment, without a close study of the individual case, is 
quite impossible. Still, I may mention the following remedies, which have 
proved themselves more or less beneficial in abscesses of the liver: Bellad., 
Bryon., China, Hcpar, Kali carb., Laches., Merc, sol., Nux vom.\ Pulsat, 
Rut a, Sepia, Silic. 

Special Hints. 

Compare what has been said under the head of Peritonitis. 

Arnica. In traumatic cases. 

Arsen. Painful bloatedness in the right hypochondrium, with violent 
burning pain; violent thirst; vomiting of black masses; black stools; burn- 
ing heat of the skin; anxiety and restlessness; very quick pulse; perforation 
into the stomach or intestines. 

Bellad. Especially with acute pain in the region of the liver, worse 
from pressure, breathing, coughing and lying upon the right side, extending 
upwards towards the shoulder and neck; congestion of the head; getting 
dark before the eyes; fainting and giddiness; bloatedness of the pit of the 
stomach; tension across the epigastrium; agonizing tossing about; sleepless- 
ness or wanting to sleep, with inability to go to sleep. 

Bryon. Burning and stitching pain, worse from motion and contact; 
after chagrin or anger; fullness of stomach and abdomen; pain in the right 
shoulder; yellowish face; white tongue; great thirst; constipation. 

Chelid. Crampy pain in the inner angle of the right shoulder-blade; 
shooting pain from the liver into the back; pressive pain in the back part of 
the head; towards the left ear; pressure in the eyeballs; bitter taste in the 
mouth; nausea; palpitation of the heart, with very quick and irregular 
pulsation and without abnormal sounds; constipation. 

China. Pain as from subcutaneous ulceration, worse from touch; liver 
swollen; diarrhoea; distended veins on the face and head. 

Hepar. When suppuration takes place. 

Kali carb. Pain through to the back; abscess; dryness of the skin. 

Laches. After Bellad. , or Mercur. , very sensitive to any pressure upon 
the hypochondriac region; much flatulence; palpitation of the heart; forma- 
tion of abscesses. 

Leptand. Yellow-coated tongue; constant nausea and vomiting; ach- 
ing in the region of the liver; dark brownish urine; black stools. 

Lycop. In slow 7 cases; complication with pneumonia; fan-like motion 
of the nostrils when breathing; one foot hot, the other cold. 

Mercur. Pressive pain and stitches in the liver; inability to lie on the 
right side; when coughing or sneezing a stitch-pain through middle of the 



CIRRHOSIS. 539 

chest from front to back; yellowish tinge of the face; perspiration without 
improvement; during fever feels chilly when changing the feet to a cooler 
place in the bed. 

Nux vom. Pain, stitch-like, or throbbing, or pressive, worse from ex- 
ternal pressure; sour or bitter taste in the mouth; nausea; vomiting; short- 
ness of breath; the dress seems oppressive; the removal of it, however, does 
not relieve; great deal of headache. Previous use of allopathic medicines, 
coffee, liquor, etc.; sedentary habits. 

Phosph. ac. P} T aemic symptoms. 

Pulsat. Spells of great anxiety at night; green, slimy diarrhoea; thirst - 
lessness. 

Silk. Hardness and distention of the region of the liver; throbbing, 
ulcerative pain, increased by contact and motion; formation of abscesses. 

Sulphur. Especially after Nux vom. and Me? cur. ; red tip of the tongue; 
red lips; sleeplessness. 

Cirrhosis, Hob-nail Liver, Interstitial Inflammation of the Liver, 
Granulated Liver, Gin- drinkers' Liver. 

It is a chronic inflammation of the areolar tissue, which, being of a 
fibrous texture, forms a capsule over the entire liver, enters as Glisson's 
capsule into the interior of the gland and accompanies the vessels, nerves 
and bile-ducts to their finest ramifications. The first consequence of inflam- 
matory action of this tissue is exudation of coagulable lymph, which forms 
new areolar tissue and adhesions between its ramifications, causing the se- 
creting cells of the liver to become isolated and compressed, and producing 
in this way larger or smaller granulations, which have been compared to 
hob-nails. In the further progress, the new formation compresses also the 
biliary ducts and blood-vessels, and the whole organ shrinks, becomes hard, 
tough, pale, anaemic, and, if cut, appears gray-yellowish, v/herefore the name 
cirrhosis. Its most frequent Cause is the abuse of alcoholic drinks; still it 
has been observed in individuals who were not addicted to drinking, and 
where it seemed to be in connection with syphilis, intermittent fever, sup- 
pressed menstruation, poor living. 

Heart diseases, according to Bamberger and others, do not cause it. It 
is much more frequently found in males than females, rarely in children, and 
most frequently in persons over thirty j^ears. 

Symptoms . — i . The liver is , during the stage of exudation , considerabl}- 
enlarged, and, during the stage of contraction, loses quite considerably in 
bulk, so that the left lobe disappears entirely. If we have an opportunit} 1 - 
to observe its progress long enough, we can witness this increase and gradual 
decrease of the liver, and in this way gain one of ■ the most important aids in 
our diagnosis. 

2. Enlargement of the spleen is met in many, not all cases, in conse- 
quence of the obstructed circulation of the blood within the portal vein and its 



54° CIRRHOSIS. 

branches, which impairs the free reflux of blood through the vena lienalis. 
This is an early symptom. 

3. Ascites appear later, but is a more constant accompaniment of 
granular induration, and depends upon the same obstruction of the portal 
circulation; still later oedema of the lower extremities occurs. 

4. Meteorismus, if strongly developed, causes difficulty in breathing. 

5. Dilatation of the abdominal veins, caput medusae, appears not until an 
advanced stage of the disease. It is caused by the obstructed portal circu- 
lation. The blood in its way from below up, being stopped, forces its way 
through neighboring veins, widening and dilating them, and thus forms a 
collateral circuit around the liver, until it reaches the vena cava. These 
widened and dilated veins appear sometimes like a large network over the 
walls of the whole abdomen, and even above it. 

6. Functional disturbances of the intestinal canal are of a varied nature. 
The appetite is, in some cases, not altered till very late; in others, again, 
want of appetite, nausea, belching of wind and vomiting predominate. The 
bowels are either constipated or diarrhceic. In severe cases we find vomiting 
of blood and bloody stools. 

7. Loss of flesh and strength sets in quite early, as a necessary conse- 
quence of imperfect circulation. 

8. Jaundice is, according to Bamberger, a prominent symptom of cir- 
rhosis, other authors have not found it so frequent. It depends upon catarrh 
of the bile ducts, or upon compression of the hepatic duct, or upon constric- 
tion of the minute biliary ducts by the newly-formed connective tissue. 

If we consider these symptoms, together with the preceding abuse of 
spirituous liquors, we shall be enabled, in most cases, to make out a sure 
diagnosis. But for the sake of Differential Diagnosis I shall compare 
a few forms of disease which might be confounded with it. 

Stricture of the biliary duct is usually caused by gall-stones, and has its 
peculiar colicky spells, but no swelling of the spleen. 

Nutmeg liver is always the consequence of heart and lung diseases, and 
has no enlargement of the spleen. 

Cancer and tuberculosis of the peritoneum, with highly- developed ascites, 
may be sometimes difficult to discern; still we have here a quicker wasting 
away; perhaps also signs of cancer or tubercles in other organs, and a devel- 
opment of oedema of the lower limbs prior to the development of ascites; 
whilst in cirrhosis we have first ascites and afterwards ©edematous swelling of 
the lower extremities. 

Cancer of the liver distinguishes itself by the peculiarly potato-shaped 
surface of the enlarged liver and the normal size of the spleen. 

Hydatids of the liver give, on palpation, the sense of fluctuation; they do 
not impair the general nutrition, nor do they cause an enlargement of the 
spleen. 

Inflammation of the portal vein, with coagula forming in it, is a much 
more rapid process, and is not caused by previous abuse of spirituous liquors. 



SYPHILITIC INFLAMMATION OF THE LIVER. 541 

Inflammation of the areolar tissue surrounding the bilary ducts is char- 
acterized by the highest degree of icterus and the complete discoloration of 
the stools. 

Colloid or fatty infiltration of the liver never decreases in size, causes no 
icterus, and is found in scrofulous, rachitic, or syphilitic individuals, or as 
a consequence of mercurial poisoning. 

Prognosis is favorable as long as the disease is still in its first stage. 
After granulations have formed throughout the organ, I do not believe that 
its parenchyma can be reorganized. 

Therapeutic Hints. 

If the disease is brought on mainly by the abuse of spirituous liquors, 
especially whiskey and brandy, the first prescription, of course, must be, 
' ' stop drinking. ' ' And, in order to destroy the appetite for alcoholic stimu- 
lants, our second prescription should be, "drink milk," and nothing but 
milk; live on milk diet. After this we shall have a choice between these 
remedies, which are antidotes to alcohol: Arsen., Bryon., Card, veg., Nux 
vom., Pulsat., Sulphur, etc. 

In its second stage we must be guided entirely by the characteristic 
symptoms of the individual case, and may choose from the following: Arg. 
nitr., Aurum, Card, mar., Chelid., Cinchona, Conium, Iodium, Laches., 
Leptand., Lycop., Magn. mur., Mercur., Natr. mur., Nitr. ac, Phosphor., 
Plumbum, Podoph., Quassia, Selen., Sepia, Tax bacc. 

Syphilitic Inflammation of the Liver 

Manifests itself either as an interstitial hepatitis and peri-hepatitis, which 
leave white depressions, like cicatrices, consisting of fibrous tissue and ex- 
tending from the thickened capsule more or less deeply into the interior of 
the gland, the secreting tissue of which is atrophied, thus producing an ir- 
regularly, lobulated form of the liver; or as hepatitis gummosa, when the 
tissue of the cicatrices just described is seen to contain whitish or yellowish 
nodules, which usually vary in size from a linseed or a bean up to a walnut, 
and resemble the nodes or gummata of syphilitic patients found in the sub- 
cutaneous areolar tissue beneath the peritoneum, in the testicles, etc. 

The symptoms during life of syphilitic hepatitis are not at all character- 
istic. A dull, temporary pain and tenderness in the region of the liver, in 
rare cases jaundice, also enlargement of the spleen and frequently co-existing 
albuminuria, may hint to this complaint, especially when other unmistakable 
signs of the secondary and tertiary stage of syphilis are present. Its treat- 
ment belongs to the chapter of Syphilis. 

Acute Yellow Atrophy- 
Is a rapid wasting of the liver in all its diameters, but especially in its thick- 
ness, sometimes preceded by a preliminary stage. Its capsule appears opaque 



54 2 ACUTE YELLOW ATROPHY. 

and puckered; its parenchyma is flabby and shriYelled and of an ochre- 
yellow or rhubarb-like color; the blood-vessels, the gall-bladder and bile- 
ducts are empty in most cases, the gall-bladder containing only a small 
quantity of gray mucus or a turbid, pale yellow, rarely brown or greenish 
fluid. The spleen is frequently greatly enlarged and congested, and there are 
considerable extravasations of blood in various organs and tissues. The 
kidneys, especially in pregnant females, are in a state of fatty degeneration 
and their tissue flabby and shrivelled. The urine is characterized by the 
absence of urea, which has accumulated in the blood, and by temporary 
presence of albumen. 

The nature of this disease is still quite obscure; several theories have 
been advanced, but that which considers the whole process as one of diffuse 
inflammation is the one most generally accepted. 

The Precursory Symptoms usually resemble the symptoms of an 
acute gastro-enteric catarrh, which' sooner or later, sometimes not until after 
the lapse of several weeks, becomes associated with a slight jaundiced tint of 
the skin. Even this may exist from eight to fourteen days or longer before 
the characteristic changes in the liver and spleen, the haemorrhages and the 
nervous disturbances become apparent. However, in other cases, these symp- 
toms appear simultaneously with the jaundice, and as soon as the} 7 do appear, 
the progress of the disease is rapid and violent, terminating in the worst cases 
at the end of twelve or twenty -four hours, in other cases after two or five 
days, latest and in rare cases only, after a week. The disease sets in with 
vomiting first of ingesta and mucus, later of blood and ultimately of coffee- 
ground substances. This is attended with headache, which, as a rule, soon 
passes into delirinm, followed by convulsions and a tremulousness of the 
muscles of the extremities and trunk. Finally the state of excitement passes 
into stupor and deep coma; the pupils enlarge, the respiration becomes sigh- 
ing, intermittent and stertorous. The pulse, at first slow, rises with the 
nervous symptoms to 120, or keeps at 70 or 80 as long as the patient is dozing, 
and rises to 120 or 130 when the patient is roused. The abdomen is tender, 
especially in the hepatic region. The extent of the hepatic dullness dimin- 
ishes as the disease advances, while that of the spleen increases at the same 
time. The bowels are almost always confined; the stools are dry and clay- 
like, later the} 7 become dark colored and tarr\< from the presence of blood. 
There appear, as the jaundice increases, numerous extravasations of blood in 
the skin in the form of petechiae and ecchymoses, and haemorrhages from the 
nose, the vagina, the stomach and bowels, and the bronchi. 

The urine is brown and contains bile-pigment, at times small quantities 
of albumen. Its deposit, upon exposure to cold, is greenish-yellow, which 
differs greatly from all other kinds of deposits. The disease is most frequently 
observed in the female sex, and then especially during pregnancy. Further 
are mentioned as exciting causes: mental emotions, venereal excesses, syphi- 
lis, miasmatic influences and typhus. 



hepar adiposum. • 543 

Therapeutic Hints. 

Aeon. Acute, feverish icterus, especially during pregnancy. 

Bcllad. Congestion to the head; headache; dizziness; sopor; pupils at 
first contracted, and afterwards dilated; spasmodic jerkings; grating of 
teeth, etc. 

Bryon. Chill first and fever afterwards; typhoid symptoms; bitter 
vomiting; constipation. 

Crot. horr. Yellow color over the whole body; convulsions with trem- 
bling of the limbs; haemorrhages from all the orifices of the body. 

Ipec. Vomiting of blood, and bloody discharge from the bowels. 

Leptand. Delirium; complete prostration; heat and dryness of the 
skin; coldness of the extremities; fetid and tarry stools; tongue thickly 
coated, with a black streak down the centre. 

Phosphor. Ought to be compared. 

Compare also Haemorrhage from the Stomach and Bowels, and Jaundice. 

Hepar Adiposum, Fatty Liver. 

A fatty infiltration of the liver cells is found very frequently on post- 
mortem examinations without ever having shown its presence during life by 
any signs of diseased action of that organ. A diet of fatty substances, or of 
large quantities of food containing an abundance of carbo-hydrogens, pro- 
duces such infiltration, which, however, disappears again when the food is 
changed. This accounts for the frequent occurrence of fatty liver in indi- 
viduals who have died suddenly in the bloom of good health. For this kind 
of infiltration there is no known line of demarcation between health and 
disease, inasmuch as the liver cells are not altered by it in their character, 
the fat being merely deposited therein. Altogether different is the fatty 
liver as found in connection with pulmonary tuberculosis, drunkard's dys- 
crasia, chronic dysentery, cancer and other wasting diseases. Here the liver 
cells cease entirely to perform their function, their nutrition becomes im- 
paired; it is indeed a fatty degeneration of the liver cells. Its production is 
not fully explained, except by the broad statement that it is owing to ab- 
normal conditions of the metamorphosis of matter. But whether it be mere 
infiltration or degeneration, the blood is always loaded with fat and the 
sebaceous glands of the skin secrete abundantly, causing a greasy or velvety 
character of the cutis. 

The Symptoms of fatty liver are not very well marked. Still, as a con- 
siderable accumulation of fat in the liver must impede the flow of blood 
through the portal vein, and the excretion of bile, we find fatty liver natur- 
ally associated with chronic congestion of the gastrointestinal mucous mem- 
brane, which may be exaggerated by slight causes into catarrhs, derange- 
ments of digestion, diarrhoea, and haemorrhoids; and with stools more or less 
deficient in bile; but an intensely jaundiced color of the skin is never pro- 
duced by it and seldom a high degree of ascites. The liver is at first enlarged 



544 COLLOID LIVER. 

but gradually becomes reduced to even below its normal size; its outer 
surface is smooth. The general appearance of the patient gradually assumes 
the character of general cachexia, and there is usually an enlargement of 
the spleen attending it. 

Its Treatment will in the case of infiltration consist of a strict regula- 
tion of diet and habit, and in the case of degeneration will fall entirely under 
the treatment of those diseases with which it is associated. 

Colloid Liver, Lardaceous Liver, Waxy Liver, Amyloid Degen- 
eration of the Liver. 

This is a degeneration of the liver cells into a waxy, translucent mass, 
so that b} 7 degrees the parenchyma of the gland presents a uniform, smooth, 
yellowish-red, somewhat glistening surface, interrupted only by the patent 
orifices of the blood-vessels pouring out a little thin blood. This morbid 
change may occur sometimes only in isolated places, but is most frequently 
distributed more or less marked throughout the entire organ. The nature 
of this substance is thus far still unknown. From the blue color produced 
by a solution of Iodine in conjunction with Sulphuric acid, Virchow supposed 
it to be an " anryloid" bod} T , but the proof from elementary analysis is still 
wanting. 

Waxy degeneration is often found combined with fatty deposit in the 
liver, especiall} T in cases of pulmonary tubercle, with cirrhotic induration, 
with syphilitic cicatrices and fibroid nodules (gummata), with simple atroph} 7 
of the liver. It is scarcely ever restricted to the liver, but is almost in- 
variably found also in the kidneys and spleen, and often likewise in the 
lymphatic glands and the mucous membrane of the gastro-intestinal canal. 
Moreover we can usually, at the same time, discover the remains of chronic 
diseases of the bones, the indications of constitutional syphilis, tubercle or 
cancer, suppuration, etc. 

The injurious effects of this degeneration upon the elaboration of blood 
and nutrition causes, as a rule, a pale, cachectic appearance of the patient 
and symptoms of anaemia and Irydraemia. The symptoms vary, however, 
according to the cause which has excited the morbid process and the direc- 
tion in which it extends; the} 7 differ naturally in cases where the kidneys 
and the mucous membrane of the intestines are attacked at an early stage, 
and in other cases where the spleen and lymphatic glands are chiefly im- 
plicated. 

The liver is in most cases enlarged, at times very greatly, at others not 
at all, and in still others it is even reduced in size. There is usually an 
abnornal tenderness in the hepatic region, or a mere feeling of fullness; in 
rare cases of the syphilitic form an acute pain consequent upon an attack of 
peri-hepatitis. Jaundice and ascites are found only exceptionally. The 
spleen is commonly enlarged to a considerable size, though not alwaj's, and 
the derangement of the gastro-intestinal canal manifests itself frequently by 
loss of appetite, vomiting, with a clean tongue, diarrhoea with alternation of 



CARCINOMA HEPATIS. 545 

pale and dark stools. The same degeneration of the kidneys manifests itself 
in the majority of cases by enlargement and albuminuria. 

Mild cases, based upon chronic diseases of the bones, hint to: Calc 
card., Lycop. , Si lie. , Sulphur. 

Syphilitic cases require: Iodhim, Kali hydr. and the different Mercurial 
preparations. Other cases will resist all treatment according to the base 
upon which they grow. 

Carcinoma Hepatis, Cancer of the Liver. 

There are three different forms of cancer of the liver. 

i. The carcinoma fasciculatum, a rare form, characterized by the pale, 
yellowish-red color, its glassy, transparent mass, which is enveloped in a bag 
of fibrous tissue. 

2. The alveolar cancer, the rarest of all, which is characterized by its 
jelly-like substance, developing within the areolar tissue around the ramifi- 
cations of the portal vein. 

3. The medullary or encephaloid cancer, the most common form, is char- 
acterized by its marrow-like substance, which is mostly of a whitish color; 
sometimes it is red from hsemorrhagic effusion, and, at other times, dark, 
even black, from a deposition of pigment. The liver appears uneven from 
nodules of various sizes, which, for the most part, feel hard to the touch, al- 
though, in some cases, the sense of touch may detect fluctuation. They in- 
crease more or less rapidly in size, and sometimes undergo changes of fatty 
degeration, or, in still rarer cases, of softening and decay, or formation of 
ichor. 

We do not know any cause for this malignant disease. It is found 
sometimes as a primary affection of the liver, but more frequently it accom- 
panies cancerous deposits in other organs. Its most frequent occurrence 
and its most rapid development have been observed after extirpation of can- 
cerous growths from other organs, especially from the mammae. Persons 
between the ages of fifty and sixty are most liable to its invasion. 

Symptoms. — i. Enlargement and uneven surface of the liver. Its size is 
sometimes enormous, reaching far over into the left hypochondrium and far 
down into the abdomen; in fact, no other disease except that of colloid liver 
causes such extensive enlargement of this organ. Its enormous size makes 
the right hypochondriac region bulge out, and its uneven surface is then 
easily detected by inspection and palpation. 

In such prominent cases there is no difficulty in the diagnosis. But 
there are cases where the cancerous nodules lie out of reach of palpation, 
either deep in the substance of the liver or on its opposite surface. So is 
also the enlargement of the liver at the beginning of the disease very incon- 
siderable, and, in cases of few and small cancerous deposits, attended with 
general anaemia and marasmus, the liver may appear even smaller. 

2. Tenderness in the region of the liver is almost always manifest, at 
35 



546 CARCINOMA HEPATIS. 

least on deep pressure, but it varies much in degree. A radiating pain 
towards the spine and the right shoulder-blade, as in other liver complaints, 
may be present. 

3. Icterus is present only when the situation of the tumors implicate the 
biliary ducts or when the cancer is associated with catarrh of the ducts. If 
once developed it never disappears. The skin generally presents a peculiar 
ash-colored, dirty-yellowish hue, and, being dry and brittle, peels off in mi- 
nute scales. 

4. Ascites results in those cases where the morbid mass is sufficiently 
large, and so situated that it impedes the portal circulation, by pressure 
upon its vessels, or it comes and grows with general dropsy, or it is due to 
chronic peritonitis, extending from the liver over the peritoneum. 

5. Disturbed nutrition and gastric symptoms are almost always present, 
but show nothing characteristic of this complaint. 

6. The Spleen is very rarely enlarged. 

7. Fever is, as a rule, quite slight, amounting at the most to febrile mo- 
tions. Where we find high fever, it is occasioned by some other compli- 
cation. 

8. Haemorrhages in the lower stages we find in the interior of the tumor, 
and from this into the abdominal cavity, also from the stomach and intes- 
tines, from the mouth, nostrils and vagina, and in the form of petechiae and 
ecchymoses upon the skin, similar to those of purpura and scurvy. 

The Diagnosis of cancer of the liver is by no means always easy. 
Where the characteristic enlargement and uneven surface of the liver has 
not yet keen developed (in the incipient state of the disease), or where 
it does not develop sufficiently to be recognized, we will have to balance the 
following points: 

1. Can it be colloid liver? No; because it is not the result of syphilitic 
or mercurial cachexia, nor is it attended by enlargement of the spleen and 
albuminuria. 

2. Can it be fatty liver ? No; because it is not the result of tuberculosis 
or overfeeding. 

3. Can it be syphilitic inflammation of the liver? No; because there is 
no constitutional syphilis present. 

4. Can it be cirrhosis? No; because there is no enlargement of the 
spleen. 

5. Can it not be nutmeg liver? No; because there is no heart or lung 
disease for its foundation. After having thus narrowed the field of possi- 
bilities, we now observe, in addition, swollen jugular glands, which Virchow 
considers of great diagnostical importance, we ascertain whether there is any 
cancerous formation in any other organ, or a hereditary tendency to it. 

Further, it is among the rarest events that cancer of the liver co-exists 
with tuberculosis, organic heart diseases, typhus or acute exanthematic 
fevers; while, on the contrary, it is frequently associated with other cancer- 
ous affections, especially within the abdominal cavity. Finally, we consider 



HYDATIDS OF THE TIVER. 547 

the age of the patient. Cancer seldom happens before the thirty-fifth year of 
age; usually between the years of fifty and sixty. 

Therapeutic Hints 

Are rather a scarcity in this complaint. I do not know of a well-attested 
case that ever has been made known as cured. The principal remedies 
promising the best alleviating results are: Arse?i., Be/lad., Carb. an., Co?iium, 
Hydrast., Lycop., Sepia, Sztic, and others according to special indications. 

Hydatids of the Liver, Echinococcus- cysts. 

They consist of a thick, fibrous, wdrite-glistening or yellowish sac of a 
roundish shape, and of various sizes, attaining even that of a child's head. 
The sac is lined on its inner surface by a half -transparent, gelatinous blad- 
der, which contains a watery, somewhat turbid fluid, in large quantities, and 
at the same time a number of smaller crysts, of the same structure, which 
again contain still smaller crysts, and so on to the fourth generation. Be- 
sides this, we observe, within these crysts and adhering to some part of their 
interior surface, groups of whitish granules, which are the scolices of taenia 
echinococcus. Under the microscope they appear with head similar to that 
of the taenia solium or the common tape-worm; having four sucking cups, in 
the middle of each of them a nozzle or snout, which is encircled by a double 
row of hooks. This echinococcus-cryst has been found in any and every part 
of the liver, sometimes singly, sometimes two, three or more in number. The 
parenchyma of the liver retains its integrity, and only where it is compressed 
by the foreign growth, its cells obliterate, and that part of the liver assumes, 
according to Rokitansky, sometimes a nutmeg-like appearance. The cysts 
themselves may undergo different changes. Their fluid contents may be 
converted into a cheesy substance, whereby the inmates perish, or the inner 
surface of the sac may become inflamed and lead to obliteration of the cyst, 
or the cyst may burst and pour its contents either into the abdominal cavity 
where it almost always causes a fatal peritonitis, or into other organs, with 
which, by previous inflammation, adhesions have been formed, exactly as in 
the case of an abscess of the liver. There are cases on record, w T here echino- 
coccus-cysts, by perforating the diaphragm, emptied their contents into the 
pleural cavity, from which they were discharged through the bronchial tubes, 
by means of abscess-formation in the lungs. There are cases also where they 
were discharged through the abdominal walls, or into the intestines, gall- 
bladder, or a large blood-vessel. Almost always such perforations are fol- 
lowed by a fatal termination, although, in favorable cases, where, for exam- 
ple, the discharge took place into the intestines, or through the abdominal 
walls, the cysts obliterated and a perfect cure followed. 

The echinococcus, when found in the liver, is also frequently found in 
other organs: the spleen, lungs, kidneys and the omentum. 

The essential Cause of the formation of hydatids is the swallowing of 



548 CATARRHAL INFLAMMATION OF THE BILIARY PASSAGES. 

the ova or embryos of the taenia echinoeoecns, which pass from the stomach 
or intestine into the liver and there undergo development. This taenia 
echinococcus is a small tape-worm belonging to the dog, which explains the 
fact that hydatids are most frequently found in Iceland, where the dog is an 
indispensable domestic animal. 

Symptoms. — Of all liver diseases this complaint causes the least dis- 
turbance in the system, and the occasional symptoms, caused by its pressure 
upon this or another organ, are of the least diagnostic value. Only when 
rupture and perforation take place, we observe, as in the case of liver ab- 
scesses, a series of violent symptoms, all of which are consequences of 
inflammation of those organs into which the perforation or rupture takes 
place. 

Our diagnosis is therefore confined to its physical signs alone. These 
are the following: 

i. A round, smooth, elastic swelling in the region of the liver. 

2. A sense of fluctuation on percussing the part in short, abrupt strokes, 
while the examining fingers of the other hand are held in close neighbor- 
hood. What Piorry has called the vibratory sense of hyatids is nothing 
more nor less than the above-mentioned sense of fluctuation; ascites or ova- 
rian cysts yield it just as clear, under certain conditions even clearer. 

Differential Diagnosis. — Liver abscess is attended by fever, "pain 
and great constitutional disturbances. 

Distended gall-bladder is preceded by colicky pains, is usually accom- 
panied by jaundice, and the swelling corresponds to the normal position of 
the gall-bladder. 

Encysted pleuritic exudation does not alter the place of dull percussion 
sound on deep inspiration; while the outline of the dullness on percussion 
lowers considerably by deep inspiration in hydatids. 

Catarrhal Inflammation of the Biliary Passages. 

Anatomically it is characterized by similar changes as appear in 
catarrhal inflammation of other mucous membranes. Post-mortem exami- 
nation reveals the lining membrane to be pale or livid, softened, tumid, and 
covered with a tenacious, vitreous, or grayish-yellow, purulent secretion, 
which often produces firm plugs of mucus in the duodenal opening of the 
ductus choledochus, and a total stoppage to the flow of bile into the intestines. 
These changes are particularly found in the lower portion of the ductus cho- 
ledochus and in the gall-bladder, less frequently in the hepatic duct and its 
roots. 

In chronic cases the walls of the ducts become thickened and dilated, 
either uniformly over long tracts or in the shape of oval sacs. In these pools 
of stagnant secretion concrements are sometimes deposited, and in rare cases 
the walls of the ducts ulcerate. 

Catarrhal inflammation of the biliary passages is most frequently in- 
duced by inflammation of the stomach and intestines, sometimes by hyper- 



cholelithiasis. 549 

aemia and chronic inflammation of the lower, and more rarely, by fatty and 
waxy degeneration. Its Symptoms correspond, therefore, with the symptoms 
of those ailments of which it is the result, always associated with the symp- 
toms of more or less intense jaundice and tenderness in the region of the liver. 
In a few cases the gall-bladder can be felt as a pear-shaped tumor at the 
margin of the liver. The jaundice lasts in most cases for some time after the 
gastric symptoms have disappeared. In cases dependent upon diseases of 
the hepatic parenchyma, the jaundice is of a fainter tint, and the digestion 
suffers less, but the symptoms are more apt to return. 

Therapeutic Hints. 

Compare catarrh of the stomach and intestine, also jaundice and the 
other affections of the liver. 

In children the following are most frequently indicated: Chamom., or 
Merc. sol. Besides compare Be/lad., Bryon., Nux vom., etc. 

Cholelithiasis, Gall- Stones. 

Gall-stones are made up of substances which are all contained in a state 
of solution in normal bile, with the exception of epithelium and mucus, both 
being furnished by the mucous membrane of the biliary passages. The prin- 
cipal constituent of gall-stones is cholesterine, although it is only sparingly 
contained in the bile; but in virtue of its insolubility it contributes, as uric 
acid does, to the formation of urinary calculi, the main portion to the forma- 
tion of gall-stones. Other constituents are the bile-pigments (cholepyrrhin 
of a brownish, cholechlorin of a green color) and their combinations with 
lime, the biliary acids and their calcareous salts, fatty acids and soaps, mucus 
and epithelium, uric acid and earths. 

In the biliary passages gall-stones occur in most cases, in numbers from 
five to ten or thirty, and occasionally even to more than a thousand. All of 
them which thus occur together, have almost invariably the same characters 
and composition, inasmuch as all of them owe their origin and growth to the 
same morbid process; still exceptionally dissimilar calculi have been found 
in the same gall-bladder. Their size varies from that of a millet-seed to that 
of a hen's egg; their form is primarily globular, but changes during their 
subsequent growth in many ways; very large stones usually assume an egg- 
shaped or cylindrical form, corresponding to the form of the gall-bladder; 
some stones present a warty or mulberry form, others but rarely found, are 
flattened, leaf -like concretions with black, metallic glistening surfaces, and 
still others are the branched varieties which form a cast of the bile-ducts in 
which they are developed. Their color is in most cases brownish or greenish- 
yellow, but all shades of color are met with, from snow-white to coal-black. 
Their specific gravity is heavier than water, but dried specimens will float on 
water because they contain air. Their structure varies exceedingly. In 
simple homogeneous calculi it is of a uniform texture, and presents an earth}-, 
saponaceous, or crystalline fracture, according to their composition of earthy 



550 CHOLELITHIASIS. 

matter, or of bile-resin and its calcareous compounds, or of pure crystallized 
cholesterine. In compound calculi, we observe a central portion or nucleus, a 
shell of greater or less thickness surrounding the nucleus, and an outer crust 
covering the shell. The nucleus consists either of the compound of chole- 
pyrrhin and lime, or of foreign bodies (a small clot of blood, a worm, a 
needle, a plum-stone). The shell is usually striated, and consists of crystals 
of cholesterine, or in rarer cases it surrounds the nucleus in concentric laminae, 
like the layers of an onion, or it is devoid of all structure, of a soapy or earthy 
character. The external crust is of various thickness; it covers the shell 
either in a uniform manner, or is thicker at one portion than at the other; 
it is not unfrequently covered with warty prominences, and its composition 
and color varies greatly according to the constituents of which it is composed. 

In addition to the gall-stones proper, pulverulent or gritty deposits, 
similar to those which are met with in the urinary passages, are found in the 
excretory apparatus of the liver. 

Not unfrequently gall-stones exhibit indications of commencing dis- 
integration; their angles and edges disappear, and their substance is eaten 
away by erosions, resembling caries of the teeth, penetrating through several 
layers, an effect undoubtedly produced by chemical action. Gall-stones may 
also be destroyed by cleaveage. 

Their mode of origin is still not fully explained. However, stagnation 
and decomposition of bile seems to constitute the primary cause of the forma- 
tion of gall-stones. The stagnation of bile is favored by repeated attacks of 
catarrh of the biliary passages, by cancer of the liver and other hepatic 
affections, and also by sedentary habits of life. The decomposition of bile is 
dependent upon physiological processes, the nature of which has thus far not 
been revealed. The tendency to gall-stones increases with the advance of 
life; before thirty years of age the}- are rarely observed. Females are more 
liable to gall-stones than males. 

Gall-stones are found rarely in the hepatic duct and its branches, but 
most frequently and in largest numbers in the gall-bladder, which they may 
leave by passing through the cystic duct into the ductus communis and from 
this into the duodenum; or they may escape by fistulous openings into the 
stomach or intestine, or externally through the abdominal wall. Through 
the ductus choledochus all concretions pass which leave the liver, whether 
they have their origin in the hepatic duct or in the gall-bladder; the)', as a 
rule, obstruct the duct and interrupt the excretion of bile. 

Symptoms. — Gall-stones may lie for years in the gall-bladder without 
giving rise to any symptoms whatever. But if the}' are washed from the 
gall-bladder, into the cystic duct, they cause, unless they are very small, the 
most violent symptoms, known under the name of " Gall-stone colic." 
Usually a few hours after a meal, when the contents of the gall-bladder are 
poured into the duodenum, or in consequence of lifting a heavy load, or after 
mental emotions, an excruciating pain, of a boring and burning character, 
is felt in the right hypochondrium and epigastrium, radiating down to the 



THERAPEUTIC HINTS TO CHOLELITHIASIS. 551 

navel, back to the spine, upwards into the chest, to the shoulder-blades and 
neck, and even down the arms to the very fingers' ends. The slightest touch 
increases the pain. It is attended by vomiting, great restlessness, singultus, 
even convulsions, delirium, S3 r ncope and speechlessness. In some cases the 
attack commences with rigors, often followed by heat and sweating, the 
temperature rising to between 99. 5 and 104.9 F., and the pulse to between 
92 and 120. Oftener, however, the pulse is small and of normal frequency, 
or even slower than normal. Jaundice is absent at first, or only slight, and 
becomes marked only when the calculus fills up the ductus choledochus. 
The duration of hepatic colic varies greatly; it may pass off in a few hours, 
or last for many days. In the latter case the pain recurs in paroxysms until 
the duct becomes so far dilated as to permit the calculus to pass. Sometimes, 
the calculus, after entering the cystic duct, may return into the gall-bladder, 
when the pain likewise ceases, and in such cases no concretions are found in 
the stools. But when the calculus remains firmly impacted in the cystic 
duct, and completely closes up the neck of the gall-bladder, the collicky pains 
gradually subside, and there only remains a sensation of tightness or pricking, 
while the gall-bladder, incapaciated of emptying itself, gradually becomes 
largely distended (Hydrops cystidis felleae), which may terminate at last 
in a destruction of this organ and consequent fatal peritonitis. 

Stones in the ductus choledochus usually excite less pain on account of 
the greater capacit}^ of this duct, and when entering the ductus communis 
the pain ceases altogether; but reaching the abdominal opening, the pain 
returns with renewed severity until the excretions have passed into the in- 
testine. As long as a stone remains in the ductus choledochus, the bile is 
more or less completely shut off from the bowel, and jaundice makes its ap- 
pearance, growing the more intense the longer the obstruction lasts. 

The Diagnosis is easy, where we find the gall-stones passed off in the 
stools, or where we can feel them in the gall-bladder. The whole row of 
symptoms as described above is characteristic. Jaundice, although not a 
constant symptom, is nevertheless, connected with the other symptoms, of 
great diagnostical value. 

Therapeutic Hints. 

Bellad. During the colic is the most important remedy. 

Baptis. Pain in the region of the gall-bladder, forcing the patient to 
stir about, although motion is painful. 

Berber, Has been advised as curing quickly and permanently. (J. 
Angell. ) 

Chelid. With pain through under the right shoulder-blade. 

China. Is indicated by " all the symptoms which arise from obstruction 
in the gall-bladder; the colic; the periodicity of its recurrence, though the 
periods of its return are often very unequal and irregular; the yellowness of 
the skin and conjunctiva; the constipated state of the bowels; the scybalated 
character of the dark, greenish stools, the scybala varying in size from that 



552 THROMBOSIS AND OCCLUSION OF THE PORTAL VEIN. 

of the largest nutmeg to that of sheep-dung, and even smaller than the 
smallest peas." " I give usually China*, six pills twice a day, till ten doses 
are taken; then six pills every other clay till ten doses are taken, etc., till at 
length the dose is taken only once a month." " I have not failed in a single 
instance to cure, permanently and radically, every patient with gall-stone 
colic who has taken the remedy as above directed." (David Thayer.) 

Coloc. Twisting, boring pain in the stomach, relieved by pressure; 
rending, tearing pain, extending up to the right mamma; nausea with cold- 
ness of the extremities. (R. Arnold.) 

Cczsm m . ( Baruch . ) 

Besides these the following remedies have been recommended: Alum., 
Apomorph., Arsen., Calc. carb., gall-stones triturated (German physi- 
cians), Card, mar., (Rademacher), Chionauthus , Evon., Chlorof., Hepar, 
Laches., Lycop., Mercur., (Porges), A T ux mosch., Nux vom., Opium, 
Osmium, Podoph., Silic, Sulphur, Teyeb. (Mossa), Thuja, Ver. alb. 

Olive oil is believed to dissolve some kinds of gall-stones, if taken in 
doses of three to four ounces each night for four nights. (C. D. Fairbank.) 

Thrombosis and Occlusion of the Portal Vein; Pylethrombosis; 
Pylephlebitis Adhsesiva Chronica. 

The portal vein derives its venous blood from the stomach, intestines, 
spleen and pancreas. It is divided into two chief branches for the right and 
left lobes of the liver in front of the transverse fissure. These two branches 
are further subdivided till they finally end in the terminals, or the so-called 
interlobular veins from which the capillary system of the hepatic lobules 
originates. From the capillaries of each acinus the blood is carried by the 
so-called vena centralis lobuli into the hepatic veins, and from the latter into 
the inferior vena cava. The radicles, trunk, and the hepatic ramifications 
of the portal vein are all destitute of valves. The blood flows in the portal 
vein under very slight pressure and with slight rapidity. Stasis of blood in 
its territory, therefore, occurs ver}' readily, giving rise to ectasia, dilatation, 
and sinuosity of the vessels, and to coagulation of the blood contained in 
them. In addition to the slight vis a tergo, inspiration acts as a motive 
force, accelerating the blood-current in the portal vein, while expiration 
rather retards it. 

From this it may be seen that coagula or thrombi may be developed in 
the portal vein as well as in other parts of the venous system. Their most 
frequent Causes are local disturbances of the circulation of blood, resulting 
from granular induration, cirrhosis and chronic atrophy of the liver, by 
which a destruction of numerous capillaries or a constriction of the branches 
of the portal vein is induced. 

Less often the same effect may be produced in consequence of weakened 
force of the circulation, from diminished action of the heart; or from maras- 
mus, and cases have also been observed where thrombosis of the portal vein 



PYLEPHLEBITIS SUPPURATIVA. 553 

was the result from compression of the vessel below the liver by contracted 
connective tissue, and by tumors of various kinds. 

The Symptoms of occlusion of the portal veins are, besides those which 
are characteristic to the diseases which lead to it: ascites, which in a few 
days attains an extraordinary amount, and which immediately returns after 
the performance of paracentesis; the superficial veins of the abdominal pari- 
etes enlarge and extend in the form of thick cords from the abdomen over 
the lower part of the thorax towards the axillae; the spleen increases in size; 
diarrhoea supervenes, of a watery, or often bloody character, not unfrequently 
accompanied by vomiting; the urine is scant}^ and dense; the patients de- 
cline rapidly and present a pale, cachectic appearance. The termination of 
the disease is, perhaps, without exception, fatal. 

Pylephlebitis Suppurativa, Purulent Inflammation of the Portal 

Vein. 

In this affection the thrombus softens from the centre into a dirty 
grayish-red pulp and afterwards dissolves more or less completely into a 
purulent fluid. The wall of the vein is thickened, softened, and infiltrated 
with exudation; its inner coat is discolored, red, brownish, or greenish- 
yellow, wrinkled, and not unfrequently torn and covered with fibrinous 
layers, or fluid pus. These alternations may spread to the hepatic branches 
of the portal vein, and even to its roots. 

It may be Produced by a direct lesion of the vascular walls (traumatic 
pylephlebitis), to which the pylephlebitis of the newborn belongs starting 
from the umbilicus; or by an inflammatory or ulcerative focus within those 
organs from which the radicles of the portal vein start; or by suppuration 
in the vicinity of the caecum and its vermiform appendix (appendicitis) ; or 
by a purulent or ichorous focus in the spleen; or by purulent deposits be- 
tween the layers of the mesentery, due to disease of the lymphatic glands; 
or by diseased conditions of the liver, the bilary passages, or in Glisson's 
capsule and the hepatico-duodenal ligament. 

Besides the Symptoms which belong to the disorders of which pylephle- 
bitis is the result, its commencement is marked by pains in the epigastrium, 
the right or left hypochondrium, the csecal or umbilical region, according as 
the trunk or one of the radicles of the vein is first diseased. This is soon 
followed by rigors, heat and profuse sweating, often recurring without any 
certain type. Liver and spleen, as a rule, increase in size, and the skin and 
urine become jaundiced. The stools are copious, thin and bilious, only ex- 
ceptionally constipated. Later S3anptoms of diffuse peritonitis, painful dis- 
tention of the abdomen, vomiting, etc., usually supervene; the patients 
rapidly lose flesh and strength; the fever assumes a hectic character, and ul- 
timately delirium or somnolence is developed and terminates in death. This 
series of symptoms may run its course in one or two to four or six weeks, 
oftentimes with several deceiving remissions. If its development cnanot 
be prevented its cure will scarcely be possible. 



554 ICTERUS, CHOI^EMIA, JAUNDICE. 

Icterus, Cholaemia, Jaundice. 

Jaundice is not a disease, but only a symptom, and consists of a yellow 
discoloration of the skin by the deposition of the coloring constituents of 
bile, namely: biliary pigment, biliphsein, cholepyrrhin. 

The so-called liver-spots (chloasmata, maculae hepaticse) have no relation 
to the diseases of the liver, but are partial deposits of pigment from various 
causes; and in some cases yellow discoloration is a disease of the skin of the 
chest, pityriasis versicolor, which consists of vegetable parasites. The yel- 
low discoloration of icterus varies greatly in degree, from a slight and light 
yellow through all shades to a blackish, and greenish-brown color. 

It is now conceded on all sides, but still not fully explained by experi- 
ments, that jaundice may originate in two different ways. First, by obstruc- 
tion to the escape of bile from the secreting gland (hepatogenous cholaemia), 
and secondly, bj- some alteration in the metamorphosis of substances con- 
tained in the blood (hematogenous cholaemia, or blood icterus). 

i. Hepatogenous Cholaemia which owes its origin to a mechanical 
impediment to the excretion of bile, and its resorption into the blood, is the 
best understood form of the two. The passage of the bile into the circula- 
tion seems, according to recent demonstrations, to take place almost exclu- 
sively b} T way of the thoracic duct, which would afford additional support to 
the theory, that there is between the secretory cells and the blood-capillaries 
of the liver, quite an extensive system of channels for the flow of lymph, 
and obviate at the same time the difficulty of understanding the mode how 
the bile could be infiltrated into the blood-capillaries which are everywhere 
separated from the gall-capillaries by the cellular substance of the liver. 

The Causes, of which stagnation of bile is the result, are very manifold. 
The ductus choledochus and hepaticus may become obstructed; by catarrh of 
their lining mucous membrane, as in icterus catarrhalis; by accumulation of 
fecal matter in the large intestines, or a pregnant uterus; by enlargement of 
the lymphatic glands in the fissure of the liver from lardaceous, tubercular, 
or cancerous infiltrations; by concretions in their own channel, usually at- 
tended with colic; by adhesions of their walls in consequence of exudative 
processes; by carcinomatous growths from the lining mucous membrane of 
their walls, or of the pylorus, of the duodenum, of the head of the pancreas, 
or by tumors in the liver. 

The biliary passages within the liver may become compressed, or con- 
stricted by a large number of morbid alterations of the liver, such as cancer, 
echinococci, cirrhosis, etc.; by stagnation of blood in the hepatic vein in con- 
sequence of organic cardiac diseases, and diseases of the lungs and pleura, in 
which affections the acceleration or retardation in the respirator}- movement 
of the diaphragm exerts also a great influence, which may be sufficient to 
cause an obstruction to the flow of bile. 

The Symptoms of a stoppage of bile and its accumulation in the blood, 
manifest themselves in a jaundiced discoloration of the liver, of the serous 



ICTERUS, CHOL^MIA, JAUNDICE. 555 

exudations, and of the secretions, especially those of the kidneys and skin. 
The urine becomes saffron- yellow, reddish-brown, dark brown, greenish- 
brown, or brownish-black, according to the quantity and quality of the bile- 
pigment which enters into it. The best reagent is nitric acid which is not 
altogether free from nitrous acid. By adding the concentrated acid, drop 
by drop into a small glass containing urine, the well-known play of colors 
from brown to green, blue, violet and red will be seen arranged in layers 
one above another, like a rainbow. The sweat, especially of the axilla, colors, 
the white linen 3 T ellow, and so also have the sputa in bilious pneumonia a 
brown, or usually, a leek-green color. With this tinging of the secretions 
with pigment goes hand in hand the discoloration of the tissues. The skin 
assumes a pale, sulphur yellow, later a saffron or citron yellow, or an olive 
or bronzed color, according to the intensity and duration of the disease. 
This discoloration is seen first on those places where the epidermis is thin, 
for instance on the nose wings, the angles of the mouth, the forehead and 
neck. As the coloring proceeds from the deeper layers of the epidermis, the 
yellow color of the skin remains until desquamation of the epidermis has 
been accomplished, which does not take place sometimes till long after the 
removal of the causes of the jaundice and the disappearance of the coloring- 
matter from the urine. The mucous membranes become only slightly tinged, 
but the coloring matter penetrates into all tissues : the adipose cellular tissue, 
the serous and fibrous membranes, the areolar tissue, the walls of the blood- 
vessels and of the lymphatics, and the substances of the bones and of the 
teeth. The cartilage, brain and nerves are less affected. When the brain 
appears yellow, the discoloration proceeds from infiltration of the cerebral 
substance with yellow serum. In the eye the jaundice color extends over all 
membranes, humors, and especially the vitreous body. In pregnant women 
even the foetus participates in the yellow color. The nervous system exhibits 
occasionally the following abnormal conditions: Itching of the skin; de- 
rangement of the general sensations, such as sadness and peevishness of temper, 
headache, giddiness, great exhaustion and debility; yellow sight or xanthopsy, 
bitter taste with clean tongue; slow pulse, in most cases 50 or 40 beats in a 
minute, in some cases still lower; the temperature in simple cases remains 
unchanged. 

The symptoms of the digestive organs, the most important in a practical 
sense, is the change in color of the feces. A total absence of bile makes the 
stools ash or clay-colored, with a tendency to constipation; a partial want of 
bile merely makes them paler than usual. 

The Duration and Prognosis of jaundice depends principally upon its 
primary causes. 

2. Hematogenous cholaemia, blood-icterus, seems to be caused by some 
alteration in the metamorphosis of substances contained in the blood not 
fully understood as yet; it runs its course independently of any influence ex- 
erted by the liver and without any detectable mechanical impediment to the 
excretion of bile. To this class belong jaundice from the effects of ether, 



556 ICTERUS, CHOU-EMIA, JAUNDICE. 

chloroform and phosphorous, from snake-bites, from pyaernic infection of the 
blood, from swamp fever, typhus and relapsing fever, and from yellow fever. 

Jaundice from violent mental emotions, especially vexation, anger, fright, 
etc. , seems likely to be produced by interruptions of the circulation of blood 
through the liver in consequence of the influence of the nerves controlling 
the calibre of the branches of the portal veins, and. by interruptions of the 
heart's action, the respiratory movements and the renal secretion. 

Icterus menstrualis is probably produced by sudden changes in the 
blood pressure in the portal vein. 

Icterus gravidarum, which makes its appearance in the latter months of 
pregnane}', is produced by the pressure of the distended uterus, or by ac- 
cumulation of fecal matter in the colon, upon the biliary ducts, or it is char- 
acterized by serious derangements of the nervous system, and, so far as cases 
of this kind have as yet been examined, depends upon acute atrophy of the 
liver and diseased kidneys. 

Icterus neonatorum appears soon after birth, and in ordinary cases seems 
to be produced by the diminished tension of the capillaries in the hepatic 
tissue, which takes place upon the stoppage of the influx of blood from the 
umbilical vein, and which gives rise to an increased transfusion of bile into 
the blood. A graver form is that in consequence of phlebitis umbilicalis fol- 
lowing by purulent infection. In some cases it may be produced by a catarrh 
of the duodenum or an accumulation of mucus within the gall-ducts. 

Jaundice of newborn children must not be confounded with the slight 
yellowish discoloration of the skin, which, in most children, is seen a few 
days after birth and is nothing but a change of color of the hsematin, which, 
in consequence of the great hyperemia of the skin after birth, becomes de- 
posited in the skin. In such cases the yellow color of the white of the eye 
is absent. 

Dr. Quine makes the following remarks upon the significance of jaun- 
dice in diagnosis: " 1. Jaundice occurring suddenly in apparent health, and 
painlessly, is usually of emotional origin and transitory. 2. When it depends 
on disease or injury of the brain, acute atrophy of the liverj snake-poisoning, 
or infectious fever, it is always associated with mental disturbances. 3. If it 
be attended with fever and well marked, it is secondary to inflammation of 
the biliary passages, pneumonia, toxaemia, or infective inflammation of the 
portal vein. 4. If it occur suddenly and is preceded by paroxysmal pain 
and vomiting, it is caused nine times out of ten by biliary calculi. 5. If it 
is preceded by typical symptoms of gastro-duodenitis, it is obviously of catar- 
rhal origin. 6. Impassable obstruction of the common duct is shown by 
great intensity of jaundice, clay-colored stools, and in recent cases by disten- 
tion of the gall-bladder. 7. Jaundice caused by sudden obstruction of the 
biliary passages is always associated with paroxysmal pain and nausea, but 
there is no means of ascertaining the nature of the obstructing body except 
its discovery in the stools. 8. In the rare cases of sudden obstruction by 
cancerous, hydatid and aneurismal tumors, there is almost always a history 



THERAPEUTIC HINTS TO ICTERUS, CHOL^EMIA, JAUNDICE. 557 

of impaired health, enlargement and deformity of the liver, ascites, etc., 
which, aided by the revelations of physical exploration, will lead to a correct 
differentiation. 9. Sudden return to normal coloration of the feces confirms 
the diagnosis of obstruction. 10. Occlusion of the cystic duct may be attended 
with as much pain, nausea and distention of the gall-bladder as occlusion of 
the common duct, but there is no jaundice. In occlusion of the hepatic duct, 
the same symptoms are present, including jaundice and excluding distention 
of the gall-bladder. It is often impossible to distinguish between occlusion 
of the hepatic and of the common duct. The former is rare because the duct 
increases in size from above downwards. 11. If jaundice persists after the 
sj'mptoms of biliary colic or catarrhal inflammation have a month since dis- 
appeared, or if jaundice has disappeared after a biliary colic to return slowly 
and painlessly, it may be assumed that stricture of the duct has resulted from 
inflammatory thickening, adhesion of the walls or cicatrization of an ulcer. 

12. A history of repeated attacks points to the probability of gall-stones. 

13. If jaundice comes on slowly without antecedent colic or catarrh, and 
without attendant evidence of impaired health or portal obstruction, it is 
probably caused either by pressure upon the duct or by the growth of a 
tumor within its walls. The pressing body, when large enough, may be 
readily appreciated, as in the case of ovarian tumor, aneurism, distended 
colon, etc. , but when it is small or constituted by enlargement of lymphatics 
in the fissure of the liver, it is apt to escape detection. 14. Slight but per- 
sistent jaundice may be due to incomplete occlusion of the common duct, or 
to complete occlusion of a branch of the hepatic, but usually it is found asso- 
ciated with either valvular diseases of the heart, some disease of the lungs 
which obstructs the circulation, or cirrhosis of the liver. 15. If ascites be 
associated with it, the disease is either cirrhosis or cancer of the liver; if the 
liver be abnormally small, the disease is cirrhosis; if it be large, the disease 
is either hypertrophic cirrhosis or cancer. Differentiation between the two 
is seldom attended with difficulty. 16. Absence of jaundice does not imply 
absence of hepatic disease, since the liver may be destroyed by disease or 
extirpated by operation without jaundice ensuing. 17. It is not a prominent 
symptom of hepatitis, if catarrhal inflammation of biliary passages be rigidly 
excluded. It is not characteristic of hepatic abscess when at most mere mud- 
diness of the complexion is usually seen. It is not a symptom of waxy or 
fatty liver or of hydatids excepting as an extraordinary complication." 
{Medical Times and Gazette. ) 

Therapeutic Hints. 

Aeon. Pain changing about from the stomach to the liver, or to the 
navel; fever, great thirst; catarrh of small intestines; constipation or diar- 
rhoea, sometimes in alternation; during pregnancy; in newborn children; 
after fright. 

Arsen. In different liver affections; in consequence of intermittent 
fevers; heat, restlessness, anxiety, irritable mood alternating with low-spir- 
itedness. 



558 THERAPEUTIC HINTS TO ICTERUS, CHOL.EMIA, JAUNDICE. 

Auruvi. Pain in the liver and upper part of the abdomen; bowels con- 
stipated; stool grayish, ashy; urine scanty, green, brownish; lower extremi- 
ties, from the knees down to the feet, painful and tired. 

Bellad. After the abuse of Peruvian bark or mercury, in complication 
with stones in the gall-bladder; hardness of the liver; congestion to the head. 

Berber. Spells of icterus with pale, tough alvine discharges, or profuse, 
acrid, water}* diarrhoea; urine dark, turbid, with copious sediment; morbid 
hunger alternating with loathing of food, or great thirst alternating with 
aversion to all kinds of drink; constant, troublesome bloatedness of the ab- 
domen, with occasional forcible and noisy discharge of flatus. 

Bryon. Stitching pain on pressure in the liver; pressure in the pit of 
the stomach; pain in the limbs, worse from motion; obstinate constipation; 
thick, white, coated tongue; nausea; gagging; vomiting after eating and 
drinking; general malaise; disinclination to move. 

Calc. carb. Stitches in the liver during or after stooping; cannot bear 
tight clothing around the waist; enlargement of the liver; habitual constipa- 
tion; grayish, whitish feces; indigestion; pit of the stomach swollen out like 
a saucer turned bottom up. 

Card. mar. In complication with gall-stones; great sensitiveness of the 
head to cold; loss of memory and smell; colicky pains in the stomach, with 
waterbrash; vomiting. 

Carb. veg. Psoric taint; scorbutic and intermittent fevers; cachexia; 
irritable, vehement disposition; loathing of meat, butter, fat; constipation, 
or pale, whitish stools; dark red, bloody-looking urine. 

Chamom. After chagrin, imprudent diet, or taking cold; in newborn 
children. 

Chelid. Pain in the liver, and in the back under the lower corner of 
the right shoulder-blade; very irregular pulsations of the heart. 

China. Gastro-duodenal catarrh, particularly after great loss of animal 
fluids, or after heavy illness; dullness and muddled condition of the head; 
oppressive, tearing headache, particularly at night; restless, unrefreshing 
sleep; yellow coating of the tongue; dry lips; loss of appetite; loathing of 
meat; loathing, and yet canine hunger; bitter or sour eructations and taste; 
gagging; oppression of the stomach and chest, especially after eating; fre- 
quent whitish stools; emission of fetid flatulence without relief; great languor, 
out of humor, and vehement. Gall-stones. 

Coniitm. Hard swelling of the liver; glandular swellings elsewhere; 
the flow of urine stops suddenly, but continues again after a while; cough 
worse after lying down. 

Digit. Constant nausea and gagging, with a clear tongue covered with 
white slime; soreness and bloatedness of the pit of the stomach; soreness and 
hardness in the region of the liver; stool delayed, chalky; urine scant}*, thick, 
turbid, blackish; pulse full, slow; chilliness and shuddering alternating with 
heat; tearful, low-spirited. 



THERAPEUTIC HINTS TO ICTERUS, CHOI^EMIA, JAUNDICE. 559 

Fel tauri. Violent paiu in the bowels with thin stools, which are fol- 
lowed after straining by crumbling masses. 

Gelsem. Prostration; clay-colored, creamy stools. 

Hepa? . Especially after mercurial poisoning. 

Hydrast. Gastro-duodenal catarrh; sense of sinking and prostration 
at the epigastrium, with violent and continued palpitation of the heart. 

Ignat. Silent melancholy; twitching of one muscle at a time. (Gushing. ) 

Iodiuvi. Dirt}', yellowish skin; great emaciation; downcast, irritable 
mood; yellow, almost dark brown, color of the face; thick coating of the 
tongue; much thirst; intense canine hunger all the time, with vomiting after 
eating; white diarrhceic stools alternating with constipation; dark yellowish- 
green, corroding urine; after mercurial poisoning; organic lesions of the 
liver; dyscratic states of the system with hectic fever. 

Kali carb. Swelling of the liver; stitch-pain in the right side of the 
chest through to the shoulder; pressive, sprained pain in the liver; can lie 
only on the right side; complete exhaustion; neither thirst nor appetite; 
purulent sediment in the urine; abscess of the liver. 

Laches. In different liver complaints; during the climacteric age; 
after intermittent fevers; pain as if something had lodged in the right side, 
with stinging and sensation as if forming into a lump moving towards the 
stomach; inability to bear anything tight around the waist, not even the 
pressure of the night-jacket; pain when coughing as if ulcerated. 

Leptand. Full, aching pain in the region of the gall-bladder; hot 
aching pain in the liver extending to the spine; with chilliness along the 
spine; clay-colored diarrhoea. 

Lycop. Chronic liver complaints; after fright; obstinate constipation; 
incarcerated flatulence; chronic intestinal catarrh. 

Magn. mur. Chronic hard swelling of the liver, with pressive pain 
extending to back and stomach; face dirty, dark yellow; tongue dirty, 
yellowish; bowels distended and hard with pressure and heaviness; stool 
hard, gray; urine turbid; dyspnoea; palpitation of the heart; oedema of the 
feet up to the calves of the legs; weak, emaciated; fearful, easily frightened. 

Mercur. One of the most frequently indicated remedies, with and with- 
out fever; duodenal catarrh, with thickly coated, flabby tongue, showing the 
imprints of the teeth; bad smell from the mouth; nausea; loathing; vomit- 
ing; soreness in the region of the liver; diarrhoea; gall-stones; jaundice of 
newborn children; after abuse of Peruvian bark. 

Myrica cerif. Dragging pain in the back; miserable feeling all over; 
dull pain in the hepatic region; tongue thickly coated of a dirty white or 
yellowish color; no appetite, loathing of food, strong desire for acids; sleep- 
lessness, unrefreshing sleep. 

Nitr. ac. In consequence of chronic derangements of the liver; costive- 
ness; great tearing pain in the rectum, continuing a long time after stool, 
even more intense after a loose stool. 

Nux vom. Gastro-duodenal catarrh; after allopathic dosing, overloading 



560 THERAPEUTIC HINTS TO ICTERUS, CHOU^EMIA, JAUNDICE. 

the stomach, the use of coffee, liquor, in sedentary habits, after anger. In 
complication with gall-stones. Headache, dizziness, loss of appetite, bitter 
taste; nausea, vomiting, gagging; pressure in the stomach, better from 
belching, soreness of pit, stomach and bowels; unsuccessful urging to stool, 
constipation. Itching of the skin in the evening; restless sleep; wakes about 
three or four o'clock in the morning and falls again into a heavy, unrefresh- 
ing morning sleep; peevish, irritable. 

Phosphor. In complication with pneumonia or deep seated brain 
diseases. Atrophy of the liver; during pregnancy, with dry cough and in- 
voluntary discharge of urine; constant chilliness, even in a warm room; 
dejected spirits; aphonia and hoarseness. 

Plumbum. Nausea in evening or at night; vomiting of food; restless, 
broken sleep. 

Podoph. In complication with gall-stone; then the pain extends from 
the region of the stomach towards the region of the gall-bladder, and, when 
at its height, is mostly attended with excessive nausea; or in complication 
with inflammatory or hyperaemic states of the liver; then there is a fullness, 
with pain and soreness, in the right hypochondrium; chronic costiveness or 
alternate constipation and diarrhoea. 

Pulsat. In consequence of chronic susceptibility to hepatitis and de- 
rangement of the secretion of bile, with looseness of the bowels; duodenal 
catarrh; disordered digestion; feverishness and thirstlessness; after quinine. 

Rheum. In consequence of eating unripe fruit, and accompanied with 
white diarrhoea. 

Sepia. With pain confined to the liver; yellow saddle across the bridge 
of the nose; brown, yellowish color of the eyelids. 

Silic. Hardness and swelling of the region of the liver; throbbing, ul- 
cerative pain in the right hy pochondrium , increased by contact and walking. 

Sulphur. In psoric persons, with or without hardness and swelling of 
the liver; vomiting of ingesta or blood; pain in the pit of the stomach and 
right hypochondrium; abdomen bloated; stool constipated; sleeplessness; 
nightly itching of the skin; hetic fever; red lips. 

According to Hartman compare, if icterus be caused by chagrin or 
anger: Aeon., Bryon., Chamom., China., Ignat., Nux vom., Natr. viur., 
Sulphur. 

By taking cold in conseqnence of sudden changes of temperature : 
Chamom., Dulcam., Merc, sol., Nux vom. 

By improper food and overloading the stomach: Ant. crud., Bryon., 
Card, veg., Chamom., Natr. card., Nux vom., Pulsat. 

By the abuse of chamomile tea : China., Ignat., Nux vom., Pulsat. 

By the abuse of mercury: Arsen., Asa/., China, Hepar, Iodium, Nitr. 
ac., Sulphur. 

By the abuse of Peruvian bark: Arsen., Ipec., Mercur., Pulsat. 

If being attended with much flatulence, according to Bcenninghausen: 
Card, veg., Chamom., China, Ignat., Lycop., Nux vom., Plumbum. 



DIGEST TO JAUNDICE. 



561 



Digest to Jaundice. 



Tearful: Digit. 

Silent, melancholy: Ignat. 

Anxiety: Arsen. 

Fearful and easily frightened: Magn. 

mur. 
Low-spirited: Arsen., Digit., lodium, 

Phosphor. 
Irritable: Arsen., Card, veg., lodium, 

Nux vom. 

and peevish : Nux vom. 

Out of humor and vehement: China. 
Miserable feeling all over: Myrica. 
Dizziness : Nux vom. 
Dull and muddled in head: China. 
Congestion to head: Bellad. 
Headache worse in night: China. 
Head sensitive to cold: Card. mar. 



Eyelids brown, yellowish: Sepia. 

Face yellow, almost dark brown: lodium. 

, dirty: lodium, Magn. mur. 

Yellow saddle across bridge of nose: 

Sepia. 
Loss of smell and taste: Card. mar. 
Lips dry: China. 

red: Sulphur. 

Tongue clear, covered with white slime: 

Digit. 
coated thick: Bryon., Ionium, 

Mercur. 

white: Myrica. 

yellowish: China, Magn. mur., 

Myrica. 
flabby, showing imprints of teeth: 

Mercur. 
Taste bitter: China, Nux vom. 
Bad smell from mouth: Mercur. 
Appetite, loss of: Kali carb., Myrica, 

Nux vom. 
Loathing of food: Mercur., Myrica. 

meat, butter, fat: Carb. veg. 

food and yet morbid hunger: Berber., 

China. 
Canine hunger with vomiting after eat- 
ing: lodium. 
Desire for acids: Myrica. 
Thirst : Aeon., lodium. 
Thirst alternating with aversion to all 

kinds of drink: Berber. 
Thirstless : Kali carb., Pul at. 
Eructation, bitter: China. 
Nausea • Bryon., Plumbum., Podoph. 

36 



and vomiting: Card, mar., Nux 

vom., Plumbum. 

Vomiting after eating with canine hun- 
ger: lodium. 

or drinking: Bryon., Sulphur. 

Gagging: Bryon., China, Digit. 



Pit of stomach sinking with palpitation: 
Hydrast. 

sore: Digit., Nux vom. 

, pressure in: Bryon. 

, better from belching: Nux 

vom. 

swollen out like a saucer turned bot- 
tom up: Calc. carb. 

Oppression of stomach and chest, after 
eating: China. 



Abdomen bloated: Berber., Sulphur. 

, hard, with pressure and heavi- 
ness: Magn. mur. 

Duodenal catarrh: Aeon., Chamom. y 
China, Hydrast., Mercur., Nux vom. y 
Pulsat. 

Colicky pains with waterbrash: Card. 



Liver, hardness of: Bellad., Coninm, 
Magn. mur., Silic, Sulphur. 

, swelling of: Calc. carb., Conium, 

Kali carb., Magn. mur., Silic, Sul- 
phur. 

, pain: Sepia. 

, dull pain: Myrica. 

, soreness in: Mercur., Podoph. 

, sprained, pressive pain: Kali carb. 

, stitching on pressure or motion: 

Bryon. 

, , during and after stooping: 

Cad. carb. 

, ulceration, worse from contact and 

walking: Silic. 

, pain in, and pit of stomach: Slphur. 

Liver, like a lump moving towards stom- 
ach: Laches. 

, pain in, and upper part of abdomen: 

Aurum. 

, pain changing to stomach or to 

navel: Aeon. 

, pain in, and stomach and gall-blad- 
der: Podoph. 



562 



DIGEST TO JAUNDICE. 



, aching in, and gall-bladder: Lep- 

tand. 

,pain in, extending to spine: Leptand. 

, , extending to back and stom- 
ach: Magn. hi ur. 

stitch-pain through to shoulder: 

Kali card. 

, pain in, and lower corner of right 

shoulder-blade : Chelid. 

Cannot bear anything tight around 
waist: Calc card., Laches. 



Constipation: Aurum, Bryon., Calc. 

card., Card, veg., Lycop., Nitr. ac, 

Nux vow., Podoph., Sulphur. 
and diarrhoea in alternation: Aeon., 

/odium, Podoph. 
Diarrhoea: Berder., Leptand., Mercur., 

Pulsat., Rheum. 
with straining, with passing crumb- 
ling masses: Fel tatiri. 
, with long-continued pain in rectum 

afterwards: Nitr. ac 
Stool, ashy, grajnsh, clay-colored, 

creamy, pale, whitish: Aeon., Calc. 

card., Card, veg., China, Digit., 

Gelsem., Leptand., Rut a. 
Flatulence: Berder., Card, veg., China, 

/gnat., Lycop., Nux vom., Plumdum. 
Urine, its flow is suddenly interrupted 

for a short time : Conium. 

, squirting when* coughing: Phosphor. 

, turbid: Berber., Digit., Magn. mur. 

, scant} 7 : Aurum, Digit. 

, thick, blackish: Digit. 

, brownish, green: Aurum. 

, dark, yello wish-green, corroding: 

/odium. 

■ , dark red, bloody looking: Card. veg. 

Sediment, copious: Berder. 
, purulent: Kali card. 



Aphonia and hoarseness: Phosphor. 

Dyspnoea: Magn. mur. 

Cough worse after lying down: Conium. 

with pain as if ulcerated: Laches. 

dry with squirting of urine: Phos- 
phor. 

Palpitation of heart : Hydroph . , Magn . 

mur. 
Irregular pulsations of heart: Chelid. 
Pulse full and slow: Digit. 



Back, dragging pain in: Myr. cerif. 



Limbs, pain in, worse from motion: 

Bryon. 
From knees to feet, pain and tired: 

Aurum. 
(Edema from feet to calves: Magn. mur. 
Twitching" of one muscle at a time: 

/gnat. 
Itching of skin in evening: Nux vom. 

Sulphur. 
Emaciation: /odium, Magn. mur. 
Exhaustion: Gelsem., Kali card. 
Disinclination to move : Bryon. 



Fever : Aeon., Arsen., Pulsat. 

or no fever: Mercur. 

, hectic: /odium, Sulphur. 

Chilliness : Pulsat. 

even in a warm room: Phosphor. 

and shuddering alternating with 

heat: Digit. 



Sleeplessness : Sulphur. 

Sleep restless, uurefreshing: China, Myr- 

ica, Nux vom. 

, broken: Plumdum. 

, wakes about 3 or 4 o'clock A.M., and 

then heavy, unrefreshing morning 

sleep: Nux vom. 
Restlessness : Arsen. 

CAUSES. 
Abuse of chamomile tea: China, /gnat., 

Nix vom., Pulsat. 
mercury: Arsen., Asa/., Bell ad., 

China, Hepar, /odium, Nitr. ac, Sul- 
phur. 
Peruvian bark: Arsen., Bel lad. /pec, 

Mercur., Pulsat. 

quinine: Pulsat. 

Allopathic dosing : Nux vom. 
Chagrin or anger: Aeon., Bryon., China, 

Chamom., /gnat., Natr. mur., Nux 

vom., Sulphur. 
Improper food or overloading stomach: 

Ant. crud., Bryon., Card, veg., 

Chamom., Natr. card., Nux vom., 

Pulsat. 
Unripe fruit : Rheum. 
Coffee, liquor: Nux vom. 
Intermittent fevers : Arsen., Card.veg., 

Laches. 
Sudden changes of temperature : 

Chamom., Dulcam., Merc sol., Nux 

vom. 



DISEASES OF THE SPLEEN. 563 

COMPLICATIONS. I Nitr. ac, Phosphor., Podoph., Pulsat. 

Brain diseases : Phosphor. Sulphur. 



Catarrh of small intestines: Aeon., Cha- 
mom., China, Hydroph., Lycop., 
Mercur. y Nux vom. 

Gall-stones: Bellad., Card, mar., China, 
J/ercur., Nux vom., Podoph. 

Liver-COmplaints of different nature: 
Arsen., Bellad., Conium, Iodium, Kali 
card., Laches., Lycop., Magn. mur. s 



Pregnancy: Aeon., Phosphor. 

Pneumonia : Phosphor. 

Climaxis: Laches. 

Newborn children: Aeon., Chamom. 

Mercur. 
Dyscratic states of system: Iodium, 
Psoric taints: Card, veg., Sulphur. 



DISEASES OF THE SPLEEN. 

Physical Examination. — When of normal size — which in an adult is 
as follows: Length, four to five inches; breadth, three to four inches; thick- 
ness, one to one and a half inches — the spleen yields on percussion a dull 
sound, bounded as follows: posteriorly by the body of the eleventh dorsal 
vertebra; in front by a vertical line drawn from the anterior border of the 
axilla to the free end of the eleventh rib; superiorly by the ninth rib; and 
inferiorly by the free end of the eleventh rib. In order to obtain a clear 
result by percussion the patient ought to be placed upon his right side. It 
must likewise be considered whether the stomach be not filled at the time of 
percussion. In cases of accumulation of fluids in the left thoracic cavity, 
either pleuritic or pericardial, in accumulation of gas, abdominal or thoracic, 
in tumors of neighboring organs (liver, omentum, kidney), it may sometimes 
be next to impossible to define the size and position of the spleen. 

A considerabty enlarged spleen, however, under ordinary circumstances 
is easily detected by percussion. And it is sometimes enormously enlarged 
and displaced, reaching inferiorly to the os pubis and anteriorly to the 
median line of the abdomen; in some cases even filling almost the whole 
abdominal cavity. 

In such cases it is also accessible to palpation. Even a moderate en- 
largement may be felt, if it extend below the eleventh rib. Its surface, 
except when invaded by cancer, is always smooth; and its form oval and 
sometimes wedge-shaped. Its rounded apex, and the notch which corre- 
sponds to the middle line of the spleen, and which becomes the more marked 
the larger the spleen grows, are characteristic signs by which to distinguish 
it from any other abdominal tumor. 

Notwithstanding great and laborious experiments, we know as 3'et but 
little concerning the functions of this organ. Only so much seems to be 
certain, that it bears an important relation to the formation of white blood- 
corpuscles, and the disintegration of the red corpuscles. And this seems 
to be corroborated by the fact, that diseases of the blood always affect 
the spleen, altering it in size and consistence and, vice versa, that lasting- 
diseases of the spleen lead to a diseased state of the blood, causing anaemia, 
leucaemia, hydrops, scurvy. 

Cases in which such a connection does not seem to exist, prove, perhaps, 



564 ANATOMICAL PECULIARITIES OF THE SPLEEN. 

only that the function of the spleen ma}', under certain circumstances, be 
performed by some other organ or organs vicariously. 

Anatomical Peculiarities of the Spleen. 

It consists of a much softer and looser texture than any other glandular 
organ of the body; its areolar framework is made up of the elastic tunic 
which forms sheaths for the vessels in their ramifications through the organ, 
which again are loosely connected by small fibrous bands, issuing in all 
directions from said sheaths. In this way a multitude of interstices is formed, 
which contain a soft, granular substance. This peculiarly loose construction 
makes the organ pre-eminently fit for the reception of large quantities of 
blood; and the more so as its capsule is also of a yielding nature, offering 
little resistance to extension; so that, on the other hand, if once overdistended, 
it regains its previous normal state very slowly; and this on account of the 
inelasticity of its tissue. The veins of the spleen constitute, by their numer- 
ous dilatations, the principal part of its bulk; they pour their blood, after 
uniting with the veins of the stomach, and other less important vessels, into 
the portal vein. 

The whole organ is held loosely in its position by a duplicature of the 
peritoneum. 

The knowledge of these anatomical peculiarities of the spleen at once 
explains its participation in various abdominal and pectoral affections. x\ll 
hepatic troubles, and all diseases of the heart and lungs which obstruct the 
portal circulation, must necessarily retard or prevent the normal egress of 
blood from the spleen, and cause it to swell; a stagnation of blood in the 
splenic vein must cause .a like stagnation in the veins from the stomach, and 
thus bring on vomiting of blood, and its loose connection explains at once 
the possibility of its sinking quite low down into the abdominal cavity under 
certain circumstances. 

Hemorrhagic Infarction; Splenitis, Lienitis, or Inflammation of 

the Spleen. 

Hemorrhagic infarction is of much more frequent occurrence in this 
organ than in any other. It consists of blocking-up of the smaller splenic 
arteries by fibrinous coagula, which have formed in the left ventricle of the 
heart in consequence of endocarditis, and which have been washed away by 
the stream of blood, and carried through the splenic artery into its smaller 
branches, where they stick fast. This is of such frequent occurrence that it 
is very rare not to find hemorrhagic infarction in the spleen, in all cases 
where post-mortem examination reveals valvular destruction to any con- 
siderable degree; much more rarely, such emboli come from gangrenous 
places of the lungs. In such cases they have to pass through the pulmonary 
veins, the left ventricle, aorta and splenic artery. Hsemorrhagic infarction 
forms also in consequence of malarial infections, typhus, septicaemia, and 



HEMORRHAGIC INFRACTION. 565 

acute exanthematic fevers; in these cases, it seems, by a stagnation of circu- 
lation within the splenic veins. These hemorrhagic coagula or thrombi are 
usually situated at the periphery of the spleen, and are roundish or wedge- 
shaped, their broad base being nearest to the periphery, while their apices 
point toward the interior. 

The}' appear at first of darker color and harder than the surrounding 
tissue, which appears perfectly sound. By-and-by, however, they become 
discolored and changed into a yellow, firm, homogeneous mass, which during 
the further progress of the disease may undergo several changes. It may 
shrink and leave a cicatrix, or suppurate and form abscesses of the spleen, 
which, if the}' are many, may transform the whole spleen into a mass of cor- 
ruption. 

These abscesses again may go on to different terminations. They may, 
by fibrinous exudation, become encysted, or they may cause pyaemia, or they 
may burst and discharge their contents, like abscesses of the liver, into the 
peritoneal sac; or when adhesions have been formed with neighboring or- 
gans, they may, by perforation, discharge their contents into the stomach, 
colon, or the pleural cavity. 

A primary inflammation of the spleen is of very rare occurrence ; even 
external injuries, a blow, a fall, a wound, are apt to cause a rupture, rather 
than an inflammation. 

Its Symptoms are frequently quite obscure and of an uncertain character, 
so that it is often not recognized until post-mortem examination brings it to 
light. We have a better chance of discovering its presence when it is pro- 
duced by cardiac diseases, and there is also an enlargement of the spleen, 
which, however, never reaches more than double its normal size, and in many 
cases is so insignificant that it cannot be discovered by percussion. 

Pain in the region of the spleen originates not in the substance of the 
spleen itself, but in its enveloping membrane or in the neighboring organs, 
and is, therefore, sometimes entirely wanting. When it does exist, it is of a 
dull character, and is increased by deep inspirations, different movements of 
the»body, and percussion. A sharp pain denotes an inflammation of its 
peritoneal covering. A radiating pain into the left shoulder is likewise 
sometimes observed. 

Fever is usually entirely or partly dependent on the original disease; 
but when suppuration has taken place, the characteristic rigors make, as a 
rule, their appearance. 

Peritonitis follows in case of rupture or perforation. On the whole a 
certain diagnosis can only be made when, after traumatic causes or in conse- 
quence of pyaemia, endocarditis, etc. , local and general symptoms arise which 
can be referred to the spleen. And the diagnosis increases in probability if 
metastatic inflammation of other organs are developed at the same time, for 
instance in the kidneys with albuminuria and haematuria. 



566 ACUTE TUMOR. 

Therapeutic Hints. 

Compare such remedies as are pointed out under the heads of those 
diseases which are either the cause or complications of splenitis, as endocar- 
ditis, valvular derangements of the heart, etc. 

Acute Tumor, or Hyperemia of the Spleen. 

This consists of a more or less copious accumulation of blood within the 
gland, by which its volume may become enlarged to three or four times its 
normal size. The color of its tissues varies from red to brown or violent, and 
in case of a long duration it changes to a dirty gray or slate color. 

This acute swelling of the spleen is an almost constant attendant upon 
typhus, intermittent, remittent, yellow and puerperal fevers; likewise upon 
cholera in its stages of reaction, and of a number of other complaints, such 
as pylephlebitis and cirrhosis, by which a stagnation in the portal circulation 
causes stagnation of blood in the spleen. We find it likewise attending 
anomalies of menstruation. It is therefore always of a secondary nature, 
and its symptoms must vary accordingly. Symptoms, which belong exclu- 
sively to it, are — 

i. The conspicuous enlargement, which can easily be discovered by per- 
cussion and palpation. 

2. A dull pain in the region of the spleen, which is generally increased 
by motion, pressure, deep breathing, and lying on the left side. 

3. A conspicuous anaemic appearance of the patient which, especially 
in intermittent fevers, sets in very quickly and keeps pace with the enlarge- 
ment of the spleen. 

All other symptoms belong to the primary disease which causes it; for 
therapeutic hints compare these diseases. 

Hyperemia of the spleen leaves with the primary disease; in some cases, 
however, it assumes a permanent form; and thus originates — 

Chronic Tumor, or Hypertrophy of the Spleen. 

The spleen sometimes attains a weight of ten, fifteen to twenty lbs., fill- 
ing almost the entire abdominal cavity. Its resistance is often like that of a 
board, and its substance appears dark brown red. This is simple hypertrophy, 
consisting of an increase of granular substances in the interstices, formed by 
the numerous fibrous bands of the splenic structure. In other forms it has, 
as a rule, the appearance of waxy or colloid degeneration, and consists in- 
deed of the same homogeneous colloid mass, which the colloid liver presents, 
and then is called amyloid degeneration of the spleen. 

A peculiar variety of this affection is the so-called Sago-spleen, where 
the whole organ appears to be infiltrated with half-solid, transparent, round 
globules, which can be taken out, and very much resemble boiled sago. It 
seems that the development of this* peculiar appearance depends upon the in- 
filtration of the same colloid mass into the vesicles of Malpighi. 



CANCER OF THK SPOKEN. 567 

The chronic tumor resulting from intermittent fevers is of a slate 
color. 

The Causes of this chronic enlargement of the spleen, when it is simple 
hypertrophy, are, all such disorders as cause a stagnation of blood within the 
venous circulation, to wit: heart and lung diseases, inflammation and obliter- 
ation of the portal veins, and cirrhosis of the liver; but when it consists of 
an amyloid degeneration, a number of diseases, which depend upon a morbid 
state of the blood — so-called dyscrasias — malaria, constitutional syphilis, 
mercurial cachexia, rachitis, scrofulosis, Bright' s disease, in a lesser degree, 
chlorosis, scurvy and leukaemia. 

Symptoms. — Enlargement of the spleen, usually very great, and charac- 
terized by its roundish apex and the notch on its inner edge. All other 
symptoms belong more or less to the primary affection, and are therefore of 
no diagnostic value for the tumor itself. 

Therapeutic Hints 

Must be looked for under the respective heads of causes; however, the 
following remedies have a special relation to the spleen: Arnica, Asaf., 
Arse?i., Borax, Bromium, Card, veg., Ceanothus in spleen pain, China, Dul- 
cani., Ferrum, Ignat., Laches., Lauroc, Mercur., Mur. ac, Natr. carb., 
Natr. mur., Nux mosh., Platina, Plumbum, Ran. bulb., Rhus tox., Ruta, 
Stannum, Sulphur, Zincum. 

Spleen affections and obstinate diarrhoea: Anac, Asaf., Bryon., China, 
Dulcam., Ignat., Pulsat., Rhux tox., Sulph ac. 

Cancer of the Spleen 

Is a very rare disease; is generally of the medullary or encephaloid form, 
and sometimes attains a pretty large size; it is always connected with cancer 
in other organs, especially those of the abdomen. 

Its Diagnosis is easy, when the existence of cancer in other organs has 
been proved, and when the enlarged spleen shows on palpation that charac- 
teristic cancer-unevenness. 

Echinococcus- cysts 
Are of very rare occurrence; they may exist in the spleen alone, and also in 
other organs at the same time. 

Its Diagnosis is difficult, being possible only under those favorable cir- 
cumstances in which the echinococcus-cyst is accessible to percussion and 
palpation, when it may be discovered as a roundish fluctuating tumor. 

Rupture of the Spleen 

May be caused by external injuries, violent concussions of the body, or by 
pathological changes of the gland itself, as in its rapid enlargement, especially 
in typhus, or during the chilly stage in intermittents. 

Symptoms. — A sudden very intense pain in the region of the spleen, 
spreading over the whole abdomen. And in consequence of the internal 



568 DISEASES OF THE PANCREAS. 

haemorrhage: paleness, collapse, cold extremities, small pulse, vanishing of 
sight and hearing, syncope, distention of the abdomen, death. 

Its Diagnosis must be founded upon the sudden pain in the region of 
the spleen, and a knowledge of the previous ailments. A perforation of the 
stomach or of the intestine always causes tympanitis by its air rushing into 
the peritoneal cavity, and peritonitis. The latter is also caused by ruptures 
of the liver, gall-ducts, and of the bladder; and besides, the pain which is 
hereby produced is not in the region of the spleen. A fatal termination 
usually follows, generally within twenty-four hours. 

DISEASES OF THE PANCREAS. 

The pancreas, the abdominal salivary gland, is situated behind the left 
lobe of the liver and the stomach, and discharges its secretion by a main 
duct into the duodenum in the vicinity of the opening of the ductus chole- 
dochus into the duodenum. Sometimes the pancreatic and biliary ducts 
become united just before the}' enter the duodenum. 

Its secretion assists in the transformation of starch into dextrine and 
sugar, and in the digestion of albumen and of fat. It shares its saccharify- 
ing power with the saliva, perhaps also with the secretion from Brunner's 
glands, its peptonizing properties with the gastric juice and succus entericus, 
and its power of emulsifying neutral fats with the bile; while its power of 
breaking up fat into fatty acids and glycerine is the only one which, as far 
as our knowledge of to-day goes, can be said to be peculiar to the pancreas. 

From this statement it may easily be seen why a diagnosis of diseased 
conditions of this gland is in most cases very difficult and in some altogether 
impossible. The following symptoms, however, may hint to affections of the 
pancreas without being pathognomonic: Emaciation of the whole body be- 
ginning early and proceeding to an unusual degree; a flow of saliva-like 
fluid from the mouth, either as eructations or by frequent spitting; the pres- 
ence of fat in the stools, sometimes in the urine floating upon it on cooling, 
like masses of butter; the presence of large quantities of undigested striped 
muscular fibres in the fecal discharges; the presence of diabetes mellitus and 
also chronic jaundice. The pain in the epigastrium is shared by a great 
number of other disturbances, and even the results of palpation are in 
many cases negative on account of the deep position of the pancreas, and its 
being covered by the stomach and liver. Occasionally, however, palpation 
may lead to positive results, when performed with both hands by lateral 
pressure on the hypochondriac regions, or in the knee-elbow position, when 
the altered pancreas ma}?- be discovered lying crosswise in the epigastric re- 
gion as a slightly movable swelling, or as a round, firm, or fluctuating tumor, 
either smooth or nodular on its surface. Among these symptoms the most 
important are: fatty stools, mellituria, darting pains in the epigastrium 
(cceliac neuralgia), together with a palpable tumor. 

Just as little certainty exists as to the Causes of pancreatic diseases. 



PANCREATITIS. 569 

In most cases, as far as we know, these affections are of a secondary nature, 
arising from diseases of neighboring organs. Fortunately pancreatic diseases 
are of great rarity. 

From among the special forms of morbid conditions of the pancreas as 
discovered principally on post-mortem examinations, the following may be 
mentioned: 

Pancreatitis, Inflammation of the Pancreas. 

Pathologically, it is characterized by swelling, redness and softening of 
the areolar tissue, which surrounds the lobules of the gland; in a higher de- 
gree it alters the whole gland into a firm mass. It results either in resolution 
or suppuration, or leads to induration of the areolar tissue and obliteration 
of the glandular structure. It may be of an acute or chronic nature. 

Fatty Disease of the Pancreas 

Consists of a fatty degeneration of the gland-cell, analogous to fatty degen- 
eration of other glandular organs, which destroys the secreting cells and 
causes atrophy of the entire organ, of which often nothing remains but a 
flacid band of connective tissue. 

Cancer of the Pancreas 

May be primary, orginating in the gland, or secondary, spreading from 
neighboring organs to the gland. It causes no characteristic symptoms be- 
sides the general cancer-cachexia, and is, therefore, not distinguishable from 
other co-existing cancerous affections. 



DISEASES OF THE KIDNEYS. 

The kidneys being the organs for secreting urine, any morbid state 
within them will, of necessity, cause changes in the product of their physiologi- 
cal function, although disease of the kidneys does not attend every abnormal 
state of the urine. Before we enter upon a considersation of the different 
renal disturbances, it will be expedient first to collect those symptoms which 
we may gain by — 

Examination of Urine. 

1. Its Reaction. Urine is naturally acid, which is easily tested by 
dipping into it blue litmus paper. This acidity varies much even in normal 
urine; it is increased before meals, decreased after meals; during digestion 
it is augmented by sulphuric, nitric, phosphoric, tartaric and oxalic acids 
when taken into the system. 

An alkaline reaction may take place sometimes during digestion without 
being a sign of disease; or it results from taking an excess of fixed alkalies, 
such as the salts of soda and potassa. In this case the red test-paper is col- 



57° DISEASES OF THE KIDNEYS. 

ored blue and retains this blue color when exposed to heat. When it exists 
as a permanent condition it generally indicates nervous depression, resulting 
from exhaustion by mental anxiety, spermatorrhoea, etc. It is said to be pro- 
duced temporarily by the juice of lemons and oranges. An alkaline urine 
may be caused also by a volatile alkali such as carbonate of ammonia, in 
consequence of decomposition. This is generally recognizable by its odor 
and the test-paper at once loses the blue color and takes on its original 
red tint when exposed to a gentle heat. This alkalinity of the urine denotes 
pathological disturbances, such as the presence of mucus or pus in the urine, 
in consequence of disease of the mucous coat of the bladder, or in conse- 
quence of paraphlegia, whereby the urine is too long retained in the bladder. 

2. Its General Appearaace. A light, pale color is usually found in 
chlorotic and anaemic states of the system; in neuraigia; in hysteria (urina 
spastica); in diabetes mellitus, with much increased quantity and gravity; 
in chronic morbus Brightii; in leukaemia; in consequence of wear and tear 
of the nervous system, with a dash of white in it, containing phosphates. 

A deep, dark color may be caused — 

i. By an increase of urea in the urine, which appears perfectly clear 
and transparent when freshly voided, and its foam when agitated is perfectly 
colorless. 

2. By an admixture of blood. In this case the urine is opaque It is 
found: #, in haemorrhages from the kidneys; b, in haemorrhages from the 
bladder; and c, during menstruation or haemorrhages from the womb, when 
it is of mere accidental occurrence. 

3. By an admixture of bile. In this case the freshly voided urine is 
usually clear and transparent; its foam, when agitated, is intensely yellow; 
white paper and linen, when dipped into it, become yellow, even olive-green „ 
and a drop of nitric acid, when permitted to fall on a thin layer of such 
urine, causes at once an interesting play of colors — commencing with green 
and blue, passing to violet, red, and finally to yellow or brown. It is found: 
a, in icterus; &, in the highest state of pyaemia; c, in the acute yellow atrophy 
of the liver; d, in some cases of pneumonia, especially on the right side. 

4. By different drugs, such as santonin, rhubarb, sena, turpentine, dyer's 
weed, beets, tar, kreosote, etc. 

A turbid appearance of the urine, when freshly voided, ma}- result — 

1. From an admixture of epithelium, thrust off by catarrhal processes of 
the mucous linings within the urinary organs. It is of a flocculent appear- 
ance and does not alter the specific gravity of the urine. 

2. From gonorrheal or leucorrhceal discharges, appearing in the other- 
wise transparent urine as whitish flakes. ♦ 

3. From cylindrical casts from out of the uriniferous tubuli, during the 
acute or subacute stages of Bright' s disease. The}- soon settle to the bottom 
of the vessel, and form a light, downy sediment. 

4. From blood, as stated above, or chyle. 

5. From pus, which settles as an opaque, creamy or clayey mass; re- 



DISEASES OF THE KIDNEYS. 571 

action, generally alkaline; it is dissolved into a dense gelatinous mass, when 
agitated with an equal quantity of liquor of potassa, and smells foul and 
ammoniacal in consequence of decomposition. It is a sign of suppuration 
somewhere in the genito-urinary system, or a proof that an abscess has 
opened into and is being discharged through this channel. In chronic catarrh 
of the bladder pus forms a layer of grayish- white sediment. 

6. From earthy salts, generally, however, on^ after cooling, a, Uric 
acid settles in little red granules of a crystalline character, visible to the 
naked eye, while urates constitute more of a pinkish or yellowish sediment; 
the urine appears dark, shows an acid reaction, and becomes transparent by 
the application of heat. When a few drops of nitric acid are added, and the 
mixture is slowly evaporated nearly to dryness over a lamp, the addition of 
a drop of ammonia instantly produces a rich purple (Dr. Prout's Purpurate 
of Ammonia), b, Phosphates — a combination of phosphoric acid with soda, 
lime or magnesia. Such urine always jaelds an alkaline reaction, is usually 
of a whitish milky color with whitish sediment of an offensive odor, and 
clears up at once by the addition of a few drops of acetic acid. 

3 a . The urine contains one or the other of its normal con- 
stituents in excess or in decreased quantity — (Compare CI. Mitch- 
ell's " Clinical Significance of the Urine and its Normal Constituents.") 

Urea, C H 4 N 2 O, may be suspected in excess if the urine is of a deep 
yellow color, of a strong urinous smell, and of high specific gravity, and 
may be chemically demonstrated as follows: " Pour an equal bulk of nitric 
acid upon the given specimen, which has not been boiled, and which ought 
to be part of the entire quantity of urine passed in twenty-four hours. ' ' This 
will produce the formation of crystals of nitrate of urea. 

Urea is increased in all fevers (except yellow fever), in acute febrile 
states with emaciation, in inflammations generally, also those of thoracic vis- 
cera often, in nervous diseases, such as epilepsy, chorea, progressive muscular 
atrophy, in pyaemia, diabetes, atrophy from dyspepsia (in children), and dif- 
fuse bronchial catarrh (without fever). 

The amount of urea is diminished in paralysis, cholera, yellow fever, 
albuminuria, acute yellow atrophy of the liver, long- continued organic dis- 
eases, chlorosis, ovarian tumors and uterine cancer. 

Chlorides of Sodium (Na CI) and Potassium (K CI) are soluble, hence 
do not appear as a deposit in the urine. Sodium chloride is largely in excess 
of the two. If a sample of urine is evaporated and the residue placed under 
the microscope, there appear octahedral crystals, which can be distinguished 
from oxalate of calcium by their solubility in water. If urea be present 
instead of octahedral crystals the sodium chloride may assume the form of 
stars or daggers. Or after filtering a sample of urine, then boiling and 
acidulating it with two to three drops of nitric acid, in order to remove the 
albumen, and adding to this solution, free from albumen, a solution of silver 
nitrate (strength one to ten), a white precipitate, silver chloride, which is 



57 2 DISEASES OF THE KIDNEYS. 

insoluble in nitric acid but soluble in ammonia, indicates the presence of the 
chlorides. 

The chlorides are increased in intermittents only during the chill and 
fever, and in progressive muscular atrophy; they are decreased in acute 
diseases, including especially inflammations with exudations, fevers, cholera, 
diabetes insipidus (not invariably) and dyspepsia (also not invariably). 

The Phosphates, as sodium bi-phosphates or sodium phosphate, and po- 
tassium, calcium and magnesium phosphate. The alkaline phosphates (so- 
dium and potassium) are soluble, and therefore not found as a deposit. The 
earthy phosphates are insoluble in alkaline liquids, and hence appear as a de- 
posit when the urine is alkaline; the deposit is whitish in color, the urine is 
of alkaline reaction and of a fetid odor. If some of this whitish deposit is 
diluted with distilled water, then acidulated with a few drops of nitric acid, 
and to it is added ammonium molybdate and heat applied, a yellow precipi- 
tate indicates the presence of earthy phosphates. The alkaline phosphates 
may be detected by the addition of a little ammonium hydrate (ammonia) to 
the urine and heat applied, which precipitates the earthy phosphates. After 
these are filtered off, and we add to the filtrate ammonium carbonate and 
magnesium sulphate, we obtain a white flocculent precipitate which consists 
of alkaline phosphates. 

The total amount of phosphates may be increased in phrenitis, meningitis, 
mania (acute paroxysms), paralysis following injury to the head, paralysis 
in general, especially if spinal cord be affected, chorea, apoplexy and epilepsy 
(after the attack), acute febrile diseases, Bright's diseases and cholera. 

The calcium phosphate may be especially increased in rachitis, molli- 
ties ossium, extensive burns, nervous exhaustion from severe study and loss 
of sleep, diabetes (when thirst is satisfied by drinking water), tertiary syphi- 
lis, cerebral and spinal tumors, osseous tumors; cancer, caries, meningitis. 

The magnesium phosphate may be especially increased in meningitis and 
in progressive muscular paralysis, while the ammonio-magnesium phosphate, 
the so-called "triple phosphate," is found largely present in the urine in cal- 
culus, paralysis of bladder, retention of urine, diseases of the spinal cord. 
Urine containing this "triple phosphate" is apt, wmen passed, to be alkaline, 
putrid, whitish in color. 

The total amount of phosphates maybe decreased in functional disturbances 
of kidneys, as in Bright's disease, in disease of the digestive organs (food not 
thoroughly absorbed), in intermittent fever during the interval, in chronic 
diseases of the brain, mania (exhaustion stage), in acute dementia (least 
amount when mind most feeble), in pneumonia (when grave), in gout, ar- 
thritis deformans, delirium tremens. 

We find magnesium phosphate lessened in amount in the urine of typhus 
fever and of grave fevers generally. 

The Sulphates of potassium and sodium are soluble in water, hence do 
not appear as a deposit. They are detected by acidulating a small quantity 
of urine by a few drops of hydrochloric acid, and then adding barium chlo- 



DISEASES OF THE KIDNEYS. 573 

ride, which causes a precipitate of sulphate of barium, insoluble in nitric 
acid. Yogel finds but little satisfaction in investigating the clinical import 
of the sulphates in disease. 

The Urates of sodium, potassium and ammonium are soluble; acid urine, 
however, on cooling may contain them as a deposit in which the urate of 
sodium is generally the most abundant of any. If such deposit disappears 
again on heating, it consists of urates. If a heavy, yellow or pink deposit oc- 
curs in acid urine on cooling, place a few grains or crystals of it on a porce- 
lain disk, add a drop of nitric acid, heat gently, add a drop of ammonium 
hydrate; magnificent red color indicates presence of urates or uric acid. 
(Uric acid is crystalline under the microscope, but urates are not). 

The amount of urates may be increased in ordinary fevers, pulmonary 
emphysema, capillary bronchitis, diphtheria, dysentery, influenza, intermit- 
tent (febrile stage), nephritis, scarlet fever (at eruption), and chiefly free 
uric acid deposit, as in tetanus, acute polyarthritic rheumatism, chronic af- 
fections of heart, liver and spleen, atrophy from dyspepsia in children, in- 
cipience of gravel or of calculus. 

The amount of urates may be diminished in yellow fever, remittent fevers, 
diabetes, albuminuria, cholera, chlorosis, anaemia, hysteria, gout (before the 
paroxysms), progressive muscular atrophy. 

3 b . The urine contains other than normal constituents, of 
which the most important are: 

i. Grape sugar. — This substance increases the specific gravity of the 
urine up to 1040 and higher; in one case it was changed as high as 1074. 
To detect it, Trommer's test with caustic potash and sulphate of copper is still 
considered the best. "If a solution of sugar is treated with a little caustic 
potash and a few drops of a solution of sulphate of copper, either no precipi- 
tate occurs, or that which takes place dissolves again to a beautiful blue 
fluid. If this mixture be heated the fluid is first colored orange-yellow, soon 
becomes cloudy, and finally a beautiful red precipitate of cuprous oxide 
separates." (Neubauer.) "This, then, is what happens when sugar is actu- 
ally present; when sugar is absent, the addition of caustic potash solution 
causes, perhaps, a cloudiness to appear; then, when the sulphate of copper 
is added, the beautiful blue color may or may not be present, according to 
the quantity of copper sulphate added, but when heat is applied, there re- 
sults either ( 1 ) , a liquid, generally of a color slightly darker than normal 
urine, containing dirty, white flocks of phosphates, or else (2), a bluish 
liquid containing these same flocks of phosphates; when there appears no 
orange-yellow, which soon becomes cloudy, ending in a beautiful red precipi- 
tate, there is no sugar." (Clifford Mitchell.) 

Or, "if a solution of grape-sugar be warmed with caustic potash, it be- 
comes a beautiful brown-red color; if nitric acid is then added, a piercing, 
sweetish odor is evolved, which reminds one of caramel or of formic acid." 
(Neubauer.) "In the case of urine containing sugar then, caustic potash 
solution added, heat applied, and further nitric acid added, converts the 



574 DISEASES OF THE KIDNEYS. 

liquid into a substance strongly resembling molasses." (Clifford Mitchell.) 

2. Albumen. — In general its presence ma}' be looked for if the specific 
gravity of the urine is persistently below 1015, and it may be detected by 
heating the urine up to a boiling point which coagulates sero-albumen, if 
only the urine itself be acid and has been rendered clear by previous filtra- 
tion. Neutral or alkaline urine must be rendered acid before the operation 
by addition of nitric acid. Or to avoid all possible chance of confounding 
albumen with phosphates or urates, fill a test-tube one-third full of a solution 
of picric acid, and pour one or two drops of the urine to be examined into it. 
If it contain albumen, a cloudiness will at once be seen in the previously clear 
fluid, which, on the application of heat, balls into a compact mass and rises 
to the surface. 

3. Chyle. — "In tropical regions, especially in the Brazils and in the 
Southern States of North America, the urine presents, on exceptional occa- 
sions, at rare and long intervals of time, an aspect that might easily be mis- 
taken for milk. This appearance depends upon a quantity of fatty matters, 
stirred up into a fine emulsion, and mixed with the secretion from the kid- 
neys; in fact, the fat is sometimes so abundant as to form a thick cream upon 
the surface of the fluid. Looked at under the microscope it does not present 
the form of fat-cells or fat-drops, such as we see in ordinary milk, but appears 
as a finely granular opacity that pervades the fluid, and is capable of being 
entirely separated from the urine by treating this with ether. We find 
invariably associated with it a considerable quantity of albumen, also red and 
white blood-cells, all characteristic, formed elements of chyle. For this 
reason the affection thus manifesting itself has been termed chyluria. The 
exact nature of it is still unknown." (Bartels.) 

4. Blood. — Its presence can usually be recognized by its characteristic 
colors, which may, however, vary from that of pale, raw meat up to brown- 
black, in accordance with the quantity present. Bloody urine is oftener 
sooty or dark colored than bright red, and the liquid is more usually cloudy 
than clear. Small quantities may be recognized by allowing the urine to 
stand in a funnel-shaped glass when the blood-corpuscles will sink to the 
bottom. By means of the microscope the blood-cells can be distinguished in 
the sediment. Bloody urine is invariably albuminous. 

5. Urinary Casts of Cylinders, when found in the urine, always denote 
an abnormal condition of the kidneys; the)' are, as a general rule, associated 
with the excretion of albumen in the kidneys. There are different kinds of 
cylindrical formations. 

a. Epithelial casts consist of simple pipes formed of the epithelia of renal 
tubes which are shed in their natural continuity in the course of acute inflam- 
mation. They are not often seen. 

b. Blood casts consist of coagulated fibrine with a large amount of en- 
tangled red blood- corpuscles, and are derived from the renal tubules in 
hematuria. 

c. Hyaline casts consist of a perfectly homogeneous, transparent and 



DISEASES OF THE KIDNEYS. 575 

colorless mass; their outlines are only with difficulty rendered apparent in 
the fluid surrounding them, but may be made visible by adding a solution of 
iodine or iodide of potassium, which colors them yellow, or a weak solution 
of carmine, which stains them red. 

d. Dark granular casts consist of granular masses and are less trans- 
parent than the hyaline casts. 

e. Waxy casts consist of a homogeneous mass which exhibits under the 
microscope a peculiar glistening aspect and they often have a distinct yellow 
staining. 

f. Cylindriform casts consist of a homogeneous, colorless and very pale 
mass; they present under the microscope more the appearance of strips of 
ribbon than of real cylinders, and their edges run parallel to each other, 
their ends are either frayed out or tattered, or pointed at one edge, or folded 
or twisted up in a spiral. The presence of such casts proves the presence of 
albuminuria, but does not point out the nature of the cause in producing 
albuminuria. However the following remarks may assist in the diagnosis of 
kidney diseases. 

A great number of pale or dark granular casts comes from an inflamed 
kidney. In the acute form the pale casts with an abundance of red or white 
blood-corpuscles — in the chronic form the dark granular casts prevail. 

The waxy casts alwaj'S point to chronic and deep-seated renal affection 
and are never present in recent cases of nephritis, nor in transitory albu- 
minuria. With them are generally found at the same time the other forms 
in the sediment. 

The dark granular casts always indicate a notable impairment of the 
nutrition of the organ, such as chronic nephritis and amyloid disease of the 
kidneys. 

Narrow hyaline colorless casts can appear in any albuminous urine, and 
they are always found in company with the dark granular and waxy 
cylinders. 

The Sediments of the urine may be distinguished in the • following 
manner: 

i. A light, flocculent, cloudy deposit is commonly mucus, entangling 
epithelial cells or spermatozoes. 

2. A yellow, orange, or pinkish deposit, dissolving by the application of 
heat (urine acid) is almost always due to urates. In very rare cases a dark 
citron-yellow color is caused by the great abundance of renal casts. 

3. A dense, abundant, white deposit, dissolving by the addition of acetic 
acid (urine alkaline) consists of phosphates. 

4. A granular, or crystalline deposit of reddish color and small in 
quantity is uric acid. 

5. A dark, sooty and dingy-red deposit is blood. 

The Quantity of urine varies, even in health, considerably. It is 
increased, however, in diabetes, chronic diuresis, hysteria, and by drinking 
large quantities of water or other fluids. Decrease: Fevers of all kinds, 



5J6 DIABETES. 

deep functional disturbances, profuse excretions other ways, such as sweat or 
diarrhoea; in consequence of heart diseases, liver diseases, dropsy. Its secre- 
tion ceases altogether in cholera, and in typhus at times. 

Its Specific gravity is also greatly variable. According to Clifford 
Mitchell's observations upon fifty analyses of urine, an iacrease in specific 
gravity simply means an increase of solids. In most febrile conditions, urea, 
phosphates, sulphates and urates are increased in amount, and with them the 
specific gravity of the urine. The presence of earth}' phosphates ma}' raise 
it to 1037. When the specific gravity is 1040 or upwards, we are very sure 
of finding sugar in the urine. When the specific gravity ranges from 1015 to 
1030, we need not expect, as a rule, to find either sugar or albumen, although 
we may find blood or pus. When the specific gravity is persistently below 
1 01 5, we are warranted in looking for albumen. The lowest specific gravity 
has been observed in diabetes insipidus and renal cirrhosis, varying between 
1004 and 10 10, and sinking at times to 1002, or even to 1001. 

Diabetes, Mellituria, Glycosuria. 

This disease is characterized by the presence of sugar in the urine, and 
although not strictly a kidney disease, it may as well be treated of here as 
under any other heading, especially as the modes of its development are still 
under discussion. The most probable modes, as applying to the majority of 
cases of diabetes, Senator states in the following language: (1) " An ab- 
normally heightened sacchaiinity of the chyle, or of the blood in the portal 
vein, or of the two together, in consequence of an impeded conversion of the 
sugar present in the intestine into lactic acid, or in consequence of accelerated 
absorption of the sugar; (2) an unnatural acceleration of the portal circula- 
tion, whereby, on the one hand, more sugar reaches the liver — a part of 
which, without being changed into glycogen, passes on into the circulation; 
and, on the other hand, the glycogen formed from sugar or other materials 
passes into sugar more rapidly and in greater quantity and is washed away." 

Under the first proposition is taken into account that the saccharinity 
of the blood may originate in the intestine by an abnormally large ingestion 
of starch or sugar with the food, or by an abnormally heightened transit of 
sugar from the intestine into the lacteals even without increased ingestion, 
all of which would explain those symptoms so common in diabetics which 
point to an implication of the gastro-intestinal canal, and which exists often 
even before the outbreak of the disease and during its development. Under 
the second proposition is taken into consideration the theory of Claude Ber- 
nard and others that the saccharinity of the urine may originate a, in some 
disturbance of the nervous system (Bernard's puncturing the fourth ventricle 
on the floor of the fossa rhomboidea, immediately above the point of origin 
of the vagi nerves, or Scruff's section of the optic thalami and the great crura 
cerebri, or the destruction of the pons Varolii and the middle and posterior 
crura cerebelli, or the complete division of the spinal cord at the level of the 



DIABETES. 577 

second dorsal vertebra, or in its lumbar portion, or Pavi's section of the me- 
dulla oblongata, etc. ), causing either a dilatation of the blood-vessels by par- 
alyzing the vasomotor nerves, or a specific irritation of the nerves which 
govern the formation of sugar (both views being hypothetical), or b, from the 
action of the liver by which sugar, glycerine, gelatine, and probably albumi- 
nates, are converted in its cells into glycogen, and that the latter is trans- 
formed* into grape-sugar by reaction with the blood which bathes the cells, 
that it then passes into the general circulation, and if its quantity exceeds a 
certain limit, is finally excreted by the kidneys. These modes of develop- 
ment, which we may designate as gastro-enterogenic, the neurogenic and 
the hepatogenic, do not exclude each other, but ma}^ for the most part, or 
altogether, occur simultaneously, or the one may proceed and the other may 
join in. 

Post-mortems have shown various morbid changes in the corresponding 
and other organs, although these changes are by no means constant. In the 
brain tumors, extravasations of blood, softenings, and on microscopic axami- 
nation, a wasting of the gray substance, degeneration and striking pigmenta- 
tion of the ganglion cells and fatty degeneration of the vessels have been 
found. The sympathetic nerves in the abdomen were found thickened and also 
of the vagus. The lungs frequently showed signs of chronic inflammations, 
tuberculosis and pleuritic exudations. The stomach and the intestinal canal 
frequently bore signs of chronic catarrh, hypersemia, thickening, tumefaction 
of their mucous membrane, slaty pigmentation and haemorrhagic erosions. 
The liver has frequently been found hypersemic, uniformly enlarged and 
hypertrophied. The pancreas has frequently been found atrophied, or, in 
addition, degenerated; and the kidneys appeared, as a rule, abnormally en- 
larged, heavy, firm and containing an abundance of blood, but without more 
profound textural changes. The pelvis of the kidneys and the ureters were 
frequently found in a state of catarrhal inflammation; and in some cases of 
young persons the testes were found atrophied. Diabetes is not of frequent 
occurrence, seems to be to a certain extent hereditary, is often connected with 
diseases of the nervous system, particularly epilepsy and mental affections, 
occurs at every period of life, but far more rarely in childhood than in middle 
age; after the age of sixty or sixty-five it scarcely ever develops; men are 
much oftener attacked than women; also obesity seems to predispose to the 
disease. As Exciting Causes the following have been mentioned: mechani- 
cal injuries, especially concussions of the whole body or of the brain and 
spinal cord in particular; diseases of the nerve-centres, such as inflammations, 
degenerations, softenings and tumors of the brain; violent mental emotions, 
such as fright, anxiety, anger, grief, solicitude, care, immoderate mental 
strain; errors in diet; exposure to cold and moisture; severe bodily exertions; 
sexual excesses; and not unfrequently diabetes has been observed to make its 
first appearance during the convalescence from febrile diseases of greater or 
less gravity, especially after intermittent fever. Besides these exciting causes 
the following substances, which, whether introduced into the general blood- 
37 



57§ DIABETES. 

current or into the portal circulation, have been found to cause mellituria 
with more or less certainty: Curare, cantharis, carbonic oxide, chloride of 
carbon, nitrite of amyl, nitro-benzole, phosphoric acid, turpentine, corrosive 
sublimate, nitrite of oxide of uranium, morphia and strychnia; injections 
into the veins of solutions of common salt, of carbonate, acetate, phosphate, 
hyposulphite, valarianate and succinate of soda; of ether, alcohol or ammonia 
into the portal vein, and of large quantities of lactic acid into the stomach. 

The Symptoms of diabetes set in at times suddenly, but in general very 
gradually, with an increase of the urinary excretion and of thirst. Its initial 
stage, if there be any, is characterized usually by loss of appetite, nausea, 
vomiting, pyrosis, eructations, irregular actions of the bowels, headache, 
sleeplessness, and even mental aberration. But perhaps much oftener the 
disease invades the system unnoticed, until the frequent desire to pass water, 
the constant dryness of the mouth, the increased debility, or an impairment 
of sight, force the attention of the patient upon it. 

In the proportion as the urine increases in quantity, its color becomes 
lighter, verging on greenish or looking almost entirely colorless and as clear 
as water; it is free from sediments. Its odor is often peculiarly aromatic, 
likened by the older physicians to that of hay, being derived, according to 
recent observations, from acetone and alcohol. Its reaction is not only acid 
while fresh but remains so much longer than health}' urine generally does. 
Its specific gravity very commonly rises to 1035 or 1040 and even to 1060 or 
1074. Its quantity is greatly increased, and generally in proportion to the 
severity of the disease, amounting to six or eight litres daily. 

Next to the altered state of the urine there is increased thirst and hunger. 
The thirst particularly is in direct ratio to the excretion of sugar. Farina- 
ceous and saccharine food not only increases the sugar but also the thirst. 
The appetite is usually largely increased, so that even unusually hearty food, 
especially the saccharine and starch} 7 , seems able to appease the hunger only 
for a short time. Still at times temporary disturbances with signs of gastric 
and intestinal catarrh set in, restricting the use of an exclusively animal 
diet. 

The patient's breath commonly emits a peculiar, apple-like odor, and 
chronic pneumonia leading to phthisis is of frequent occurence, although in 
patients under favorable surroundings and good dietetic conditions it is de- 
veloped exceedingly slow. 

The nervous system shows many disturbances, of which are to be men- 
tioned: pronounced mental affections and aberrations, delusions of rapidly 
approaching financial ruin, (becoming parsimonious, avaricious,) varying 
moods, irritability, sadness, melancholy, disinclination to bodily or mental 
exertion, headaches, sensations in the limbs as being asleep, formication, 
neuralgic pains, partial anaesthesia, muscular twitchings, and a decrease of 
the sexual instinct. The most common form of disturbance of vision is oc- 
casioned by the formation of cataract, less often by partial paralysis of ac- 
commodation, by amblyopia, gradually passing into progressive atrophy of 



THERAPEUTIC HINTS TO DIABETES. 579 

the optic nerve, by haemorrhagic and inflammatory affections of the retina. 
The hearing is rareb T impaired; oftener there is a nervous roaring in the ears. 
Blunting of the senses of smell and taste have also been observed. 

The skin is usually dry, and hectic sweats set in only as concomitants of 
pulmonary phthisis. As a general thing, there is a great tendency to the 
formation of furuncles and carbuncles, also at times to gangrene of the skin, 
or of the toes or even a whole limb. CEdema, especially of the lower limbs, 
is the result of advanced cachexia, exceptionally only of a complicating 
severe affection of the kidneys. 

Fever, in the absence of inflammatory complications, does not occur; on 
the contrar} T , the temperature is very commonly somewhat below the normal, 
between 95. 9 ° and 97. 7 ° F., and even temperatures as low as 93. 2 ° F. have 
been observed. 

The duration of the disease is, in rare cases, extraordinarily brief, last- 
ing only some weeks or months. Such cases occur, without exception, only 
in children and young persons. Usually the disease lasts for years. No doubt 
a number of cases have been cured by different modes of treatment, or have 
at least been greatly relieved. 

Therapeutic Hints. 

The diet, as recommended on physiological grounds, should be selected 
from the following articles: the flesh of mammalia and birds, fishes, oysters, 
clams, crabs, lobsters, etc., cheese, eggs; salads, cucumbers, water-cresses, 
spinach, asparagus, cabbage, oyster-plant, radishes, beets, truffles; butter, 
lard (oil to a certain extent); fruits, especially peaches, cherries, strawber- 
ries and currants; nuts. Bread, although containing a great deal of starch, 
can never be entirely omitted. Milk is allowable, but exclusive use of skimmed 
milk can only be exceptionally borne ; some have seen nothing but detriment 
from it. Among the spirituous drinks the red wines are allowable; sugared 
brandies, sweet wines, champagne and cider should be entirely avoided. 

Dr. During, of Hamburg, treats his patients in the following manner: 
At six o'clock, A. m., the patient is wrapped in wet sheets and being well 
covered with blankets, he remains lying by open windows for one to two 
hours. After having been rubbed until dry, he gets his breakfast consisting 
of milk, with the addition of one tablespoonful of lime-water to one cupful 
of milk, and stale bread. This is followed by one or two hours walk in the 
open air. At about 10^ ton a.m., the patient receives another piece of stale 
bread with some meat, or a soft-boiled egg and half a glass of good red wine 
mixed with water. Should this not agree he receives instead a plateful of 
rice or farina soup, with or without milk, the milk being always mixed with 
lime-water. This lunch is again followed by a walk in the open air of one- 
half to one hour's duration. Before dinner the patient takes a nap or rest 
for one hour. For dinner at two o'clock p. m. , he receives rice and roasted 
meat, or ham or smoked meat, or venison — but without spices or vinegar. 
In some cases dry peas or white beans, well boiled, are allowed. Dried 



580 THERAPEUTIC HINTS TO DIABETES. 

apples, prunes or cherries, also asparagus, green beans, cauliflower and car- 
rots boiled in water, not in broth, and without butter or fat, constitute other 
articles for dinner. A moderate allowance of green apples or cherries is 
given only in exceptional cases. The dinner is followed again by a walk of 
one or two hours' duration. Supper takes place at seven o'clock p. m., con- 
sisting of rice, grits, pearl-barley or water soup, with salt, but without but- 
ter, and is followed by another half-hour's walk. At nine or latest at ten 
o'clock the patient retires to bed. 

This mode of treatment of Dr. During' s has produced undoubtedly the 
most gratifying results in diabetic patients, and it clearly demonstrates that 
the exclusive ' ' meat diet, ' ' recommended on ' 'physiological grounds, ' ' is very 
much like the treatment of chlorotics with ' ' iron preparations' ' on physio- 
logical grounds, both of which lack merely in this important point, that they 
do not cure, because the human body is not a chemical laboratory, but a 
living organism. 

Prout's experience, probably the largest of an} r observer, and drawn 
principally from the well-to-do class, is to this effect: "Within the last thirty 
years I have seen more or less of nearly seven hundred instances of diabetes, 
and of this great number, as far as minor and concomitant symptoms have 
been concerned, no two cases have been exactly alike, or have been benefited 
by exactly the same treatment, so greatly diversied in this apparently simple 
form of disease." 

Therefore a specific remedy for diabetes does not exist, and a homceop- 
athist w r ill only feel gratified to find the special hints extended over a large 
number of remedies. 

Arg. met. Hahnemann says, some forms of diabetes may be cured by 
silver if the other symptoms correspond to the symptoms of this remedy. 
Ruckert mentions a case which he cured by Arge?it., but which died of 
phthisis afterwards. He mentions: urine, turbid, of a sweetish taste and 
profuse, especially at night; scrotum and feet cedematously swollen; anxiety 
and pressure in the pit of the stomach and w r ant of breath. 

Ars. alb. In a drunkard, horrible thirst, emaciation and exhaustion, 
with odd hallucinations. Eruptions on the skin and tendency to boils; vulva 
and vagina become red and swollen, with pruritus; teeth loose; skin dry and 
mealy; cachexia; kidneys affected; oedema of legs. 

Asclep. vin. Five cases reported as essentially improved by it; arthri- 
tis; bleeding of gums; impotence. 

Berber. Sticky, saliva, like cotton; pale yellow urine with a gelatinous 
sediment; pulse slow and weak; paralyzed, bruised sensation in the back; 
intense coldness of knees. 

Canthar. One case improved as reported by Goullon, with frequent 
and profuse urination, rapid loss of strength and great dejection of spirits. 
(30th potency in water every two hours.) And one case was cured by Can- 
thar., given on account of existing satyriasis. (Fellger.) 

Carb. ac. One case with short, dry, hacking cough. (Haesseler — 



THERAPEUTIC HINTS TO DIABETES. 58 1 



j-^ and later yg- dilution.) Goullon thinks it one of the most important 
remedies. 

Chelid. Enlargement of liver and icteric color of face, bloated face; 
great weakness, emaciation. (In ten-drop doses of tincture.) 

Coloc. Urine when voided is white and turbid, when getting cold it 
coagulates and becomes a milk-white, jelly-like mass, which, when poured 
out, glides in a compact cake out of the vessel. (Chyluria?) 

Cuprum. Recommended, but no cures. 

Curare. Recommended for acute cases. 

Dig-it. Recommended, but no cures. 

Helon. dioic. Several cases reported as cured. Dull, gloomy and 
irritable; melancholy; complete impotence; pain and lame feeling in back; 
numbness in the feet, going off by motion. 

Hepar. After previous abuse of mineral drugs. " The slightest thing 
made him break out into great violence; he could have killed some one 
without hesitation." (Thos. Skinner Berridge.) 

Iodiu?n. Appears to have all the peculiar symptoms of diabetes; unap- 
peasable hunger with steadily increasing emaciation; violent thirst; hepatic 
and gastric troubles; increased secretion of urine; pulmonary inflammatory 
symptoms; tendency to eruptions and furuncles. I cannot find that it has 
ever been given. 

Kali brom. Tongue red and tender; gums spongy and bleeding; liver 
tumid and tender; bowels constipated, urine loaded with sugar. 

Kali hydr. In complication with pneumonic troubles, recommended by 
Kafka. 

Kreos. Three cures and one improvement. Heaviness all over with 
drowsiness; dimsightedness; impotence; bruised sensation of chest and all 
along the back; physical exhaustion. 

Laches. Recommended. 

Lact. ac. Recommended by Cantani and used with considerable suc- 
cess by others. Tongue dry, parched; sticky; feeling of emptiness and sink- 
ing at stomach; bowels costive, feces hard and black; debility; aversion to 
move; chilliness, especially extremities. (First dil. in five-drop doses morn- 
ing and evening. J. E. Wittemore.) 

Lycop. Excessive micturition in gushes; fluor albus drops out in clots; 
drawing pains in right groin on rising from seat, better after motion. 
(Eippe.) Sexual desire and power gone; pulmonary phthisis, with hectic 
fever; gouty lithaemia. 

Lye. virg. From central and sympathetic nervous system; bronchial 
irritation, with sighing respiration; cardiac depression. 

Magn. usta. Relieved in one case. 

Magn. sulph. Cured one case. 

Mineral waters. Karlsbad, Gastein, Wildungen, in Germany; Vichy, 
in France; Bethesda and Gettysburg, in United States. 

Moschus. One case with impotence cured. 



582 THERAPEUTIC HINTS TO DIABETES. 

Natr. mui'. Despondency; excessive dryness of mouth; no sweat; skin 
cool; sallow complexion; constipation, with sensation of contraction of the 
anus. 

Natr. sitlph. One case cured by Aegidi, with 3d dil., five drops four 
times a day. Hydrogenoid constitution. 

Nux. vojti. Spinal lesions exciting cause; irritable temper; odd sensa- 
tions in the limbs, fidgets; numbness and paretic condition of the lower ex- 
tremities;- stomach and liver complaints. High living, sedentary habits, 
previous abuse of liquors and drugs. 

Opium. And its derivatives. Dullness, sadness, weak memory; atfter 
mental shocks, or injuries. 

Phosphor. Gout}* diathesis; disease of the brain; cerebral symptoms; 
cheesy degeneration of the lungs. 

Phosh. ac. Urine like milk, mixed with jelly-like, bloody mucus, or 
clear like water; pain in the back and region of the kidneys; sleeplessness; 
excessive emaciation; great prostration. After loss of animal fluids; after 
grief, anguish, sorrow and care. ' ' When the starting point lies in the nervous 
S3 T stem . " ( Prout. ) 

Plumbum. I^owness of spirits, anguish and melancholy; diminution of 
sight; dryness of mouth; dry, cracked tongue; suppuration of lungs; hectic 
fever; impotence; dryness and brittleness of skin; gangrene. Dr. Hering 
considered it one of the most important remedies in this form of disease. 

Ratan. Case much improved. 

Sec. com. Is similar to Plumbum; furuncles, petechia, gangrene. 

Silic. Successful in several cases. 

Sizygium jam. Has cured diabetis. 

Sulphur. Cured one case. 

Sulph. ac. A case much improved. 

Tarant. Profound grief and anxiety; loss of memory and dimness of 
sight; violent pain in lumbar region and paralysis of the lower extremities; 
miliary eruptions and furuncles. 

Tereb. Caused sugar in the urine, and cured diabetes. 

Uran. mur. and nitr. Many cases have been cured or much improved 
by either of these preparations, usually administered in the 1st or 2d tritura- 
tion or dilution, several times a day for weeks. It is indicated, according to 
Prout, w T hen the disease originates in assimilating derangements. Tongue 
reddish at edges; dyspepsia. 

Dr. Francis Black recommends: 

For debility: Phosphor., Phosh. ac, Arsen., China, Moschus, Camphora, 
Pier. ac. 

For Hepatic symptoms: Digit., Kali bichr., Merc, sol., Iod. m., Hepar, 
Sulphur, when there is diminishedbile in the feces. 

Euvonymin, Iridin, Leptaud., Podoph., Merc, corr., Iod. m., Nitr. ac, 
when there is increased flow of bile. 

Nux vom., Lycop,, Nitr. ac, Merc, corr., Iod. m., Chelid., when there 



DIABETES INSIPIDUS. 583 

is no marked disturbance in the secretion of bile, but headache, frontal or 
occipital, vertigo, languor, weariness in limbs, uneasiness about the liver or 
scapular regions, furred tongue, often indented at sides, loss of appetite, 
flatulence, great depression and irritability of temper, constipation, with dark 
or pale motion, or normal color, sometimes alternating with diarrhoea, in- 
termitting pulse and palpitation of the heart. 

A mm. mur. when there is lithaemia, and catarrh of the fauces extending 
to stomach. 

Col chic, Nux vom., Kali iod., when there is gouty disposition. 

Kali iod., in syphilitic taint. 

For urinary and sexual symptoms: Arsen., Aeon., Camphora, Tereb., 
Canthar. , Kali bithr. , when there is rapid decrease in the secretion of urine 
with strangury, or excessive itching and sense of fullness in the vagina. 

For pulmonary affections: Phosphor., A? sen., Iodium, Hepar. 

For nervous symptoms: Aeon., Atropia, Phosphor., Argent., Aurum, 
Kali hydr. , if cerebral. 

Nux vom., Veratr., Silic., Phosphor., if spinal, and Aeon., Atropia, 
Opium, Nitrite of Amy I, if tendency to apoplexy. 

For furuncles and carbuncles: Arnica, Phosphor., Arsen., Silic, Hepar. 

This list may be enlarged from the above given special hints. 

Diabetes Insipidus, 

Also known under the name of polyuria, hyperuresis, urinse pronuxio, poly- 
dipsia, ' ' is applied to every chronic, morbidly increased excretion of urine, 
free from sugar, which is caused by no profound structural changes of the 
kidney, and which constitutes either the sole or at least the most prominent 
and primary morbid phenomenon." (Senator.) 

The term diabetes insipidus excludes any temporary increase of urine 
which is caused by excessive ingestion of fluids, by the use of diuretics, by 
interference with the loss of water through the lungs and skin, by the ab- 
sorption of watery exudations, during convalescence from febrile diseases, or 
during hysteria or other diseases in the nervous system. 

The amount of urine evacuated in twenty-four hours varies greatly in 
different cases and in the same case at different times; it may vary from a 
point only slightly above the physiological maximum to ten or twenty times 
that amount. Its color is pale and clear, resembling water with a slight 
greenish tint; the peculiar odor of the urine is scarcely to be perceived, and 
its reaction is very faintly acid; it becomes neutral and alkaline more rapidly 
than usual, and turbid from earthy phosphates and bacteria. 

Its specific gravity varies, as a rule, between 1004 and 1010, thought it 
may approach the lower physiological limit, or sink lower than in any other 
disease, viz., to 1002, and even to 1001. This low grade of specific gravity 
is not the result of an absence of solid urinary constituents, but of the rela- 
tively too great amount of water with which they are diluted. Compara- 



584 HEMATURIA. 

tively there is as great an amount of solid urinary constituents excreted as 
in healthy persons, at times even a greater. A diminished amount occurs 
only exceptionally and temporarily, and for any great length of time, or 
during the whole disease only in consequenc of the association of some other 
malady. 

With the amount of urine excreted stands in direct proportion the thirst 
of diabetic patients; it is almost inappeasable. As a very peculiar phenom- 
enon may be mentioned a great flow of saliva at the same time, in a case ob- 
served by Kuelz. The skin is generally dry and the temperature insignifi- 
cantly lowered, but on the other organs and on the general health, diabetes 
insipidus has, so far as its direct influence is concerned, no effect worth men- 
tioning, if the patients are allowed to drink freely. A sudden deprivation of 
drink may seriously endanger the life by the drying of all the tissues, and 
would cause besides a scarcely endurable distress to the patient. 

Diabetes insipidus is much more frequently observed in youth and 
middle age than in later life. As Exciting Causes have been mentioned: 
injuries of the skull, violent and sudden emotions, chronic diseases of the 
brain and spinal cord, and a single excessive ingestion of cold beverages or 
other fluids. The patients very rarely die of this disease if uncomplicated; 
it Taay last for 3 T ears if not an intercurrent disease, or the malady in the 
course of which the diabetes has arisen, and which is to be regarded as its 
cause (affections of the brain or spinal cord), terminates in death. On the 
other hand recovery has been sometimes brought about by an intercurrent 
disease, by pregnane} 7 , etc. 

Therapeutic Hints. 

The single case will have to be studied, and it is quite likel} 7 that a 
remedy might be found to suit the case without having the two prominent 
signs of the disease: "profuse urination and insatiable thirst," in a very 
high degree. The following remedies are to be recommended: Apis, Bellad. y 
Cepa, Ferr. phosph. (Schiissler and Huber), Nitrum, Phosph. ac, Squilla^ 
Compare also Diabetes Mellitus. 

Hematuria, Passing Blood with the Urine. 

The blood mixed with the urine may be derived : 

1. From the substance of the kidney. — In this case the coagula present 
will be few, if the haematuria be produced by venous stasis; there will be a 
large number of renal casts and entangling blood-cells present, if the bleeding 
be caused by inflammation of the kidneys; and there will be profuse bleed- 
ing which leads to the formation of large clots in the pelvis of the kidney or in 
the bladder, only in the rare instances of traumatic lesion of one kidney (for 
example, crushing or rupture of a kidney by a kick or the like), or in cases 
where a highly vascular cancer has grown into the pelvis of the kidney. 

2. From the pelvis of the kidney. — In this case the haemorrhage may be 



THERAPEUTIC HINTS TO HEMATURIA. 585 

more profuse and form blood-clots corresponding to the shape and size of the 
caliees, being most generally caused by renal calculi, preceded by renal colic 
and attended with calcareous deposits in the urine. If the entire pelvis of a 
kidney be filled with blood or with masses of cancer, it may happen that the 
corresponding ureter becomes blocked up and distended with a thrombus, 
which assumes the shape of the ureter, measuring often more than a finger' s 
length, and being of about the size and shape of a lumbricoid worm when 
finally passed. 

3. From the bladder. — In this case the blood-clots may form of so large 
a size that they cannot pass through the urethra without being first com- 
pressed by the contraction of the bladder or broken up by instruments. 
Haemorrhages of this kind may be caused by traumatic lesions (urinary cal- 
culi, external violence upon the bladder), by catarrh and ulceration of the 
bladder or by suppressed haemorrhoidal or menstrual flow. 

4. From the prostate gland or urethra. — In this case the blood often dis- 
charges from the urethra without micturition and on examination will reveal 
the sore and swollen parts from which it issues. Its causes are most fre- 
quently external injuries or inflammations, especially gonorrhceal. 

The presence of blood in the urine can best be demonstrated by the mi- 
croscope, which shows the cells in the sediment. However, there are cases 
where only the coloring matter of the blood is present, but no cell, where, 
therefore, a dissolution or destruction of the blood-corpuscles has taken place, 
as in the case of graver forms of typhoid fever, in haemmorhagic small-pox, in 
scorbutus, in morbus maculosus Werlhofii, in septicaemia and in poisoning by 
phosphorus, arsenic and its compounds, and sulphuric acid. The source of 
the bleeding in these cases has been traced to one or the other kidney pelvis, 
or, more rarely, to both, or to the bladder, or the dissolution of the red cells 
has taken place even before they leave the renal vessels. The Causes of re- 
nal haemorrhage, apart from the effects of injuries and cancerous growths, are: 
different kinds of inflammations of the kidney substance; active congestion, like 
that produced by turpentine or cantharides, or in some persons by asparagus, 
or in rare cases by the action of cold upon the integument of the body; by 
venous or passive congestion, like that (although but rarely induced) by car- 
diac insufficiency, or by haemorrhagic infarction of the kidney, the result of 
embolism in consequence of heart disease. 

Therapeutic Hints. 

Ar7iica. When caused by external violence. 

Arseyi. Haemorrhoids of the bladder; very painful micturition; scanty 
secretion; burning pain in the urinary organs; paralytic symptoms of the 
bladder; great anguish and restlessness; dissolution of blood-copuscles. 

Calc. carb. In chronic cases; haemorrhoidal affections; polypi; leuco- 
phlegmatic persons. 

Campho7 r a. After irritating drugs, especially cantharides, and after 
exanthematic fevers. 



586 THERAPEUTIC HINTS TO HEMATURIA. 

Canthar. Violent cutting, pressing and cratnpy pains in the bladder, 
extending into the urethra and into the kidneys; strangury, burning pain 
before, during, and after micturition; cylindrical exudations in the urine; 
pain increased from drinking water, even from the sight of water. 

Colchic. After being drenched when sweating. 

Chim. viae. In consequence of severe and long-continued gonorrhceal 
inflammation. 

Crotal. Haemorrhage from all the orifices of the bod)'. 

Eriger. Empirically used, without an}' characteristic indications; gon- 
orrhoea. 

Ha77ia??i. Haemorrhoids of the bladder; passive congestions. 

Ipec. Profuse bleeding, with fainting, deadly paleness, sickness of the 
stomach; oppression of the chest. 

Laches. The urine looks black like coffee-grounds; scarlet fever. 

Lycop. Especially in connection with gravel or chronic catarrh. 

Mercur. Painless discharge of blood; also very violent urging to urinate, 
and painful micturition, whereby sweat easily breaks out. 

Mezer. Crampy pain in the bladder; and, after that, bloody urine is 
voided. 

Millefol. Pain in the region of the kidneys, with chilliness, necessity to 
lie down; the blood forms a sediment in the vessel like a blood)' cake; pres- 
sive pain in the urethra during the flow of blood. 

Nitr. ac. According to Goullon, specific in active haemorrhage, also 
after mercury; urging after micturition, with shuddering along the spine 
during micturition; gonorrhceal affections, dissolution of blood-corpuscles. 

Nux vom. After the abuse of alcoholic stimulants, or allopathic drugs: 
suppression of haemorrhoidal or menstrual discharges; full, tensive feeling, 
pressure and distention in the abdomen, loins and region of the kidneys; 
signs of stagnation in the portal circulation. 

Phosphor. Dissolution of blood-corpuscles; after sexual excesses; after 
poisoning with turpentine; haemophiles. 

Pulsat. Drawing, cutting pain around the navel into the small of the 
back; penis and scrotum drawn up; crampy pain in the right leg from the 
knee to the groin. 

Secale. Passive haemorrhage; blood thin; blood-corpuscles wanting in 
consequence of dissolution; or painless discharge of thick, black blood in 
consequence of kidney disease; coldness of the body; cold perspiration on 
forehead; great weakness. 

Sulphur. After suppressed cutaneous eruptions and haemorrhoidal dis- 
charges; stinging and burning in the urethra. 

Tereb. The blood is thoroughly mixed with the urine, forming a dirty, 
reddish-brown or blackish fluid, or a coffee-ground-like sediment; burning, 
drawing pains in the kidneys; pressure in the bladder, extending up into the 
kidneys when sitting, disappearing when walking about; before urination, 
pressing and straining in the bladder when sitting, going off when walking; 



ALBUMINURIA. 587 

burning in the bladder, worst during micturition; in complication with scor- 
butic affections, and if caused by living in damp, moist dwellings. 

Uva ursi. Constant urging to make water and straining, with discharge 
of blood and slime; or constant straining without an}^ discharge at all, or 
only a few drops of urine, after this burning and cutting in the urethra, 
which is succeeded by a discharge of blood; hard stools. 

Zinciim. Vicarious bleeding through the urethra in consequence of sup- 
pressed menstruation, with pain in the bowels, diarrhoea, and night-cough 
with expectoration of mucus. 

Compare also the corresponding diseases, of which Hematuria may be 
the consequence. 

Albuminuria. 

Albumen in the urine is not only derived from the kidneys; it may come 
from the renal pelves, from the ureters, from the bladder, or even from the 
urethra, when the mucous membrane of these passages has become inflamed, 
or when some abscess has burst and poured its matter into these channels; 
but then the percentage quantity of albumen present is only trivial. A 
highly albuminous urine has been observed after the application of large 
Spanish fly-blister, in consequence of the inflammation of the urinary passages 
caused thereby. 

A transitory presence of albumen in the urine, secreted by the kidneys, is 
usually due to an abnormal increase of the blood-pressure with perfectly 
healthy kidneys, as we find, for instance, in heart disease, especially mitral 
stenosis, or extensive muscular degeneration, in pleuritic effusions, in ob- 
literation of several branches of the pulmonary artery, as follows upon cir- 
rhotic degeneration of the lung substance, in emphysema. Still, as a rule, 
the above affections of the respiratory organs do not often lead to congestive 
albuminuria. Much more frequently we meet albuminuria, as an entirely 
temporary symptom, during attacks of severe fever, as occur in the course of 
severe angina, in pneumonia, in typhoid fever and the congestive stage of the 
acute exanthemata, in pyaemia, and occasionally in cerebro-spinal meningitis. 
This febrile albuminuria is not attended with any specific disease of the kid- 
neys, and must, therefore, not be confounded with albuminuria in conse- 
quence of acute diffuse nephritis, which so often occurs in diphtheria, relaps- 
ing and scarlet fever. This inflammatory albuminuria is the prominent 
symptom of inflammation of the kidneys, and especially that form which runs 
a chronic course. It furnishes the largest percentage amount of albumen to 
the urine, which we find also usually containing, at the same time, fibrine 
and white and red blood-cells. It seems that by the inflammatory process 
the walls of the capillaries within the glomeruli are so changed as to con- 
stitute a special perviousness to albuminous substances from the blood. 
Other diseases of the kidneys, such as fatty degeneration of the renal epi- 
thelium, cirrhosis, granular atrophy, amyloid disease of the kidneys, are not 
particularly characterized by the presence of albumen in the urine, although 



588 UREMIA. 

it may not entirely be wanting in these affections. It is the diffuse inflam- 
mation of the kidneys (the acute and especially the chronic form) which 
furnishes the largest amount of albumen to the urine, and to which the term 
albuminuria is particularly applicable. 

Therapeutic Hints. 

According to Bucher, when in consequence of gonorrhoea or syphilis: 
Thuja, Sabina, Nitr. ac, Aurum, Cuprum, Tart. emet. (Natr. sulph., Be?iz. 
ac. , Kali bichr. ) . 

Nitr. ac. Worse at night; nausea; sour taste; bilious diarrhoea or con- 
stipation; dry skin; fever; headache; dull systolic sound of the heart (similar 
to Arsen.); pressure in the kidneys; turbid, fetid urine; oedema of the feet. 

Albuminuria being merely a symptom, but pre-eminently a symptom of 
acute and chronic nephritis, further special hints will be given in these 
chapters. 

Uraemia. 

Notwithstanding the most strenuous efforts by a host of inquirers to dis- 
cover the essential nature of uraemia, only conflicting views have thus far 
been the result of the labors of the different experimenters. The most 
probable of all theories seems to be this, that ' ' uraemia arises in consequence 
of imperfect depuration of the blood in renal disease, the results of the reten- 
tion in the blood of the dross of the capillary interchanges, namely, nitroge- 
nous substances and specific urine contents/' (Bartels.) 

Acute uraemia. In acute as well as chronic kidney diseases, it manifests 
itself in the form of epileptic convulsions, which are succeeded by coma, or in 
some instances, by a condition of maniacal excitement. Xot unfrequently 
a series of such epileptic attacks terminate at last in death. At times these 
uraemic fits are preceded by dropsy, dyspepsia, obstinate vomiting, and even 
amaurosis, which latter, however, ma}' subside as suddenly as it comes. 

In the Chronic form of uraemia the epileptiform fits are usually absent or 
amount only to twitchings of certain groups of muscles, or the)' close the 
scene after long-continued, complete coma. The principal symptoms are in- 
creasing somnolence, apathy, or stupefaction, advancing at last to complete 
coma, frequently preceded by stubborn and incessant vomiting of masses 
which contain carbonate of ammonia. Often there is in this form a most 
tormenting itching of the skin, which compels the patient to scratch himself 
incessantly, even when lying in a state of unconsciousness. This symptom 
has been observed in patients who had crystals of urea upon the surface of 
their skins, or exhaled a urinous odor from their persons. Lastly there have 
been observed in chronic renal affections, a long while before the fatal ter- 
mination, paroxysms of asthma, most frequent at night, with intervals of com- 
plete freedom. 



bright's disease. 589 

Therapeutic Hints. 

According to Biichner: 

Main remedies: Arsen., Cuprum., Phosplwr., Aurtim, Tereb, Ctcp. ars. 

Cuprum. Eclamptic form; alternation of convulsions and nervous 
asthma with talkative delirium, which is interrupted by amaurosis or deaf- 
ness; the most violent paroxysms are followed by apathy and greatest in- 
difference. During the paroxysm: face distorted, often red; eyes projecting, 
staring; spasms most prominent in the extensors; tongue and breath cold; 
long, shrill screams; finally exhaustion, sweat, torpor, and cessation of con- 
vulsions. 

Arsen. In the narcotic form, with oedema of the brain. 

Phosphor. Where there is acute atrophy of the brain and medulla 
oblongata. 

Hydr. ac. Action of heart diminished; pulse accelerated, soft; stag- 
nation of circulation in heart and lungs; palpitation, with indescribable 
anguish and dyspnoea; depression of sensibility; first convulsions and after- 
wards paralysis; extreme apathy; slow moaning breathing; rattling in 
trachea; paralysis of larynx or sudden paralysis of heart. 

Nicot. Paralysis of diaphragm; indifference; want of reaction; cold 
forehead; thirstlessness; serous transfusion in the intestines, without diar- 
rhoea; want of secretion in liver and kidneys. 

Bright's Disease. 

Bright 's disease is a generic term embracing the various forms of organic 
kidney disease of inflammatory origin, with resulting albuminuria and 
dropsy. Strictly speaking the acute and chronic forms of diffuse nephritis 
constitute this group, although chronic interstitial nephritis is generally con- 
sidered here also for anatomical and clinical reasons. 

Acute Parenchymatous Nephritis. 

This is the First stage of Bright's disease of many writers, also known 
as acute diffuse nephritis, or Traube's hemorrhagic nephritis, or the catarrhal 
of some, and the croupous nephritis of other recent pathological hand-books. 

Its PathoeogicaIv Changes consist in the following: dropsical effusion 
into the substaneous cellular tissue, at times also into the pleura, the peri- 
cardium, or the peritoneal cavity; still less frequently extensive pulmonary 
oedema; and rarest of all oedema of the mucous membranes of the folds at 
the upper part of the larynx. The kidneys are enlarged and swollen, espe- 
cially the cortical substance, so that the capsule is tightly stretched; the 
color of the cortical substance on section is paler than normal; it has a dull, 
grayish-red aspect, and gives a doughty feel; the glomeruli distended with 
blood, contrast with the paler ground as dark red points and streaks; the 
pyramids are always greatly congested, sometimes blueish-red in color. In 



590 ACUTE PARENCHYMATOUS NEPHRITIS. 

other cases no very essential deviation is exhibited from the normal appear- 
ance of the kidneys, with the exception of the swelling of the cortical sub- 
stance, and even this is in some cases, when the patient died from other 
causes than the attending nephritis, very slight in degree. Between these 
extremes many differences in degree appear which correspond to the differ- 
ence in the intensity of the functional disturbances observed at the bedside 
previous to death. 

The epithelial cells are cloudy and swollen, owing to a deposit of gran- 
ular masses in them; the interstices between the renal tubules, which are 
distended and dilated by the swelling of their epithelial lining, appear wider, 
and contain lymphoid elements in varying numbers; there appear drops of 
fat in the cellular stroma, and in more protracted cases yellow patches seem 
to indicate fatt}^ degeneration. In all cases there is an infiltration of the 
epithelial cells and an albuminous transudation from the blood-vessels. Acute 
cases are usually attended with haemorrhages into the tubuli uriniferi, where 
the}' form blood-casts, which are also found in the urine; also homogeneous, 
small and pale cylindrical plugs have been observed filling here and there 
the lumina of the tubuli. 

The Etiology of acute inflammation of the kidneys embraces specific 
and mechanical causes. 

As Specific Causes must be mentioned: poisoning with cantharides 
and similar irritating drugs; but scarlet fever is the most common cause. 
Yet not all scarlatina epidemics furnish a like percentage of this disease. 
For although malignant epidemics, generally speaking, show the largest per- 
centage, yet there are epidemics in which even bad cases produce no nephritis, 
and others where quite light cases are followed by it; and this is not referable 
to any imprudent exposure of the patient, as the disease may attack a child 
which never has left the bed. The onset of the disease, if an average be 
taken, occurs about the twentieth day from the first appearance of the rash; 
the earliest date of its occurrence was the tenth, the latest the thirty-first day. 
With this renal inflammation we must not confound febrile albuminuria 
(compare Albuminuria), which generally appears at the height of the ex- 
anthem and disappears again with the subsidence of the fever. 

Next to scarlet fever follows diphtheria as a specific cause of nephritis; 
and like scarlet fever it does not excite a renal affection in every instance; 
nor does the renal affection stand in direct proportion to the intensity of 
diphtheria. 

Measles, rubella (Rbtheln), small-pox excite nephritis far less frequently 
than either scarlet fever or diphtheria, but relapsing fever is, according to 
Ponfink, almost without exception attended by nephritis. Besides these 
principal specific causes are yet to be mentioned: erysipelas, carbuncles, phleg- 
mons, profuse suppurations in cavities where decomposition of the pus begins 
in consequence of the admittance of atmospheric air, and very rarely cases 
of dysentery. 

The Mechanical Causes which act upon the vessels and thus affect the 



ACUTE PARENCHYMATOUS NEPHRITIS. 591 

circulation of the blood through them, are: Cholera, which leads to complete 
stoppage of the circulation in the kidneys and a consequent anuria; catching 
cold, which contracts the cutaneous vessels and drives the blood into the in- 
ternal parts of the bodj^ where it produces an elevation of the blood-pressure; 
extensive burns of the surface of the body, which cause a general depression 
of the temperature of the body in consequence of the great loss of heat; ab- 
dominal typhus and other diseases attended by an unbroken continuous high 
temperature, which causes dilatation of the vessels and other alterations in 
the walls of the vessels (of rare occurrence) ; and acute rheumatism, when 
complicated with endocarditis. Pregnancy also is a cause of acute parenchy- 
matous nephritis. Usually its appearance takes place in the last months of 
pregnancy, and it attacks primiparse more frequently than women who have 
already borne children. Its first S3 7 mptom in the majority of cases is drop- 
sical swelling not confined to the lower extremities, but attacking face and 
hands as well. The percentage of albumen is greater than in nephritis of 
any of the other causes, and its fearful terminal symytoms: epileptiform con- 
vulsions, amaurosis and maniacal excitement are well known under the name 
of eclampsia gravidarum, parturientium et puerperarum. However, it must 
not be surmised that every case of eclampsia must be ascribed to disease of the 
kidneys and uraemia, not even if there should be found albumen and a few 
casts in the urine after the attacks, inasmuch as cases of this kind have been 
observed which showed after death not a sign of diseased kidneys. 

The Symptoms of acute parenchymatous nephritis are in the majority 
of cases accompanied by the symptoms of the primary disease — the febrile 
movement especially must often be ascribed to the latter. In cases from 
catching cold, however, the temperature has been observed to rise above 104 
F. lasting commonly but a short time; the outbreak of uraemic convulsions 
or of secondary inflammatory processes, too, heighten the temperature. Ach- 
ing pains in the lumbar region is not at all a constant symptom and frequently 
is absent altogether. But a tenderness in the region of the kidneys upon 
deep pressure is often present. Frequent and excessively urgent desire to mic- 
turate, with the voidance of only a few drops, often of bloody urine, is also 
not a constant symptom and is apt to disappear very quickly. The quantity 
of urine is always diminished at the commencement; the urine may even be 
entirely suppressed; later, when the case takes a favorable turn, the quantity 
increases above the normal quantity or may for some time alternately in- 
crease and diminish. The urine is at first always cloudy from the presence 
of urates and other elements. Its color is, from the admixture of blood, 
tinged reddish, or is quite dark blackish-red, when a thick sediment of 
chocolate-brown color is formed, consisting of urates and blood-corpuscles. 
Its reaction is always acid and its specific gravity varies with the quanthvy 
passed. At first it may rise as high as 1031, and later, when the quantity 
increases, sink as low as ion, 1009 and even 1006. The urine always con- 
tains albumen, although in no case as much as in chronic parenclrymatous 
nephritis, and also casts of a hyaline nature with epithelial cells from the 



59^ THERAPEUTIC HINTS TO ACUTE PARENCHYMATOUS NEPHRITIS. 

tubuli uriniferi attached to them, or covered with small drops of fat, also 
white and red blood-globules and their debris, epithelial cells from the uniferi 
tubules, and granular masses, the latter being probably the detritus of broken- 
down epithelial cells. 

The danger of acute nephritis consists in the retention in the blood of 
the special constituents of the urine, causing acute uraemia, and in the insuf- 
ficent excretion of water, which leads to dropsy, a symptom which is scarcely 
ever absent, except in very mild cases. The cedema commences usually at 
first in the lumbar region of the back or in the face; later often an accumu- 
lation of water fills the serous cavities of the trunk; in rare cases there is 
cedema of the glottis. 

Vomiting is occasionally at the commencement severe and obstinate; at 
a later period it may be ursemic in its character .- 

The Prognosis of acute nephritis depends much upon the cause from 
which it is derived. That following scarlet fever is the most dangerous. 

Its transition to a chronic renal affection is only exceptional; that fol- 
lowing catching cold or articular rheumatism is perhaps the most prone to 
became chronic. Total suppression of urine, except in cholera, is a very 
grave symptom, often fatal; uraemic attacks do not always prove fatal. 

Therapeutic Hints. 

In complication with scarlet fever compare: Apis, Arsen., Ascl. syr., 
Bellad., Bryon., Colchic, Helleb., Kali carb., Laches., Lycop., Me) cur., Rhus 
tox., Secale, Senega, under the head of Scarlet Fever. 

After the abuse of cantharides, or balsam of copaiva, the best antidote 
is Camp ho ra; after turpentine, Phosphor. 

Aco?i. High fever; restlessness; dark, scanty urine; consequence of 
exposure to cold. 

Apis. After scarlatina or diphtheria. 

Arsen. After burns. 

Bellad. Skin sweaty; renal region very tender to pressure: uraemic 
spasms. 

Canthar. High fever; pulse frequent and hard; drawing, tearing pain 
in loins and testes, worse from motion; sometimes in spells, stopping breath- 
ing; micturition exceedingly painful, drop by drop; scanty, dark urine, 
with burning in the bladder and urethra; the urine contains cylindrical 
casts of fibrinous exudation, epithelial cells and blood, and is therefore easily 
coagulable; constipation; uraemic, cerebral symptoms, like stupor, numbness; 
after exposure to cold, or mechanical injuries; complication with prostatic 
derangements, inflammation of the bladder, and stricture of the urethra; 
after burns. 

Chelid. With pneumonia on right side. 

Balsam of Copaiva and Cubebs. Have been observed to cause inflam- 
mation of the kidneys, though their sphere of action is not sufficiently known. 

Colchic. After getting thoroughly wet; articular rheumatism. 



CHRONIC PARENCHYMATOUS NEPHRITIS. 593 

Hclon. In connection with pregnancy, and symptoms of approaching 
convulsions. 

Hepar. Is recommended by Kafka on the ground of its having a de- 
cided relationship to croupous exudations elsewhere. 

Kali card. Tensive pain in the region of the left side; swelling of the 
inguinal glands; oedema of the left foot, extending gradually to the right 
foot and upwards over the whole body; oedema of upper eyelid; blackish 
urine, which, on shaking, foams, and on standing leaves a thick, reddish, 
sliiny sediment; frequent, soft, palish evacuations from the bowels; after a 
blow upon the left side and staying for hours in wet clothes. 

Kali hydr. Scanty, dark urine; painful micturition; sediment dirty, 
yellowish; great thirst; heat in the head. likewise recommended by Kafka 
on the same ground as Hepar. 

Laches. After scarlet fever or diphtheria; dark, almost black urine; 
difficulty of breathing. 

Merc. corr. Great dyspnoea; colic and tenesmus, offensive secretions; 
puffiness of face and feet. 

Phosphor. The skin is pale and anaemic; frequent watery diarrhaea; 
in complication with pneumonia, bronchial catarrh, ulceration of the bones, 
amaurosis. Antidote to turpentine. 

Rheum. " Bloating around the eyes, pallor of face, covered with cool 
sweat; forehead and hair sopping wet, lips, eyelids, fingers twitching; urine 
scanty, hot, with slimy shreds and strings of blood on diaper; renal region 
tender to pressure. After diphtheria." (M. B. Tuller.) 

Rhus tox. Tearing pain in the region of the kidneys; cedematous 
swelling all over; after exposure to wet. 

Tereb. Scanty secretion of dark (occasionally), bloody urine, which 
coagulates on addition of nitric acid under the application of heat; oedema 
all over; intestinal catarrh and diarhcea; bronchial catarrh with expectora- 
tion of much mucus. 

Amaurotic symptoms may especially require: Apis, Arsen., Colchic, 
Gelsem., Hepar, Kalmia, Merc, corr., Phosph. ac, Plumbum. 

Chronic Parenchymatous Nephritis. 

This is the Second Stage of Bright's disease of most writers, also chronio 
diffuse nephritis, or the non-desquamative nephritis of Johnson. Being, as 
stated in the last chapter, occasionally developed from acute nephritis, its 
anatomical changes may certainly be expected to correspond to a certain ex- 
tent to those described there. We find the kidneys still more enlarged than 
in the acute form, and being exceedingly anaemic, they look strikingly pale, 
almost white, with a strong tinge of yellow, wherefore Wilks called them 
the "Large white kidney." With this yellowish -white color of the surface 
as well as of the cortical substance contrast sharply the bluish-red, stellate 
venous radicles, and the enlarged, but often dark red pyramidal substance. 
The microscopical examination reveals the same changes as described under 
38 



594 CHRONIC PARENCHYMATOUS NEPHRITIS. 

acute nephritis. The long-continued inflammatory hyperplasia of the inter- 
stitial tissue finally results (in consequence of the pressure which the callous 
tissue exerts upon the blood-vessels) in a gradual obliteration of the glomeruli 
and a secondary atrophy of the secreting parenchyma of the kidneys, 
although such kidneys are rarely found much smaller than normal kidneys. 
In cases like these the left ventricle of the heart becomes hypertrophied. The 
bodies are always more or less dropsical. 

The Etiology of chronic nephritis shows a small percentage of cases 
to have grown out of some acute forms, but the great majority of cases 
develops insidiously during the course of affections that are accompanied by 
persistent suppuration, such as diseases of the bones and joints, the more 
severe forms of inveterate syphilis, phthisical, ulcerative destruction of the 
lungs; in consequence of long-continued exposure to cold and moisture (a 
sudden catching cold is more apt to produce acute nephritis, and therefore 
almost all writers on the causes of chronic Bright 's disease, mention living 
in cold and wet habitations, occupations in which the body is frequently 
wetted and chilled through, etc., as one of the causes); and in consequence 
of marsh miasm. Young persons are decidedly more frequently attacked 
with this disease than those who are advanced in years. 

Symptoms of chronic parenclrymatous nephritis are on account of its 
insidious inroad at first entirely wanting; not even a pain is felt by those 
persons who enjoyed previous good health. When no examination of urine 
has been instituted, the first sign that betrays the s malady is dropsy, and at 
the same time the patient appears pale and anaemic, and complains of losing 
bodily strength. The dropsy, beginning either in the feet or in the face, ex- 
tends gradually over the whole body; the external genitals in particular, and 
also the abdominal walls are greatly swollen, before any perceptible quantity 
of fluid is collected in the peritoneal, pleural or pericardial cavity. The 
general anasarca develops to a higher degree than in any other disease of the 
kidneys, often to such an extent that the epidermal layer bursts, and the 
dropsical fluid trickles out of the cracks in enormous quantities. In such 
places where the corium has been deprived of its epidermis, frequently fol- 
lows a gangrenous destruction of the parts. Even the lining mucous mem- 
brane of the intestinal tract becomes involved in the dropsical swelling, which 
manifests itself by vomiting of watery masses and profuse watery diarrhoea. 
The advance of the drops} 7 will not be checked until the excretion of urine 
again becomes abundant, and even then it may take a long time before it 
entirely and permanently disappears. When this is accomplished the patients 
appear skeleton-like, for not only the subcutaneous adipose tissue, but also 
the muscles have been reduced to the merest remnants; there is extreme 
anaemia. Should complete recovery take place, which is rarely the case, the 
convalescence is very slow. Dropsy is absent only in the very mildest cases. 

The urine invariably contains albumen, and when the disease is at its 
height, in greater quantity than under any other circumstances; it also con- 
tains casts of various description, epithelium, debris, white blood-cells, urates 



THERAPEUTIC HINTS TO CHRONIC PARENCHYMATOUS NEPHRITIS. 595 

and uric acid. Red blood-corpuscles appear only transitorily in cases which 
commenced acutely, for instance, after catching cold. In consequence of and 
according to the presence and quantity of these contents, the color of the 
urine is ordinarily dirty brown, and darker in proportion to the smallness of 
the quantity. The scantier the excretion, the more clouded it is — even before 
cooling. The urates are held in suspension after cooling, when there is a 
large amount of albumen present, and make the urine thick and muddy- 
The uric acid crystals fall to the bottom and adhere to the vessel. 

The specific gravity of the urine is highest at the height of the disease — 
in some cases above 1040, and it falls below the normal weight as soon as a 
more abundant excretion of urine sets in, even before the diurnal quantity 
of urine has reached its normal point. With this fall in specific gravity is 
not found a like fall in the amount of albumen, while it may be taken as a 
rule that the relative quantity of urea to a certain extent rises and falls with 
the rise and fall of the specific gravity of the urine. 

The pulse at the beginning is usually remarkably slow, full and tense, 
and the heart-sounds loud and sharp, in persons who, previous to the attack, 
were robust and vigorous, but later becomes weaker and more frequent, while 
in enfeebled persons the pulse and action of the heart are weak from the first. 

Respiratory difficulties set in only in consequence of dropsy in the serous 
cavities, or of pulmonary oedema. 

Digestion may and may not be disturbed; but vomiting and diarrhoea 
are frequent symptoms when the dropsy is at its height; the latter may ter- 
minate in secondary dysentery and ulceration of the bowels. 

Epileptiform attacks, coma, amaurosis, are much less frequently observed 
than in acute nephritis. 

When secondary atrophy has taken place, a hypertrophy of the left ven- 
tricle develops, with its train of symptoms, in consequence of the obliteration 
of so many peripheral arterial branches. 

The Prognosis of this disease is a bad one, when the affection has lasted 
already for a long time, or is complicated by some incurable constitutional 
or organic disease, or when the urine is very scanty, high in specific gravity, 
with a large amount of albumen; or when the urine, after the subsidence of 
dropsy, is pale, of low specific gravity, never even temporarily attaining a 
normal density, and still containing albumen and casts in extraordinary 
number, with commencing secondary hypertrophy of the left ventricle; or 
when oedema of the glottis or lungs, pneumonic infiltrations of the pulmonary 
tissue, phlegmonous inflammations of the subcutaneous cellular tissue are 
added to the already poor condition of the patient. 

Therapeutic Hints. 

Compare Acute Nephritis. 

Arg. nitr. Is said to have caused albuminuria. 

Arsen. Great anxiety at night, driving out of bed; vomiting of brown- 
ish masses, with violent pain in the bowels, pressure and burning pain in the 



596 THERAPEUTIC HINTS TO CHRONIC PARENCHYMATOUS NEPHRITIS. 

stomach; swelling of the genitals; palpitation of the heart, left side of heart 
predominantly affected. 

Aurum. When complicated with gout, renal calculi, protracted suppu- 
rations, syphilis, liver degenerations, mercurial affections. (Buchner.) 
Melancholy; desires death. 

Benz. ac. Gout}- diathesis, with strong-smelling urine. 

Brachiglottis repe?is (puke-puke). Highly recommended by Dr. C. 
F. Fisher. 

Bryon. Intercurrent inflammation and exudation of serous membranes. 

China. Stands next to Arsen. (D. Thayer.) 

Colchic. Damp rooms; relapses from taking cold in damp weather; 
suppressed perspiration; affection of salivary glands; cannot bear the smell 
from cooking. 

Digit. Peculiar, seemingly rheumatic pains, and catarrhal affections of 
the lungs, with serous secretions. 

Helleb. Indifferent, sad, silent; anasarca and effusion in the pericar- 
dium or pleura; black urine. 

Hepar. After abuse of mercury; renal region sensitive to slightest 
touch; incessant, painful urging to urinate, with voiding of a few drops of 
thick urine; fever; thirst; colliquative diarrhoea; night sweats. 

Lycop. Hydropericardium ; ascites; anasarca, especially lower limbs; 
oozing of water from sore places of the cedematous legs; urine dark red, 
scanty, albuminous, w 7 ith strangury. Very irritable after sleep; scarlet 
fever. 

Nitr. ac. Pulse intermits every third or fourth beat; urine scanty, 
dark brown, smelling strong, like horses' urine; turbid urine; syphilis; abuse 
of mercury. 

Phosphor. Tuberculosis; diseases of right heart and of the pulmonary 
artery. (Buchner.) 

Phytol. After diphtheria in rheumatic and syphilitic patients. 

When in consequence of exposure to cold and wet: Calc. ca?'b., Colchic. , 
Ditlcam., Kali carb., Mercur., Nux vom., Rhus tox., Sepia. 

When in consequence of suppuration, cachectic states of the system: 
Asa/., Aurum., Calc. phosph., China, Ferrum, Hepar, Mezer., Phosphor. , 
Silic, Sulphur. 

Buchner recommends for: 

Anasarca: Arsen., Dulcam., Helleb. 

Hydro-thorax: Arsen., Bryon., Colchic. 

Hydropericardium: Arse?i., Digit., Lycop. 

Ascites: Arsen. , Aurum. 

Affections of the liver: Aurum, Cuprun),, Lycop. 

After taking cold: Arsen., Calc. carb., Dulcam. 



INTERSTITIAL INFLAMMATION. 597 

Interstitial Inflammation or Induration of the Connective Tissue 

of the Kidneys. 

This is the so-called Third Stage of Bright's disease of many authors, or 
genuine contracting kidney, or the granular atrophy of the kidney, or renal 
cirrhosis, or renal sclerosis of other writers. 

It is, according to Bartels, "the result of a primary growth or pro- 
liferation of the intertubular connective tissue, and commences and pursues 
its course quite independently of the other forms of renal inflammation pre- 
viously described. It is, in fact, an altogether independent form of the disease. 
This process leads from its commencement steadily to the dwindling of the 
substance of the gland, a wasting preceded by no anterior inflammatory 
swelling of the organ. And this wasting does not affect the whole mass of 
the cortical substance simultaneously, but commences in scattered spots upon 
the surface of the kidney and extends very gradually from the spots first im- 
plicated both upon the surface and into the depth of the organ." 

Post-mortem examinations show, in most cases, both kidneys atrophied 
principally in their cortical substance, though the medullary substance also 
takes part in it. The pelvis is occasionally distended to a pouch, but oftener 
drawn together into narrower dimensions than normal. The capsule is tough 
and thick, and portions of the renal substance are always found adhering to 
it. The surface of the gland, after being freed from the capsule, appears 
finely granulated, and its entire substance is very tough; occasionally small 
cysts are found in the scanty cortical substance. The color of the kidneys is 
sometimes dark colored throughout, at other times pale, nearly grayish- white, 
but in no case is that marked yellow color exhibited which we find in the 
secondary contraction after nephritis. The microscope shows an extensive 
wasting away of the glandular structure proper, of the renal tubes with their 
epithelium and of the vessels attached to them. There are extensive layers 
of very firm and chief! y fibrinous organized connective tissue, and between 
them here and there some well preserved renal tubules. The great number 
of wasted glomeruli appear like dark round bodies, in which the outline of 
the capillary coils is still plainly perceptible. The cysts in the cortical sub- 
stance above mentioned, appear to be developed from partially dilated and 
strangulated renal tubules, the contents of the tubes having subsequently 
suffered colloid metamorphosis, and the granules upon the surface of the kid- 
ney seem to be the remains of the renal tubuli still beset with epithelium. 
However, such general degeneration is not found in every case. In some 
only a partial contraction has taken place, while other portions retain their 
normal appearance; neither are both kidneys always affected alike. In al- 
most every instance, however, there is found, hypertrophy of the left ventricle 
of the heart. Other features often met with are: retinitis albuminurica, 
thickening of the skull cap, apoplectic effusions, and occasionally dropsical 
effusions usually of small amount. 

The Etiology of renal cirrhosis is not very clearlv understood. It is 



59° INTERSTITIAL INFLAMMATION. 

of rare occurrence in youth, more frequently in middle life, and at any age 
most frequent in the male sex. As exciting causes are mentioned: spirituous 
liquors, especially gin, lead-poisoning, gout and inveterate gonorrhoea. 

Symptoms. — Its commencement eludes diagnosis. As the first symptom 
which draws attention to itself is the frequent desire to pass water, especially 
at night, and without pain or ache. In some cases the patient experiences 
occasional attacks of palpitation, accompanied sometimes with vertigo, or a 
sense of great uneasiness, or suffocation, or want of breath, also principally at 
night. In such cases the heart will be found hypertrophied. There also 
occur occasional paroxysms of headache under the form of hemicrania, re- 
curring often and lasting for several clays. A terrible itching of the skin 
with more or less extended so-called rheumatic pains sets in frequently toward 
the end of life, but visual disorders under the form of retinitis albuminurica, 
also occasionally a most repulsive smell of the breath are symptoms of an earlier 
stage. At first, appetite and strength are not affected, later, however, the 
appetite fails, especially for meat-diet, with occasional vomiting after eat- 
ing, and an increased thirst for large quantities of water, with increased 
exertion of urine. This is followed by emaciation, anaemia, and loss of 
strength; the skin acquires a peculiar dryness and assumes a dirty, faded color, 
and the sexual power is either greatly diminished or lost altogether. The 
larger number of patients die either of anaemia or apoplexy, or of inflamma- 
tory exudations into the servus cavities, or of inflammatory infiltra- 
tion of the lung tissue, or else of erysipelatous and phlegmonous inflam- 
mations of the general surface of some part of the body. Dropsy may 
be entirely wanting, except when the disease advances to its most extreme 
grade, in which the kidneys become incapable of performing their function, 
or when intercurrent diseases of the lungs or heart, especialty mitral insuf- 
ficiency, bring it about independently of the kidney affection. Diarrhoea is 
often found toward the end of the disease, and then very profuse, watery and 
fetid. Haemorrhages from different parts of the body (nose, mouth, bronchi, 
stomach, intestines, and the skin principally of the extremities in the form 
of petechiae or ecchymoses) occur likewise in the later stages of the disease. 
But the most important indications can only be gained by frequent and care- 
ful examinations of the urine. "As a general rule, the genuine process of 
contraction of the kidney is associated with polyuria. But neither does this 
symptom at once become prominent at the very beginning of the malady, nor 
does it persist absolutely to the very end of the case. In fact, in the progress 
of the disease it may entirely subside for a longer or shorter interval of time, 
whenever, from an} 7 debilitating influence, the vigor of the heart's propulsive 
power is diminished for a longer or shorter period, or the urinary secretion 
may be completely arrested for several days before death, if the patient loses 
much water by any other channel, or severe collapse precedes death for some 
time." (Bartels.) 

The color of the urine is pale yellow, or yellowish-green. It is clear 
without sediment, only occasionally crystals of uric acid, and still more rarely 



THERAPEUTIC HINTS TO INTERSTITIAL INFLAMMATION. 599 

urates are found upon cooling. Its specific gravity is, as a rule, below nor- 
mal, fluctuating between 1004 and 1012, and its reaction slightly acid, but may 
become alkaline by decomposition, dietetic or medicinal treatment, or vesical 
affections. It contains albumen in the vast majority of cases, though this 
abnormal constituent may be wanting at the beginning, or for a greater 
length of time during the course of the disease, or be absent altogether in 
exceptional cases. On the whole, however, the percentage of albumen in 
this disease is much less than that furnished by the inflammatory processes 
in the kidneys before described; its amount changes greatly according to the 
mode of life, the food and the general state of nutrition, and there is no con- 
stant ratio between the percentage of albumen and the total quantity of urine. 

The percentage of solid constituents, especially of urea, is abnormally 
small; epithelieal cells from the renal tubes are seldom found; red blood-cor- 
puscles, few in number, may be found scattered in the sediment, but never 
to an extent as to make the urine red or sooty; and white blood-corpuscles 
or pus-cells seem to derive somewhere from the mucous membrane of the 
urinary passages. 

The Diagnostic Signs then of renal cirrhosis are: the large quan- 
tity of urine daily secreted, its pale color, its low specific gravity, and the 
comparatively small amount of albumen it contains, combined with hyper- 
trophy of the left heart. From this the secondary atrophy of the kidneys in 
consequence of diffuse nephritis, differs in the smaller amount of daily secre- 
tion of urine; in the urinary sediment consisting of numerous casts of different 
character and of large quantities of granular detritus; and in the presence 
of considerable dropsy for a long time. 

Therapeutic Hints. 

I find only one case as having been cured, which can be classed under 
this head, although neither albuminous urine nor hypertrophy of the left 
heart are mentioned in it, yet both may have been present according to the 
symptoms. The case is this: Iy. K. M., aet. 52, of robust frame; family his- 
tory good. The past and present absence of any oedema, the general pro- 
fuseness of urine, with all else, led to the diagnosis of Bright's disease, — 
variety, granular degeneration. Perspires all over the body, as soon as he 
gets into bed; perspiration comes and goes all through the night. Cough on 
first waking. Cough comes as he gets out of bed; continues until he has 
had his breakfast. It is occasioned by a sensation as if he had a " wheat 
hull" low in his throat, just behind the manubrium sterni. Ikying on his 
back makes him cough; on right side also. When lying on his back, feels 
as if fluid rolled from one side of his chest to the other. (Purely subjective, 
no fluid there.) In the morning, mouth and lips are dry, and lips swollen. 
Tongue also dry. Iyips crack open when coughing. Drinks at night on ac- 
count of dry mouth. Oppressed for breath; breathes with difficult}', espe- 
cially after waking. Going upstairs causes it. Is markedly weak now. 
Rash as it may appear, considering that the sweat did not break out each 



600 AMYLOID DEGENERATION OF THE KIDNEYS. 

time he awoke, I gave him one drachm of Sambuc, first dec. dil., in half a 
glass of water, a dessertspoonful ever)' hour. Result: No sweat that night. 
Ma} T 1 8th, Bryon. 30 , for pleuritic pains in the right lateral thoracic wall. 
This was an old trouble of his — sinapisms and cantharides-blisters having 
hitherto been applied for them. The action of Bryon. won his heart. He 
had thought the effect of Sambuc. on his night-sweats a "coincidence;" but 
the Bryon. dispelled the pain inside of fifteen minutes. May 23d, his pre- 
scription was Plumb, met., 30th trit., a powder (two grains) every four 
hours. He has exchanged his pasty yellow look for the ruddy hue of health, 
for he is a rudd}' man now again. (S. A. Jones, Am. Obs., Nov., 1875, 
p. 561.) 

Compare also the previous chapters. 

Amyloid Degeneration of the Kidneys, Lardaceous or Waxy 

Kidney. 

Amyloid degeneration is scarcely ever confined to the kidneys alone, but 
exists at the same time in the spleen, the liver, the abdominal lymphatic 
glands, the blood-vessels of the mucous membrane of the intestines, as well 
as those of the various other organs, and is invariabl}' the local manifestation 
of a general constitutional disease, of a cachexia which arises from prolonged 
suppuration, in consequence of scrofula, chronic tuberculosis or inveterate and 
hereditary siphilis. Intestinal ulcerations favor the development of the dis- 
ease more than ulcers of any other mucous membrane. 

Post-mortem examination shows in lighter cases no abnormal appearances 
of the kidneys to the naked eye. In extreme cases the kidneys are greatly 
enlarged, heavy, tough and firm; the color of their surface is pale, at times 
almost white, and so is their broadened cortical substance; upon the cut sur- 
face in the cortex appears a peculiar polish; but there is no sign of yellow 
coloration, as is always observed in the equally enlarged and anaemic kidney 
of chronic parenchymatous inflammation. If a watery solution of iodine or 
iodide of potassium is applied to the cut surface there soon appear bright 
reddish-brown points and branching lines, denoting the Malpighian tufts and 
the arteries with their branches, which have undergone amyloid degeneration, 
and on adding a drop of concentrated sulphuric acid the reddish-brown 
structures at once turn blue. 

Amyloid degeneration often occurs together with chronic parenchyma- 
tous nephritis in both kidneys, and as it is furthermore the result of other 
constitutional troubles, it is scarcely possible to separate its Symptoms from 
those produced by the coincidental diseases. In fact it develops itself quite 
insidiously, or, so to speak, without symptoms. The urine, as a rule, is aug- 
mented, and then always clear and pale like water; but when scanty it is 
darker and occasionally clouded with urates. Its specific gravity may sink 
to 1003, when passed freely, and may rise to 1030 and over, when passed but 
scantily. It contains albumen, and more at the beginning than later, when 



SUPPURATIVE NEPHRITIS. 6oi 

polyuria has set in. Casts are seldom found in any considerable number. 
Dropsy may or may not be present; but if it does appear, it usually remains 
persistent, especially the ascites, even in spite of abundant urinary secretion. 
Diarrhoea is very common and nearly always fatal, being induced by ulcera- 
tion, as in phthisis and S3^philis. Vomiting is less frequent and consists of 
watery masses of a faintly acid reaction. Other ursemic symptoms, if the 
vomiting may be considered as such, are still rarer, and the cardiac hyper- 
trophy is altogether absent, but in some cases the heart has been found small 
and atrophied. As a rule the fatal issue is brought about by gradual ex- 
haustion. 

The Prognosis is entirely dependent on the fundamental disease and 
its Diagnosis is always quite difficult, and in most cases impossible. 

Therapeutic Hints 

Must be derived from a study of the constitutional malady of which amyloid 
degeneration is the result. 

Suppurative Nephritis, Renal Abscess. 

This may be produced: 

1. By renal concretions, which irritate the renal tissue and cause sup- 
puration. 

2. By injuries, for instance gunshot wounds, bruises, etc. 

3. By chronic retention and decomposition of the urine, which affects the 
renal pelvis and parenchyma almost always simultaneously strictures. 

4. By metastasis through embolism of smaller renal vessels with infecting 
substances, in consequence of endocarditis sinistra. 

5. By the so-called pysemic affections. 

6. By the extension of suppurative processes from neighboring organs, 
especially from the perinephritic tissues, the psoas muscle, the liver, etc. 

7. By the misuse of diuretics, especially of cantharides. 

8. By unknown causes, perhaps exposure to cold, etc. 

The Diagnosis of traumatic nephritis rests upon the history of the 
case; of all other forms it is exceedingly difficult, often impossible. 

Therapeutic Hints 

Must entirely be derived from the special symptoms of the individual 
case. 

Nephrolithasis, Renal Gravel or Calculi; Nephralgia, Oolica 

Renalis. 

Renal gravel and larger renal concretions consist of and are developed 
from both normal and abnormal ingredients of the urine. Renal sand con- 
sists of fine powdery deposits: renal gravel at most attains the size of a pin- 



602 . NEPHROLITHIASIS. 

head; renal stones are or" larger size, but seldom exceed that of a bean. The 
chemical composition of these concretions is various. Of the most frequent 
occurrence are those consisting of uric acid; those consisting of urates, es- 
pecially of urate of ammonia, are found much more frequently in nurslings 
than in adults; they are soft. Oxalate of lime calculi are very hard, thorny 
and warty, and very irritating to the tissues; they are rare, and occur more 
frequently in alternate layers with urates. Calculi of basic phosphate of lime 
(bone earth) or of ammonio-magnesium phosphate, or of the two mixed, are 
white or yellowish- white and of not unfrequent occurrence, while concretions 
of carbonate of lime are very rarely found. Cystine stones are of a dull yellow 
color, with scarcely any variation in the shade; they are rare; and still 
rarer are those composed of xanthine, which have a light brown or dark 
brown color, and a smooth surface. Concretions of fibrine are the result of 
renal haemorrhages with subsequent secretion of fibrine; they are often found 
mixed with other kinds of concretions; they have a dirty white or yellowish- 
brown color, and their consistency is that of wax, tough and elastic. We 
know little of the Etiology of nephrolithiasis. Heredity and family idiosyn- 
crasy, also habits of life and conditions of nutrition, are among the predis- 
posing causes mentioned. 

Symptoms — Renal sand usually causes no inconvenience to the patient; 
it is w r ashed away with the urine. Gravel and calculi are often attended 
with more or tess pain in the region of the kidneys, and when entering the 
ureters may cause the most severe paroxysms of pain, known under the name 
of lenal colic or nephralgia. Most usually the pain is only on one side, fol- 
lowing the course of the ureter down into the bladde, and in males, into 
the corresponding testicle w T hich is generally drawn up, often radiating to 
the glans penis, and causing a feeling of numbness in the corresponding 
lower extremity. These paroxysms of pain often alternate w T ith remissions, 
but w r hen at their height cause vomiting, cold perspiration, cold exremities, 
small pulse, great agony, collapsed features, even fainting fits and general 
convulsions. Pregnant women often abort under these circumstances. The 
urine is voided only drop by drop, with burning in the urethra, is scanty, 
red, brown or blackish, exceedingly loaded with blood, often mixed with 
mucus or pus, or is suppressed altogether, with subsequent uraemic symptoms, 
when the ureters of both kidneys are obstructed at the same time. The 
urine is often colorless, as clear as water, when only one kidney is affected 
and its ureter obstructed, and it is of very rare occurrence that complete 
anuria will take place, if only one kidney be diseased. During the inter- 
vals of renal colic the urine shows at times single crystals or particles of the 
urinary components constituting the renal calculi. The paroxysms of ex- 
treme pain cease, as soon as the calculus has completed its way through the 
ureter into the bladder; this occurs suddenly in most cases. In other cases 
the colic abates only slowly and gradually, when for instance the stones are 
of but slight consistency and crumble by degrees into smaller particles within 
the ureter. In some persons attacks of renal colic appear periodically and at 



THERAPEUTIC HINTS TO NEPHROLITH ASIS. 603 

regular intervals of time. The later attacks are milder than those previous, 
if the size of the calculi be not larger than the ones previously discharged, 
because the accumulation of fluids accompanying each attack result in en- 
largement of the calibre of the ureter. 

Nephrolithiasis is a chronic affection. A fatal termination may occur 
when, the result of the arrest of renal stone during its passage through the 
ureter, a rupture of the latter takes place, which is followed by fatal perito- 
nitis; or when, as the result of the complete arrest of the urinary secretion 
by obstruction of the ureters, uraemia is developed. Hydronephrosis, that is 
a dilation of the pelves and ureters by the retained, urine, or suppuration 
of the renal parenchyma in consequence of the presence of renal calculi, as- 
sumes a very chronic course, as one sound kidney usually is capable for a 
long time of performing the normal functions of both. 

Therapeutic Hints. 

A prevention of the formation of renal sand and calculi will be possible 
only by a deep study of the single case, and a long course of treatment based 
thereon. The physician is called in most cases only to prescribe for the 
present emergency, the renal colic, and here Homoeopathy has won many 
victories. The following remedies have been applied in many cases most 
successfully. A prescribing of opium or morphine in large doses or hypo- 
dermic injections is not at all the highest aim to which a student of Homoe- 
opathy should aspire. 

Arnica. Piercing pains as if a knife were plunged into the region of the 
kidne3*s; violent tenesmus of the bladder; chilly and inclined to vomit. 
Sulphate of morphia had been given large doses without relief. Arnica, 
1st. dec. dil. , in water, relieved in half an hour. (A. K. Small) 

Arse?i. Passage from time to time of gravel with dull pain in renal 
region, extending down to ureter; gastralgia; tickling and itching in 
urethra; difficult micturition; sediment of uric acid. (Bourgeois.) Urine 
alkaline, dark yellow, with sediment of mucus and crystals of urate of lime. 
(Schadler. ) 

Bell ad. Spasmodic, crampy straining along the ureter, through which 
the calculus makes its way. After Opium or morphine. 

Berber. When there is red sediment in urine, pain in back, etc. (S. 
K. Newton.) 

Canthar. High; intense pain above crest of ilium. (S. Swan.) 
Diosc. Has relieved the writing, twitching and crampy pains. (E. M. 
Hale.) 

Lycop. After Nux vom.; colicky pain in the right side of the abdomen, 
extending into the bladder, with frequent urging to urinate. Urine incrust- 
ing the vessel with red sand. 

Nux vom. Always the best remedy after the palliative use of so- 
called anodynes; pain, especially in the right kidney, extending into the 
genitals and right leg; nausea; vomiting; constant urging to urinate; insuf- 



604 PYELITIS. 

ficient urging to stool; inability to lie on the right side; better while lying 
on the back; rising and walking increase the pain. 

Opium, or Morphine. Is given by the old school in large doses, to lull 
the pain; it is indicated where there are pressive, squeezing pains, as though 
something had to force its way through a narrow space; shooting pains from 
different places into the bladder and testicles; vomiting of slime and bile; 
obstinate constipation; dysuria; greatest anxiety and restlessness; constant 
changing position; face hot; pulse slow. 

Piper meth. Pain agonizing; irresistably impelled to try all sorts of 
motions and positions for relief, without finding it. (Hiller.) 

Tabac. Constant deadly sickness of the stomach and retching, with 
cold perspiration; violent colicky pains in the region of the ureter, right or 
left side. 

The following may also be mentioned: Calc. urinaria, Cannab., Eriger., 
Eupat. per/., Galium., Sarsap., Si lie., Zincum. 

Pyelitis, Inflammation of the Renal Pelvis. 

In the catarrhal form the blood-vessels of the mucosa are distended, and 
the surface of the mucous membrane is covered with mucus or a muco-puru- 
lent secretion. In the diphtheritic form we find upon the mucous mem- 
brane yellow spots, which consist of mortified tissue. 

In the calculous form ston} T concrements are always present. 

Pyelitis may be excited by the abuse of balsam of copaiva, cubebs, tur- 
pentine, cantharides; by catching cold; by the presence of urinary concre- 
ments, animal parasites; by the ammoniacal decomposition of the urine; in 
women after obstetrical operations, in the puerperal stage and during preg- 
nane}-; by inflammation of neighboring parts; and it is often a complication 
of typhus, typhoid, and exanthematic fevers, of diphtheria, cholera, car- 
buncle and scurvy. 

It usually runs a latent course, when it is the accompaniment of some 
severe constitutional affection. In the catarrhal form the urine is always 
acid, often contains some blood, mucus and pus, and at times epithelial cells 
of the renal pelves. A sense of weight or pain in the region of the kidneys 
extending downward to the bladder, slight febrile movements and digestive 
disturbances are often, but not always present. 

When it is caused by ammoniacal decomposition of the urine, it is al- 
ways a complication of some other chronic disease, strictures, hypertrophy of 
the prostata, catarrh of the bladder, spinal diseases, etc., which cause a reten- 
tion of urine. Its symptoms are finally those of uraemia. 

The inflammation of the renal pelvis sometimes extends to the paren- 
chyma of the kidneys, when it is called Pyelonephritis. 

The most characteristic symptom of pyelitis is the presence of epithelial 
cells of the renal pelvis in the purulent urine. But these are not always 
found, and the maladies which accompany pyelitis are often of so grave a 



MORBUS ADDISONII. 605 

nature that the morbid manifestation in the kidneys is altogether over- 
looked. 

Therapeutic Hints. 

Purulent sediment: Canthar., Merc, corr., Nux vom., Petrol., Phosphor. , 
Pulsat., Sepia, Sulphur. 

Gravel in the urine: Lycop., Sarsap. Compare the preceding chapter. 

Perinephritis, Paranephritis, Inflammation of the Renal Capsule. 

The capsule appears injected and infiltated with exudation, or covered 
with purulent secretion, in consequence of which adhesions are formed with 
neighboring organs. It may lead to a thickening of the capsule, or to the 
formation of abscesses. 

Primarily, it is caused by external injuries, and exposure to cold. 

Secondarily, It may be a continuation of an inflammatory process in its 
vicinity, or of pj-aemia. 

Its Symptoms very much resemble those of other inflammatory affec- 
tions of the kidneys. There are rigors, followed by fever, and a temperature 
usually reaching io3 T 1 - -° F. ; there is a dull and often acute pain in the re- 
gion of the kidney or kidneys; there is constant desire to urinate, with but 
little discharge; the urine is highly colored and hot, but contains no blood, 
thus differing from nephritis, nor purulent sediments, thus differing from 
pyelitis. There is vomiting, and when an abscess is formed, the pus dis- 
charges either into the peritoneal cavity, or, in consequence of adhesion, 
gradually burrows downward in different directons between the different 
fascias, or works towards the surface and breaks through the lumbar region, 
In the latter case we observe a gradual increasing swelling in the renal re- 
gion, which fluctuates, points and bursts. 

Therapeutic Hints. 

Aeon., Arnica, Bellad., after exposure to cold or external injury; Hepaj , 
Mercur., Si lie., for abscess. 

Morbus Addisonii. 

Quite a number of well observed cases have been recorded, in which 
the symptoms of this disease have been found in connection with disease of 
the supra-renal capsules, so that the probability of a relation of cause and ef- 
fect between the two becomes almost a certainty. The morbid changes found 
in the supra-renal capsules consist of a proliferation of small cells in conse- 
quence of chronic inflammation and final breaking down of the structure 
into caseous masses of various sizes. In this way gradually ever}- trace of 
proper tissue disappears and we have nothing left but a firm caseous mass, 
which has grown from the middle of the medullar}^ portion towards the sur- 



606 MORBUS ADDISONII. 

face. There also have been observed in many cases of undoubted Addison's 
disease haemorrhages into the tissue of these bodies, which ma}* be so severe 
as to .swell one of them up into a tumor the size of a child's closed fist; less 
frequently new formations are found, comprising carcinoma, sarcoma and 
echinococcus. 

The changes met with in the sympathetic nervous system, such as: de- 
position of pigment in ganglion cells, fatty degeneration, proliferation of the 
connective tissue, excessive hyperaemia and dilatation of the vessels, are 
changes which also have been observed in connection with pathological pro- 
cesses. 

Symptoms. — Among the first signs of the disease which the patient can 
recall after ailing for months and longer, are great weariness throughout the 
body, and tearing, dragging pains in both hypochondria (frequently more 
intense in the right), along the back, in the sacrum and especially in the 
joints, which latter resemble most closely the arthritic neuroses of hysterical 
individuals and which might be mistaken for acute rheumatism, if it were 
not for the absence of any swelling or alteration in the shape of the joints. 
With these are associated dyspeptic symptoms, such as cardialgia, eructations, 
loss of appetite, nausea, vomiting and distention of the stomach and abdomen. 
The fat of the body is at first well preserved, but the loss of muscular power 
is apparent very earl}*, manifesting itself by a slight tremor of the hands, an 
inability to squeeze tightly and a tiredness after very little exertion. These 
symptoms may be considered as the prodromal stage. 

Further on we observe an exceedingly soft, small, weak and generally 
rapid pulse, weak cardiac impulse and a want of sharpness, or of faint 
casual murmurs here and there, in the case of all the valves as also of the 
larger vessels. Resulting from this there is a remarkable paleness of the 
skin, sometimes amounting to cyanosis, a somewhat quickened respiration 
and a temperature generally somewhat below the normal. The dyspeptic 
symptoms increase and an alternate constipation and diarrhoea is often present. 
The urine remains normal. Along with these symptoms, a more or less dis- 
tinctly marked discoloration of the skin gradually develops, commencing as a 
light dusky gray and passing on to dark brown, first on the hands and face, 
either as a mottling, or diffusely, or occasionally in streaks. The areola of 
the breast, the genitals and the fold of the axilla color most intensely. On 
the mucous membrane of the lips and cheeks, irregular bluish or blackish 
spots occur; the sclerotic, the nails, the palms of the hands and the soles of 
the feet, however, remain perfectly clear. With this associates quickly or 
more slowly an intense anaemia and debility, painful deglutition, profuse 
diarrhoea and vomiting, headache, dullness of the sensorium, difficulty in col- 
lecting his thoughts, weakness of memory and actual fainting fits, and epilep- 
tic seizures. Meanwhile the discoloration of the skin attains to an intensely 
dark bronze color, through all the shades from an ashy-gray, darkly icteric, 
mulatto and even copper color, while the sclerotics still remain strikingly 
white. 



DISEASES OF THE BE ADDER. 607 

There are cases in which the symptoms run a more acute and tumultuous 
course, when the patient, after ailing for some time, is suddenly confined to 
bed with great prostration, trembling of limbs on being raised, confusion of 
mind, dry tongue and lips, covered with sordes, a frequent and small pulse, 
and a temperature of 104 F., similating precisely a case of enteric fever, if 
it were not for the absence of rose spots and enlargement of the spleen. 

Pulmonary consumption is the most frequent complication, which mixes 
itself up with the peculiar characteristics of Addison's disease, that we are 
often induced to look upon the double set of symptoms as almost inseparable. 

The Prognosis is thus far considered fatal. We have not, to my 
knowledge, an authenticated case of this disease cured in our literature. 

Trerapeutic Hints. 

J. Payr recommends: Be/lad., Natr. mur., Iodium, 01. jec. asel., Cin- 
chona, Ferritin, Phosphor., Cuprum Lycop, Card, veg., Arg. nitr., Ars. hydr. 

Hughes mentions: At sen., Calc. ars., Kreos. 

Lilienthal refers to: Psori?i., Therid., according to Baruch, and Natr. 
sulph., to which I may add Kali carb., on account of the paretic effects upon 
the heart-muscle of potassa salts; Sepia and Stdphur, especially for the 
earlier stage. 

A. Rockwell has seen beneficial effects from the application of the Fara- 
day current. 

DISEASES OF THE BLADDER. 
Cystitis, Inflammation of the Bladder. 

As the walls of the bladder consist of a mucous lining interiorly, a mus- 
cular coat exteriorly, which is partly covered by the peritoneum, and con- 
nective tissue between them, it is clear that an inflammatory process may 
have its seat more or less exclusively in any of these tissues, or involve the 
whole structure. Pathologsts speak therefore of: 

Cystitis catarrhalis, when the mucous membrane; of 
Cystitis submucosa, when the submucous connective tissue; of 
Cystitis subserosa, when the subserous connective tissue; of 
Pericystitis or Paracystitis, when the peritoneal or cellular covering; 
and of 

Cystitis parenchymatosa, when the whole structure is the principal seat 
of the inflammatory process. But these forms are always more or less mixed 
up with one another. # 

The catarrhal form-, when recent, is characterized by congestion of, and 
mucous secretion from, the mucous membrane, when chronic, by a livid ap- 
pearance of the membrane, and slate colored spots on it; the membrane itself 
gradually disorganizes, is found softened, thickened, infiltrated, and covered 
with a thick, grayish, purulent secretion, which by decomposition makes the 
urine ammoniacal. The inflammation rarely stays confined to the mucosa, 
but spreads to the submucous connective tissue, causing the formation of 



608 DISEASES OF THE BLADDER. 

abscesses, or involves the muscularis, inducing hypertrophy of the same. In 
this way the walls of the bladder ma}' attain great thickness; the bladder 
may enlarge in size generally, reaching often as high up as the navel (eccen- 
tric hypertrophy) ; or its size may shrink down to that of a walnut (con- 
centric hypertrophy) . Sometimes, when the bladder is capacious, the muscu- 
lar bundles are pushed asunder and the mucous membrane prolapses between 
them, and becoming in time more and more distended by urine, forms diver- 
ticula of the bladder, which by degrees may attain the size of a fist and over. 
As the urine contained therein is scarcely ever completely evacuated, these 
diverticula of the bladder form exceedingly fit places for the retention of con- 
crements and the consequent formation of stones. 

The abscesses which form in the connective tissues may burst internally, 
and before bursting, if they be situated in the posterior or lateral walls of the 
bladder, may by their bulging into the bladder greatly obstruct the flow of 
urine from the ureters, and cause regurgitation of the urine to the kidneys, 
or if situated in the neighborhood of the neck of the bladder, may lead to 
complete retention of urine. An abscess may also burst externally, either 
into the peritoneum with rapidly following peritonitis, or into the cellular 
tissue surrounding the bladder, giving rise to infiltration of urine, inflamma- 
tion, intense congestion, cedematous swelling of the ano-perineal region, per- 
foration of this region, or the rectum or vagina, and escape of urine through 
the fistulous openings subsequently remaining. In other cases fistulae may 
form at the side of the pubic symphisis. 

Cystitis maybe caused by exposure to cold and wet, by external injuries, 
by irritating drugs (cantharides, copaiva balsam, etc.), either administered 
internally or injected, by calculi, by retention of urine, by extension of in- 
flammatory processes in neighboring organs (diseases of the prostata, strict- 
ures and inflammation of the urethra, etc.), by infectious diseases. 

Symptoms. — The acute form is characterized by severe pain in the 
region of the bladder, which isw T orse from external pressure and motion, and 
frequently extends along the ureters upwards into the kidney's, or downwards 
through the urethra, by frequent painful micturition and strangury. The 
urine is voided drop by drop, under great straining, and a feeling of scald- 
ing; it is highly colored, hot, and occasionally mixed with blood, mucus and 
pus. By fever, associated with a temperatuure of 100.4 to 102. 2 F. , vomit- 
ing, prostration, cold perspiration, singultus, etc. , in severe cases. 

The chronic form is not so acutely painful, but always attended with 
frequent urging to micturate, and the passing of turbid urine which, after 
standing, yields a heavy, thick, glairy, viscid sediment of muco-purulent 
matter, which, on being poured from one vessel into another, falls out as a 
ropy mass. The specific gravity of the urine is not remarkably increased; 
its reaction is at times slightly acid, at other times neutral, or alkaline; its 
smell is often offensive, ammoniacal. The chronic form is subjected to fre- 
quent acute exacerbations from any irritating cause, and is generally found 
in advanced age. Its Prognosis, if once advanced to a high degree of dis- 
organization of the bladder, is very doubtful. 



therapeutic hints to diseases of the bladder. 609 

Therapeutic Hints. 

The most infamous practice is the administration of morphine, which 
not only gives no real relief, but destroys all chances of recovery by paralyz- 
ing the whole nervous system. 

High fever; restlessness; constant urging, yet fearful of voiding the 
urine on account of the painfulness of the act, Aeon., Bellad. 

Violent burning in the bladder, Aeon., Arsen. 

Burning and pressure in the bladder, Nux vom. 

Violent tenesmus and burning, Canthar. 

Bladder largely distended, Arsen. 

Congestion of the head; tongue red and dry, Aeon. 

If attended with vomiting, cold perspiration and anxiety, Arsen. 

Vomiting and nausea, Canthar.; great thirst, A? sen., Canthar. 

Frequent small pulse, Canthar. 

After a fall, blow, etc., Arnica. 

After taking cold, Mercur., Pulsat. 

After irritating drugs, Camphora. 

In chronic cases, Calc. carb., Catb. veg., Coloe., Dulcam., Lycop., Phos- 
phor., Pefrol., Sarsap., Sulphur, Uva ursi. 

Aeon. In all acute catarrhs, characterized by high fever, restlessness, 
and brought on by exposure to cold, dry winds. The urine is scalding hot, 
dark red or turbid; micturition painful, difficult, sometimes only drop by 
drop; children reach with their hands to the genitals and cry out. 

Apis. Urine scanty, smoky, bloody; if caused by cantharides. 

Arse?i. Burning pain, especially at the commencement of urinating; 
fever; great restlessness; cold perspiration; face and extremities cold; or in 
chronic cases with inability to void the water; bladder greatly distended and 
paral} T zed; urine turbid, mixed with pus and blood. 

Bellad. If not better some twelve hours after Aeon.; rapid sinking of 
strength; the region of the bladder is very sensitive to the touch; the urine 
hot and fiery-red, clear at first, but soon becoming turbid on standing, and 
depositing a copious, slimy, bright red, bran-like sediment. 

Berber. Stitching, recurring, crampy pain; constrictive pain in blad- 
der; thick mucous and bright red, mealy sediment. 

Cantphora. If caused by cantharides, balsam of copaiva, turpentine, 
etc. ; after measles. 

Ca?inab. If not better after Canthar. within about twelve hours 
gonorrhceal inflammation; urine loaded with mucus. 

Canthar. Spasmodic pain in the perineum along the urethra down into 
the testes, which are drawn up; intolerable burning pain in the bladder; 
cramping pain in the thighs; cutting through the abdomen; burning pain in 
the glans penis, the orifice of which is reddened; micturition difficult, only 
droy by drop, with a feeling as though melted lead were passing through the 
urethra, with violent straining, which increases the pain; urine at first clear, 
39 



6lO THERAPEUTIC HINTS TO DISEASES OF THE BLADDER. 

but afterwards turbid, bloody, scanty, or only blood; painful erections of the 
penis; great restlessness and fever; thirst, but drinking or even the sight of 
water increases the pain. 

Card. veg. In old people and chronic cases where the acute inflamma- 
tion has subsided and only blennorhcea exists. 

Caustic. When in consequence of long retention of the urine the mus- 
cular coat becomes paralyzed; compare Arsen., Gelsem., Helleb., Hyosc. 

Chimaph. Urging to urinate after micturition; the urine is high 
colored, depositing a copious, mucous sediment; constipation. 

Coloc. After alleviation of the most violent symptoms, when the pain 
during micturition extends all over the abdomen, and the urine looks turbid 
when first voided, depositing, on standing, a tough, mucous sediment, which 
can be drawn into strings. 

Copaiva balsam. Swelling and dilatation of orifice of urethra. 

Dulcam. In chronic cases, with constant desire to urinate, deep in the 
abdomen; urine is limpid when voided, but assumes an oily consistence on 
cooling, and contains a tough, jelly-like, whitish or reddish mucus inter- 
mixed with little lumps of blood; it smells foul. All symptoms grow worse 
when the weather changes from warm to cold. 

Elater. Constant heat at neck of bladder, with extremely painful mic- 
turition, inducing even convulsions. 

Gelsem. Detrusor and sphincter muscles paralyzed; bladder distended; 
urine constantly drippling off involuntarily; not a drop by straining; no 
pain. 

Helleb. The inflammatory process increases slowly to the greatest vio- 
lence, with constant desire to urinate, causing spasms; little urine is voided; 
constant nausea; distended abdomen. 

Hydrast. Thick, ropy mucus and bloody sediment. 

Hyosc. Retention of urine, so that the bladder becomes largely dis- 
tended; urine turbid, depositing a mucous or purulent sediment; great 
thirst; dry tongue; delirium; subsultus tendinum. 

Kali bichr. Urine alkaline and ropy. 

Laches. Discharge of bad-looking mucus during micturition; dull 
pain in the bladder; sensation as if a ball were rolling in the bladder. 

Lycop. Dull, pressing pain in the region of the bladder and abdomen; 
the urine is turbid, milky, depositing a thick, purulent sediment of a most 
nauseating smell; chronic cases; disposition to urinary concretions. 

Mercur. Fever with chilliness; great soreness in the region of the 
bladder when touching it; violent urging; the urine flows in a thin steam, 
or only drop b\- drop; contains mucus, blood, even pus; during micturition 
sweat breaks forth; gonorrhceal inflammation. 

Natr. mur. Pain is greatest after micturition. 

Nux vom. Painful, ineffectual desire to urinate, or discharge of urine 
drop by drop, with burning and tearing; pale urine followed \>\ thick, whit- 
ish, purulent matter, with violent, burning pain; spasmodic retention of 



THERAPEUTIC HINTS TO DISEASES OF THE BLADDER. 6ll 

urine; constipation, with ineffectual urging; after drugs, or suppressed gonor- 
rhoea. 

Pareira brava. Constant urging to urinate, with violent pain in the 
glans penis and straining; the pain is so great that it extorts loud screams 
from the patient; " he can emit urine only when he goes on his knees, press- 
ing his head firmly against the floor; remaining in this position from ten to 
twenty minutes, perspiration breaks out, and finally the urine begins to drop 
off with interruptions, with great pain at point of penis." (lyippe.) Always 
worse after midnight till morning; the urine has a strong ammoniacal smell, 
and contains large quantities of thick, tough mucus. 

Phosph. ac. When the urine looks like milk, and quickly becomes de- 
composed. 

Popul. Chronic catarrh; chronic gleet; elderly persons. 

Pidsat. After exposure to cold, the urine deposits a slimy sediment, 
which sticks to the vessel; tenesmus and stinging in the neck of the bladder; 
the pain continuing a while after micturition. 

Senega. Urging and scalding before and after micturition; urine 
loaded with mucous shreds. 

Sepia. In chronic cases; distention of the lower portion of the abdo- 
men; annoying, itching sensation in the region of the bladder, with urging 
to urinate, especially in the night; the urine does not flow until sitting on 
the vessel for some time; during and after micturition chilliness and heat in 
the head; the discharge of mucus does not take place at each evacuation of 
urine, but comes on periodically; sometimes pieces of coagulated mucus 
clog up the urethra; admixture of a kind of dark brown pigment; constipa- 
tion. 

Sulphur. Constant desire to urinate, day and night; the urine drops 
slowly out of the urethra; it deposits thick, tough mucus, which sticks to the 
bottom of the vessel; purulent sediment; after micturition, the pain con- 
tinues in the urethra until a new urging ensues; stools likewise painful; 
feverish and sleepless through the night; cutaneous eruptions here and there 
•on the body; suppressed itch; gonorrhoeal discharges; hemorrhoidal dis- 
position. 

Tereb. Sensitiveness of hypogastrium ; tenesmus of bladder; stran- 
gury; burning in region of kidneys; urine deposits a slimy, thick, muddy 
sediment. After drinking cold water while being heated. 

Uva ursi. Frequent urging with a little discharge, and a burning, cut- 
ting pain afterwards; the urine is yellow, but deposits a tough mucus; some- 
times blood and mucus are voided at the same time with great straining; se- 
vere spasm of bladder before micturition; at all times burning and tearing 
pain in region of bla,dder; constipation. 

A number of other remedies may present themselves for consideration: 
Calc. carb., Capsic., Conium, Eriger., Graphit., Hepar., Nitr. ac., Phosphor., 
Sarsap. 

Compare also the remedies mentioned under the head of Kidney 
Diseases. 



6l2 CALCULI VESICA. 

Calculi Vesicae, Stones in the Bladder. 

Calculi vary from the size of gravel to conglomerations of the size of a 
man's fist, and even larger. In shape they are either round, or flat, or 
rough, irregularly shaped. 

In regard to their chemical composition, the} 7 consist either of crystals 
of clear uric acid, or a combination of uric acid and ammonia, soda, magne- 
sia or lime. These are hard, heavy, brown, yellow or grayish- white, and are 
mostly smooth, roundish, rarely irregular in shape. 

Next in frequency are those which consist of phosphates. The}' are not 
so compact, but are brittle, crumbly and light, of a whitish, grayish, sel- 
dom yellowish color, and of a roundish shape, with a smooth but sandy 
surface. 

Still rarer are those which consist of oxalate of lime. They are the 
hardest and heaviest of all, have a dark brown or blackish appearance, an 
uneven, wart-like surface and are therefore called mulberry stones. 

Conglomerates which consist of carbonate of limr, or cystine, or xanth- 
oxide are of very rare occurrence, while mixtures of urates and phosphates 
are quite frequently found. They generally present a striated appearance, 
or the one material forms nucleus and the other the periphery. 

Such urinary concretions may be very numerous. Liston extracted 
five hundred from one bladder. They are usually formed in the renal pel- 
vis, and work their way gradually through the ureters into the bladder, 
where they remain and increase in size. Stones which are formed primarily 
in the bladder are generally solitary. They are either movable in the blad- 
der or they are entangled between the folds of its mucus membrane, or 
they have formed by their weight an extension of the bladder, where they 
are held stationary, or they have originated in a diverticle of the bladder. 

Those which roll about freely in the bladder are always of a roundish 
shape and smooth, while those which are stationary assume an uneven and 
jagged surface. Very large stones nearly fill the cavity of the bladder; they 
have been found to weigh from five to six pounds. 

Gravel passes away without much difficulty. Xeither do smooth and 
movable stones, if not too large, cause much inconvenience. But when they 
are of larger size, and of a rough and irregular shape, they cause consider- 
able trouble. 

Symptoms. — i. In rare cases the patient feels a heavy body in the blad- 
der moving about when changing position. 

2. Pain in the neck of the bladder when walking, standing, sitting or 
during stool; still worse when riding in a carriage or on horseback, but much 
less during rest, and especially while lying on the back or on the face. This 
symptom becomes quite characteristic when, after riding in a carriage or on 
horseback, there follows — 

3. A discharge of bloody urine and an increase of catarrhal inflammation 
of the bladder. 



HYPERESTHESIA. 613 

4. Sometimes the pain is not felt in the bladder at all, but in the glans 
penis and along the urethra, which constantly tempts the patient to squeeze 
and pull at the penis. This constant irritation may lead boys to the habit 
of masturbation, and the frequently repeated pulling may produce an elonga- 
tion of the penis and hypertrophy of the prepuce. 

5." Strangury commences when the last drops of urine are voided and 
continues for a while afterwards. 

6. Sudden stoppage in the flow of urine (although the bladder be not 
emptied) by the rolling of a calculus before the opening of the bladder. In 
other positions, especially that of lying on the back, the urine flows again. 

7. Sometimes a distinct feeling, as though something were wedged into 
the neck of the bladder, causing difficulty in making water, when a calculus 
has been driven into the opening at the neck of the bladder. 

8. Reflected pains, as spasms in the rectum, vagina, testicles, kidneys, 
perineum, legs, etc. 

9. In rare cases, when there are many stones in the bladder, on succus- 
sion of the body they may even be heard and felt rattling in the bladder. 

10. Examination by the metallic sound reveals a hard body, which, on 
being struck, gives a metallic sound. 

Therapeutic Hints. 

Large stones, it is true, cannot be dissolved again, but belong into the 
domain of surgery. But it is a question whether we cannot do something to 
prevent their formation. According to our records a number of remedies 
have shown themselves efficacious in expelling gravel and in restoring a 
normal secretion of urine. If such be the case, is it not equal to preventing 
larger conglomerations ? and is not one pound of preventing worth more than 
ten pounds of cure ? 

Moreover it is true that all who suffer with gravel need not necessarily 
become affected with stone in the bladder; just as every one who falls need 
not necessarily break his neck. But who can tell beforehand the result in 
either case ? The remedies, after the use of which gravel and small stones 
have been observed to be discharged, are: Aspar., Berber., Calc. card., Calc. 
urinaria, Cannab., Ipom. (Jeanes), Lycop., Lith. carb., Nitr. ac., Nux vom., 
Petrol., Phosphor., Pidsat., Sarsap., Sulphur, Tabac., Uva 117 si. 

Among the new remedies are mentioned: Aln. rub., Chimaph., Collin., 
Corydal., Eriger., Eryng., Eupat. arom. and per/., Frasera, Galium, Gossyp., 
Pooloph. 

For particulars, study Iyithiasis Renalis, Catarrh of the Bladder and the 
Materia Medica. 

Hyperesthesia, or Irritability of the Bladder; Spasm of the 

Bladder. 

Hyperesthesia shows itself as an increasing intolerance, especially of 
the neck of the bladder, for the normal irritation of the urine, so that even 



6 14 ATONY, PARESIS. 

a small quantity of urine excites a more or less painful urging to pass water. 
Such a condition may often be traced to a rapid fall of temperature, or to 
too often repeated sexual indulgence. 

Spasm of the sphincter is much severer; it is attended with strangury, 
that not a drop of urine is allowed to escape; or if by reflex action, the de- 
frusor urinse be alternately irritated, the urine is squirted out in jerks, with 
frequent interruptions, or passes slowly, drop by drop, with much trouble 
and pain. It is often attended with neuralgia pains in the hypogastrium and 
in the ano-perineal region, which may spread to the urethra, glans, testes v 
clitoris, thighs, loins and inguinal region, and upwards to the epigastrium 
and lowest ribs. These vesical spasms may occur at each attempt to pass 
water, or only occasionally; sometimes the urine escapes involuntarily. The 
paroxysms may last from a few minutes to half an hour or more, and usually 
subside when the urine flows; when very severe, they may be accompanied 
by great excitement, anxiety, nausea, vomiting, clonic convulsions, small 
pulse and cold perspiration. In uncomplicated cases the urine is usually of 
a normal condition, at times remarkably pale, like urine in spasmodic affec- 
tions generally. 

Spasm of the bladder occurs in children and adults, and may be caused 
by mental excitement, excessive sexual indulgence, onanism; drugs, sour 
wine, young beer, sitting on damp and cold ground; the} 7 ' may be connected 
with disease of the rectum, such as fistulae, fissures, ulcers, hcemorrhoids, etc., 
or with other neuralgic affections and various cerebro- spinal diseases. 

Therapeutic Hints. 

The irritability of the bladder is frequently met by: 

Arnica. Feeling of great fullness of the bladder. 

Bryon. Worse from moving. 

Colchic. Gouty diathesis. 

Ferr. phosph. Worse in daytime. 

Nux vom. After taking cold. 

Ox. ac. Worse when thinking of it. 

Rhus tox. Worse in the night and when at rest. 

Sabina. Gouty diathesis. 

Sulphur. Irresistible desire to urinate on seeing water running from the 
hydrant, similar to Canthar. and Lyssin. 

Spasms of the bladder principally: Bellad., Hyosc, Nux vom., Opiu??i, 
Pulsat. , Rhus tox., Ruta, Sulphur. Other remedies will be suggested by the 
causes and connections of this trouble. 

Atony, Paresis, Paralysis of the Bladder. 

The detrusor urinae loses its power to contract, and in consequence the 
urine is only partially or not at all expelled. This causes great distention of 
the bladder. The patient complains that he can only make water slowly; 



THERAPEUTIC HINTS TO ATONY, PARESIS. 615 

the desire to pass water becomes less frequent, is felt only when the bladder 
is greatly distended, and then only for a short time, if not soon attended to. 
The stream of the water grows feebler, is frequently interrupted, and at last 
voluntary efforts are unavailing, but the presence of the accumulated mass 
of urine becomes so great that the sphincter yields and the urine escapes in 
drops involuntarily, and has a disagreeable ammoniacal odor. By and by 
the paralysis also extends to the sphincter, and now the urine flows away un- 
interruptedly, which constitutes true Incontinentia urinae. But even in 
these cases the bladder is never fully emptied, and it occasionally happens 
that, in consequence of this prolonged retention of urine, ursemic symptoms 
supervene. 

The Diagnosis is readily made out by percussing the region of the 
bladder, which will be found greatly distended, and by introducing the 
catheter, which will drain off immense quantities of urine. 

Paralysis of the bladder is found in diseases of the brain and spinal 
cord, in typhoid fever, in consequence of the bad habit of suppressing urgent 
calls to urinate, in old age, in diseases of the prostate, after injuries to the 
bladder or urethra, or spine. 

Therapeutic Hints. 

Care should be taken to drain off, by the catheter, the accumulated 
urine in time, and, if possible, at regular hours. 

Arnica. Feeling of fullness of the bladder with urging and impossibility 
to void urine. (Aegidi.) 

Arse?i. Urging in the bladder and bowels without success; great 
anxiety and restlessness; after taking cold. (Gauwerky.) Paralysis of 
bladder in old people. (Krummacher. ) 

Canthar. After having retained the urine too long voluntarily. 

Caustic. From long retention of urine. 

Cicuta. Paralysis of the bladder with great anxiety about it. 

Gels em. Constant dribbling of urine, but not a drop flows on making 
the greatest effort; bladder distended up to the navel; no pain, not even on 
pressure. 

Helleb. Paralysis of the detrusor; oedema of the legs; vomiting of all 
he eats; constipation; sleeplessness; despair of getting well. (Mossbauer.) 

Hyosc. After labor, and in children with affections of the head. 
(Small.) 

Iodium. Incontinence of urine in the aged. 

Nux. mosch. Hysteria with strangury. 

Nux vom. After catching cold; after sexual excesses. 

Opuim. Retention of stool and urine. 

Phosphor. In spinal troubles. 

Staphis. Involuntary discharge of urine, acrid and corroding, with 
burning; worse from motion; constipation; straining or external pressure 
causes no discharge; after difficult confinement. (Wm. Gross.) 



6l6 ENURESIS NOCTURNA. 

Compare also: Bar. card., Bellad., China, /gnat., Lycop., Natr. mur., 
Phosphor. , Podoph., Rhus fox., Rata. 

Enuresis Nocturna. 

Wetting the bed may be a bad habit with some children, or the con- 
sequence of their sleeping too soundly, but in most cases it depends upon a 
local atony associated with increased sensitiveness of the neck of the bladder. 
It is more frequently found in boys than in girls, and it ceases on the average 
about the tenth or twelfth year, latest at puberty. 

Therapeutic Hints. 

Rough and harsh treatment will be of no avail. 

Amm. carb. Enuresis occurring at any time at night; pale urine; red 
sediment. (Greeley. ) 

Arg. nitr. Incontinence of urine during the day. 

Bellad. Starting in sleep; moaning and screaming during sleep; scrofu- 
lous glandular swellings. 

Benz. ac. When the urine has a very penetrating smell. 

Calc. carb. Scrofulous children, who sweat and catch cold easily. 

Caustic. Enuresis during first sleep; chronic, periodic swelling of the 
tonsils; sequelae of itch; sweat on genitals; green halo around the candle- 
flame. (Wm. Gross.) Blepharitis ciliaris of herpetic nature. (Goullon.) 

Chamom. Child cross, has to be carried; whooping-cough as a complica- 
tion. (Miller.) 

Chloral. Enuresis in the later part of the night, even if they have 
urinated during the night and drank no water. (Oehme.) 

Cina. Urine profuse and of strong ammoniacal odor; great appetite 
soon after leaving the table. (O. M. Pierson.) 

Equisetum. When there is no tangible cause except a habit. 

Ferr. met. When the child presents an anaemic appearance with pale 
face which flushes easily from excitement or pain. (Hering. ) Frequent 
wetting the clothes during the day. 

Ferr. phosph. Similar. 

Kreos. When it is very difficult to waken the child out of sleep. 
(Boenninghausen. ) 

Pla?itago. Copious enuresis; atony of the sphincter. 

Sepia. Follows well after Caustic, same symptoms. 

Silic. Complication with worms or chorea. 

Sulphur. Disagreeable sensation of hunger with flushes of heat about 
ii A. m. (Goodno. ) Pale, lean children with large abdomen, who love 
sugar and highly seasoned food, and abhor to be washed. 

Thuja. When the urine is highly colored and of a strong smell; warts 
here and there. (I^insley.) 



RETENTION OE URINE. 617 

Retention of Urine, Ischuria Vesicaiis, 

May be the consequence of spasm of the sphincter, of paralysis of the detrusor 
urinae, of haemorrhoidal swellings about the sphincter, of clots of blood, or 
mucus, or calculi, obstructing the passages, of inflammation and consequent 
thickening of the bladder. We find the bladder distended above the pubis. 
In such cases it will often be necessary to introduce the catheter, and that 
may sometimes be attended with great difficulty, especially in men. The 
patient may be placed on his back, with a pillow under his head, holding his 
thighs slightly flexed upon the abdomen; or he may sit up on the edge of 
the bed, slightly bent forward; or he may stand up, leaning the body for- 
ward, and supporting himself on the back of a chair, or some other object, 
Sometimes the introduction of the catherer could be affected only in the 
standing position; the horizontal position is the one usually preferred. 

The catheter may be of metal or caoutchouc; either kind may be prefer- 
able in certain cases; they are of various sizes, numbers 7, 8 and 9 of the 
English scale are those most frequently called for in grown persons. Before 
entering the catheter, it should be warmed and oiled; some fill the catheter 
with oil, so that it may lubricate the parts before it. Sometimes it will be 
well to inject first some oil, or warm water into the urethra, to make the 
parts more pliable. Now the catheter should be held with the thumb and 
forefinger of the right hand on its handle, so that it is parallel with and 
touching almost the abdomen of the patient, on whose left side the operator 
is sitting, while the thumb and forefinger of the left hand grasp the penis 
and draw it up toward the abdomen, so that the movable portion of the 
urethra is put on a stretch and the folds of the lining mucous membrane 
become obliterated. The instrument is now inserted and allowed to follow 
the urethral channel until it reaches the triangular ligament. Here we find 
often the first obstacle; the instrument has to enter the fixed curve of the 
urethra, and the handle of the catheter should be held parallel to the linea 
alba, and gently raised from off the abdomen, so that its curved portion be 
brought in the direction of the fixed curve of the urethra, and be carried 
along in it. The next obstacle we will often find at the sphincter vesicae, 
especially when there is a spasmodic affection of the same; a gentle, but per- 
sistent pressure exerted upon the instrument will gradually overcome it in 
many cases. Simple as this operation appears to be, it is nevertheless fre- 
quently attended with great difficulties, and even experienced surgeons have 
been foiled in the attempt; it requires great gentleness, dexterity and per- 
severance. ' ' (Helmuth. ) 

In some cases the retention of urine may be overcome by the external 
application of wet, hot cloths to the genitals, or hot sitz-baths, or injections 
of hot (of course not scalding) water into the urethra. 

Therapeutic Hints. 

Aeon. Common cases, especially in children, with frequent unsuccessful 
urging, crying, screaming, and putting the hands to the genitals; no dis- 



6l8 RETENTION OF URINE. 

charge, or scanty, dark and turbid discharge. Also in cases of hemor- 
rhoidal patients, when there is great pain and burning and the urine passes 
off only in drops, sometimes bloody. (Hering.) 

Apis. After repelled eruptions, with stinging, burning and itching here 
and there; abdomen is sore and tender to touch; chilly from slightest motion, 
worse in evening; heat without thirst; yawning, but sleepless. (Hering.) 

Arnica. After a fall or knock upon the back or region of the bladder. 

Bel lad. Stitching pain from the back into the bladder; in spells with 
great anxiety, restlessness and colic. It is followed well by Hepar, if it 
only relieves but not cures. (Hering.) 

Camphora. After the abuse of fly-blisters; also after measles. 

Cannab., Canthar. Inflammatory states of the bladder with bloody 
urine. 

Coloc. Thick, jelly-like urine, with labor-like pain in the abdomen, 
extending down into the thighs. 

Sepia. Retention and suppression of urine often occurring in fevers, 
when there is delay in voiding, after the desire is felt, along with scanty, 
muddy discharge, the sediment of which sticks to the vessel and the odor of 
which is abominable. (Edw. Cranch.) 

Sulphur. Often if Aeon, or Pulsat. have failed to relieve. 



ORGANS OF GENERATION 

MALE GENITALS. 



VENEREAL DISEASES. 



We understand by this term all those morbid affections of the genitals 
in particular, and of the whole system in general, which originate ex usu 
veneris in consequence of the absorption of a specific poison. The nature of 
this poison is as little known as that of smallpox, or of scarlet fever and 
measles; only that it is not volatile, but fixed to the morbid secretion. As 
to the rest, like either of them, it produces, when introduced into a healthy 
organism, a certain series of symptoms specific in their nature, by which pro- 
cess the same virus is produced anew, capable of further propagation. The 
principal forms caused by this specific contagion are: gonorrhea, chancre, and 
constitutional syphilis in all its various forms. 

It lies entirely beyond the limits of this work to go into any details in 
regard to the different views about the identity or non-identity of the venereal 
virus and its effects, as have been set forth in the last fifteen years by a num- 
ber of renowned syphilodologists. Their works alone would make up a small 
library. I shall merely give what seems to be the result of these contro- 
versies adopted by the majority at present. 

Gonorrhoea. 

We understand by it a virulent catarrh of the genital organs, which in 
appearance is entirely analogous to any other catarrhal inflammation of any 
of the mucous membranes; but which entirely differs from all the others by 
being the result of a specific virus, acquired during coition with an individual 
thus affected. The Exciting Cause is the gonococcus of Neisser, which is 
characteristic, being found grouped in the substance of the pus-cells and 
around the nuclei. 

Its seat is usually the fossa novicularis, and that portion of the urethra 
which lies back of the glans; sometimes, however, the inflammation extends 
further back to the bulbus, the membranous portion of the uretha, and even 
to the neck of the bladder. 

In women the inflammation and secretion extend over the vulva, vagina 
and urethra, sometimes spreading even into the womb* 

Symptoms. — The first symptoms generally appear from one to two, 



620 GONORRHOEA. 

rarely from six to eight days or more, after the infection. The)' consist of a 
tickling sensation at the orifice of the urethra and in the fossa navicularis. 
Soon there is an increased secretion of mucus in the urethra, which pastes 
the lips of the orifice together; the tickling changes into burning, and the 
mucus, at first transparent, becomes thick, whitish, j-ellowish, greenish, or 
even bloody, and more or less profuse. The orifice of the urethra is in- 
flamed and swollen; a tensive pain extends all along the urethra into the 
testicles and inguinal regions; micturition is very painful and frequent. 

Iu some cases, the so-called synochal or phlegmonous gonorrhoea, the in- 
flammation extends into the parenchyma of the glans, which appears dark- 
ened and swollen; and into the corpus cavernosum, with exudation, which 
forms ha^d places in the penis. This gives rise to the so-called Chordee, by 
which, during erections, the penis is bent either downwards or sideways. 
The urine can be passed only drop by drop, with the most intense pain and 
great strain. The discharge becomes still more discolored — dark or bloody, 
even ichorous; or it is not discharged at all, on account of the high state of 
inflammation. The prepuce is contracted and cannot be brought back over 
the glans — Phimosis; or it is contracted behind the glans, and cannot be 
brought forward — Paraphimosis. 

The inflammation spreads even to the neck of the bladder and the 
neighboring areola tissue, in consequence of which abscesses may form and 
break through the perineum, giving rise to fistula urinse. 

Other cases, the so-called indolent or torpid gonorrhoea, are attended 
with very little pain; and the only symptom, which is of an}- inconvenience 
to the patient is a more or less profuse mucous discharge. This indolent 
form is usually found in persons who have had the disease several times. 
It seems, that the system gets accustomed even to the most violent poisons, 
as may be seen in prostitutes. Yet, innocent as it seems, it is generally 
very obstinate, and is apt to become chronic; and if transferred to other per- 
sons not quite so hardened, it may cause the most virulent symptoms. In 
still other cases — the so-called erysipelatous gonorrhoeas — the glans and pre- 
puce are cedematously swollen and inflamed, as in erysipelas. The pain is 
not so great as in the synochal form, and the discharge is of a more watery, 
ichorous nature. 

Mild forms of acute genorrhcea are said to run their course in about five 
or six weeks; but most cases assume a chronic form and are then called 
Gonorrhoea secundaria or Gleet. This form is usually without pain; 
when there is any, it is a fixed pain in the fossa navicularis. The discharge 
is mostly watery, sometimes thick and yellowish. Usually there is only a 
single drop, and that to be seen in the morning; at other times the lips of 
the meatus urinarius merely stick together; sometimes, however, the dis- 
charge continues to be more or less profuse. This state of things may last, 
with various degrees of severity, for months, even years. 

In the female the symptoms of gonorrhoea are nearly the same; gener- 
ally, however, they are less painful, because the vagina, the part principally 



THERAPEUTIC HINTS TO GONORRHOEA. 62 1 

affected, is wider and less sensitive than the urethra in the male. Still, in 
higher degrees of inflammation and when extending to the female urethra, 
the clitoris and the labia, it may become quite as painful. The discharge is 
then quite profuse and discolored, excoriating the external parts. Frequently 
it is associated with condylomata on the inside of the thighs and around the 
anus. Excoriations and ulcers also exist on the neck of the uterus, and 
sometimes the morbid process extends into the womb and ovaries, causing 
chronic catarrhal affections there. Its cause is, as stated above, an infection 
by a specific virus. 

Catarrhal inflammation of the mucous membrane of the sexual organs 
maybe brought on by a variety of causes — irritation by foreign bodies, sexual 
excess, coitus with menstruating women, or such women as suffer with acrid 
leucorrhcea. Even drinking new wine or sour beer may cause strangury and 
a gonorrhoea-like discharge. Such inflammations are of a much lighter 
nature, and cease in a few days without medication; but as we cannot dis- 
tinguish between a chronic gonorrhceal discharge and a mere acrid leucor- 
rhcea, it is ver} T well to know that a gonorrhoea-like discharge may be caused 
by a mere acrid leucorrhcea, if for nothing more than to preserve the peace 
of a family. 

The gonorrhceal virus is transferable by the muco-purulent discharge of 
a gonorrhceal patient whenever it comes in contact with the mucous mem- 
brane of the urethra or vagina of a healthy person. None are proof against 
the contagion, although some persons are more easily infected than others; 
and any one who has once had gonorrhoea is very liable to have it again. 

Therapeutic Hints. 

The number of recommended remedies for this complaint is great, but 
yet the curing of it is often a difficult task. For its very first stage Grauvogl 
has recommended Natr. sulph.; Jahr, Sepia; Wahle, Bryon.; Baehr, Merc. 
sol.; Kafka, Sulphur; a number of others, Cannab. Schiissler: Ferr. p/wspk., 
later Kali mur. and Kali sulph. 

In this, as well as in all other cases, we must closely individualize: 

Aeon. Inflammatory stage. 

Agave Americana. Excruciating, painful erection; chordee, stran- 
gury; drawing in the spermatic cords and testicles, extending to the thighs, 
so violent that he wishes to die. 

Ag?i. cast. Gleet, yellow purulent discharge; old sinners with sexual 
inability. 

Alum. P. S. Gleet. 

Ant. crud. Urine mixed with blood; suppression of urine. 

Apis. "Scanty, painful micturition, with a burning, stinging in the 
urethra, and a smarting in the meatus; prepuce swollen, perhaps cedematous; 
pus profuse . " ( Gilchrist . ) 

Arg. nitr. Burning in the urethra during micturition, with a feeling 
as though the urethra were swollen and sore inside; the last portion of the 



62 2 THERAPEUTIC HINTS TO GONORRHCEA. 

urine remains in the urethra; discharge of blood and pus from the urethra; 
chordee; sensation as if the urethra were drawn into knots; swelling of 
penis; feverishness. 

Arscn. " Deficient discharge, but intense urethral inflammation, which 
seems to closa the urethra; intense heat and burning in the parts; urine 
scalding hot; the whole penis swollen without erection, and hot." (Gil- 
christ. ) 

Calc. card. Gleet, after Sulphur; fat, lymphatic persons. 

Camphora. Sticking together of the meatus; chordee; testicles relaxed; 
want of erections. 

Cann. ind. Priapism; chordee; involuntary erections and emissions; 
nymphomania. 

Ca?in. sat. Great swelling of the prepuce, approaching to phimosis; 
dark redness of glands and prepuce; light red spots on the glans, of the size 
of a lentil; inflammatory stage with all its painful symptoms, especially vio- 
lent burning in the urethra during and after micturition. 

Canthar. When the inflammation has spread to the bladder, with 
intense tenesmus; bloody discharge and soreness of the urethra during the 
flow of gonorrhoeal mucus; violent and very painful erections at night. 

Capsic. White discharge like cream; cutting, stinging pain in the 
urethra without, burning during micturition; chordee. 

Clemat. After great straining a few drops of urine pass awa} r , which 
is followed by a full stream without pain; after this sometimes dribbling of 
urine. 

Colchic. Scanty, dark, albuminous urine; constant urging with burn- 
ing in urethra when urinating; whitish, flocculent or purulent sediment in 
urine. 

Copaiva. Soreness, smarting, itching and swelling of urethra; purulent 
discharge; violet smell of urine; eruption like measles, or urticaria with 
great itching. 

Cubeb. Dark and reddish discharge as if mixed with blood; violet 
smell of urine; cutting and constriction after micturition. 

Doriph. Glans swollen and bluish-red; gleet. 

Ferrum. Gleet, painless discharge like milk. 

Ferr. phosph. Inflammatory stage. 

Fluor, ac. Gleet, little discharge during the night, which makes a yel- 
low stain on the linen; oily transpiration of the genitals with a penetrating 
smell. 

Gelsem. Whitish discharge; severe erections; burning when urinating; 
rheumatism; orchitis. 

Graphit. Gluey, sticky discharge at the meatus urinarius. 

Hydrast. Acute and chronic form; feeling of debility and faintness 
after each passage from the bowels. 

Kali bichr. A drop of urine seems to remain after micturition, which 
cannot be expelled and troubles for a long time. 



THERAPEUTIC HINTS TO GONORRHOEA. 623 

Kali mur. Gleet combined with eczema (latent or visible); or a dispo- 
sition to glandular swellings. 

Mat i co. In acute and chronic forms — no particulars given. 

Mercur. When complicated with chancre; or in gleet, after Cannab., 
when the discharge is yello wish-green and purulent; discharge more profuse 
at night than during the day. Phimosis, bloody pollutions. 

Mezer. Gleet; hematuria during gonorrhoea; tearing pains from front 
to back. 

Millef. Swollen penis; discharge of blood and watery slime. 

Naphthalin. In a chronic case with cough similar to whooping-cough. 
(Haupt.) 

Natr. mur. After injections of nitrate of silver, in gleet; in gonorrhoea- 
like discharges from acrid menstrual discharges; cutting and burning after 
micturition. " Malarial combination; strong impulse of the heart; irregular 
or intermitting pulse by clear sounds of the heart; often great prostration, 
lameness of the lower extremities, especially in the knees; dejected, tearful 
mood, frequently changing; anaemic state with thirst, horripilations. All 
worse in the forenoon, better towards evening; pain in small of back, con- 
stipation, sleepiness during day; weak digestion; pain in stomach better from 
eating." (Kunkel.) 

Nitr. ac. In complication with chancres, balanitis and fig- warts; small 
blisters on the orifice of the urethra and inner surface of the prepuce, form- 
ing chancre-like ulcers; painful brown spots of the glans; after mercurial 
treatment; gleet; ulcerating buboes; condylomata. 

Nux vom. After the use of copaiva and cubebs, and after allopathic 
treatment, dull pain in the back part of the head; haemorrhoidal disposition; 
constipation; suppressed discharge, with swelling of the testicles; high 
living. 

Petj'ol. Chronic cases with stricture of the urethra; prostatitis; frequent 
emissions and imperfect erections; itching and humid eczema on scrotum, 
perineum, or between the scrotum and thighs. 

Petros. Troublesome tickling and itching in the urethra, with constant 
desire'to urinate, worse in the morning in bed; better when sitting or stand- 
ing, chronic cases; suitable for old persons; " intense, maddening, biting- 
itching, deep in the urethra, the patient being almost wild with it; and feels 
as if he must push some rough article down to the spot and rub it for relief. 
Profuse discharge, and chordee of common occurrence." (Gilchrist.) 

Phosphor. Gleet; every morning a drop of watery fluid at the orifice of 
the urethra, sticking its lips together; also in case of hypertrophy of the 
prostata. 

Phosph. ac. Gleet; every morning a few drops of a white discharge 
from the ueethra, and in the evening discharge of prostatic juice. " Similar 
to Thuja." (Kunkel.) 

Pulsat. In consequence of suppression of a gonorrheal discharge, 
swelling of the testicles and prostate gland; inflammation of the eyes. 



624 COMPLICATIONS AND SE0UELLE. 

Sarsap. Rheumatism of the joints after suppression. 

Sepia. Gleet, no pain, no discharge, except through the night a drop or 
so, staining the linen yellowish; or milky or greenish discharge, attended 
with pain in the back; frequently quite important for women. 

Sulphur. The orifice of the urethra is red and feels hot; whitish dis-' 
charge; no pain, or some slight burning in the urethra; rheumatic pains; 
chronic inflammation of the eyes; chronic prostatic affections; hemorrhoidal 
disturbances; psoric cutaneous eruptions; gleet. 

Tarant. Chronic form; loss of memory; timidity; weakness; great 
nervous agitation; burning of soles of feet and palms of hands; shaking, 
twitching and incessant movements of legs, worse when quiet. 

Tereb. Chordee; gleet; gonorrhceal rheumatism. 

Thuja. Gleet; condylomata; prostatic affections; discharge thin and 
greenish; red spots and erosions on the glans; sudden stitches along the 
urethra from back to front; or a sensation as if a drop of urine were passing 
along the urethra with cutting pains; " dejected mood, prostration, weakness, 
lame feeling in lower extremities; sleeplessness. The next best following 
remedy is Phosph. ac." ( Kunkel. ) 

Besides these, a number of remedies are mentioned and praised by 
eclectics (see Hale's New Remedies), but without the slightest characteristic 
indications. 

COMPLICATIONS AND SEQUELS. 

1. Epididymitis; Orchitis. 

Usuall}- only one side is affected at a time; but the inflammation some- 
times goes also to the other. The scrotum of the affected side becomes greatly 
enlarged, is hard, red, shining and very painful to the slightest touch or 
move; it is usually attended with fever, and follows either upon undue ex- 
ertions, taking cold, and most frequently after the suppression of gonorrhceal 
discharges by injections. 

Compare Agn. cast., Aurum, Bromium, Clemat., Hamavi., Mercur., 
Nitr. ac, Nux vom. t Phytol., Pulsat., Rhodod., Rhus fox., Tussil. 

2. Prostatitis Gonorrhoica, Inflammation of the Prostata, 

Is of rare occurrence, and only in those cases in which the inflammation 
spreads to the neck of the bladder, or in consequence of suppression of the 
discharge b} T injections. It is attended with a sensation of heat in the peri- 
neum, in the region of the bladder and .towards the rectum, and with tenes- 
mus in bladder and rectum. It may end in suppuration and the formation 
of an abscess, which may discharge its contents into the bladder or urethra, 
or through the perineum, or it may end in chronic induration of the prostatic 
gland. 

Compare Mercur. , Nitr. ac. Phosphor., Pulsat., Selen., Sulphur, Thuja. 



GONORRHOEA VESICA. 625 

3. Gonorrhoea Vesicae, 

That is, a transmission of the disease to the neck, or into the body of the 
bladder, consequent upon suppressing the discharge by injections. The pa- 
tient feels violent pains in the region of the bladder, the perineum and anus, 
with constant urging to urinate. By dint of the greatest straining, a few 
drops only of a turbid urine, mixed with blood and pus, are discharged. 
Main remedy: Canthar. Compare Cystitis. 

4. Buboes. 

Inflammatory swelling of the inguinal glands, which generally grow 
very slowly, and are brought on either by overexertion or suppression of the 
discharge. 

Compare Iodium, Laches., Mercur., Nitr. ac. 

5. Ophthalmia Gonorrhoica. 

One of the most dangerous inflammations of the eyes. The infection 
may be caused either by the direct contact of the poison with the eyes, by 
means of the fingers or soiled handkerchiefs, or by metastasis. 

Compare Aeon., Arsen., Bellad., Hepar., Merc. sol. and subl., Nitr. ac. y 
Pulsat., Tussil. 

6. Gonorrhoea of the Rectum. 

Pain in the rectum; mucous membrane inflamed; sphincter spasmodi- 
cally closed; discharge of purulent mucus mixed with blood. 

Compare Mercur., Nux vom., Pulsat., Sepia, Sulphur, Thuja. 

7. Strictures of the Urethra. 

They consist of a fibrous or callous hardening of certain portions of the 
urethra, whereby the canal becomes narrowed and the passage of urine diffi- 
cult or altogether impossible. Their main seat is the membranous portion 
of the urethra and the fossa navicularis, although other parts may likewise 
adhere or become constricted in consequence of inflammation. 

The first and main symptom is difficulty in making water. The stream 
is thin, twisted, split and flows in jerks. The bladder cannot be fully 
emptied and there is a continued dribbling oT urine for a great while after 
micturition. 

They are caused frequently no doubt by the use of injections, misman- 
aged introductions of bougies, the long continuance of chronic gonorrhoea 
and excessive indulgence in sexual intercourse. 

Compare Clemat., Digit., Dulcam., Petrol., Pulsat., Rhus tox., Sulphur. 

Gradual dilatation by bougies. 

8. Gonorrhoeal Rheumatism. 

It is sometimes acute, attacking muscles and joints, and sometimes 
chronic. It has been frequently observed to follow the use of copaiva bal- 
40 



626 GENERAL CONTAMINATION. 

sam, or the sudden suppression of the gonorrhoeal discharge by other means, 
and after taking cold. Those of a rheumatic or gouty disposition are, of 
course, the most subject to it. 

Compare Hepar, Mercur., Mezer., Phytol., Sarsap., Thuja. 

9. General Contamination of the System in Consequence of 

Gonorrhoea. 

Although modern writers deny such consequences of gonorrhoea upon 
the whole system, there is not the slightest doubt that a suppression of it is 
followed in many cases, by severe and deeply-seated ailments. We find cases 
on record where its suppression brought on tuberculosis; in others dyspnoea, 
lasting for many years — until, under homoeopathic treatment, an old gonor- 
rhoeal discharge suddenly appeared again and the dyspnoea disappeared. 
Schcenlein, Autenrieth and others acknowledge this, whilst Ricord denies a 
specific gonorrhoea- virus altogether, which seems to be driving the thing 
rather to its smallest point, on which it cannot stand. Grauvogl, in his Pro- 
phylaxis, gives a whole list of constitutional disorders growing out of gonor- 
rhoeal poisoning, among which we find: glandular-like swellings upon the 
membranes of the brain, on the neck and tongue; in the axillae and ab- 
domen, and its viscera; deafness; paralysis and mental derangement, etc. 

The most important remedies which ought to be borne in mind, and 
which cover this gonorrhoeal contamination of the system, as Sulphur does 
psoric, and Mercurius syphilitic affections, are, according to Grauvogl, Natr. 
sulph. and Thuja. 

Balanitis, Gonorrhoea Spuria, or Praeputialis. 

This affection is a profuse secretion of mucus between the glans and 
prepuce, which is formed only in men with a long foreskin. It is sometimes 
associated with genuine gonorrhoea, but ma}' just as well originate from un- 
cleanliness, friction, coitus with women who suffer with acrid fluor albus. 
In most cases it is altogether an innocent affair, although at times it may be 
of a poisonous nature. 

Symptoms. — Itching underneath the prepuce, which appears red and 
moist. In a few days there appear heat, pain and swelling of the prepuce, 
with considerable discharge of a yellowish, purulent mucus. Sometimes 
it is very difficult to push the prepuce back, in which case the glans appears 
excoriated. If allowed to remain, ulceration and adhesion may form be- 
tweeti'the glans and the prepuce and cause considerable trouble. If of an 
innocent nature, it is easily managed by cleanliness and perhaps one dose of 
Mercur.; if it is in connection with gonorrhoea or chancre, it of course 
assumes the nature of its companions and requires the same treatment. 

Chancre. 

The name chancre is derived from cancer, meaning a corroding ulcer, 
with hard bottom and callous edges. Its seat is at the point where the poison 



CHANCRE. 627 

gained access, in men chiefly the glans, prepuce, fraenum, front part of 
urethra, the penis external^, the scrotum, or the groins; in females the labia, 
vagina, urethra, or the neck of the uterus. But the poison may also be 
transferred to other parts, such as the lips, tongue, nipples, or fingers, if 
through wounds, cracks, or denudations, it can enter into the circulation. 

There are two theories about the nature of chancre-poison. The one 
maintains that all is but one kind, which may or may not produce constitu- 
tional syphilis; the other has tried to prove a duality of the chancre- virus, 
meaning that there are in realit3 T two totally different kinds of sores, of which 
each propagates only its own kind. These two different kinds of chancre 
have become known under the name of soft and indurated or Hunter's 
chancre. 

The soft chancre is according to this theory only a local affection, and 
inoculable upon the bearer, and upon others, both healthy and syphilitic, to 
an almost unlimited extent. It develops without incubation in twenty-four 
hours. Through resorption an irritation of the adjacent glands takes place, 
which has an acute inflammatory character and usually leads to suppuration, 
but is not followed b3^ constitutional syphilis. The pus of the glandular 
suppuration has the same properties as the chancre pus. 

The hard chancre produces and is produced by true syphilitic poison; it 
is, notwithstanding the assertions of Ricord, inoculable upon the bearer and 
upon others syphilitic, but produces then a soft chancre, to which Clerc, as 
Maratray had done before him, gave the name of "chancroid." Whether 
the poison of this chancroid, when communicated to a healthy person, is 
capable of producing syphilis, or only local sores, has not been positively de- 
termined. The syphilitic poison (of a hard chancre) when inoculated upon 
healthy subjects, causes after a period of incubation of three to four weeks, a 
papule, which gradually hardens or superficially ulcerates, or at other times 
immediately inflames and ulcerates, as in the soft chancre, being followed 
later by induration together with general syphilis. 

The minute anatomy of chancre does not show any marked differences 
between the two; the one thing common to both is a dense cellular infiltra- 
tion of the tissue of the cutis or mucous membrane. Induration, therefore, 
will not hold good as a positive distinction between the two, especially in the 
female genitals, where it may be very inconsiderable, even in so-called genuine 
hard chancres. Only if an affection is seen to begin as a papule, at a certain 
time after a possible occasion for infection, and afterwards gradually enlarg- 
ing, it may be considered as true syphilis; but if, following immediately after 
an infection, a pustule appears, with subsequent ulceration, which is, perhaps, 
afterwards neglected by the patient, or irritated in various ways, as by im- 
proper treatment, it should be classed under the soft chancres, but in such 
cases it is often impossible to decide whether it is a specific induration or a 
mere inflammatory infiltration, because the beginning of it has not come 
under observation; and if we add to this what has been stated before, that a 
syphilitic or so-called hard chancre or ulcer may originate immediately after 



628 CHANCRE. 

infection like a so-called soft chancre, the diagnosis between the two becomes 
a complete conundrum. Neither hardness nor incubation prove to be entirely 
satisfactory. There remains only the subsequent development of constitu- 
tional syphilis for a distinction between the two; but then the chancre has 
usually disappeared, and our wisdom comes post festum. In praxi then the 
so-called soft and hard chancre resemble each other frequently very closely, 
at least while being under observation; but even if we consider the theory of 
duality of chancre poison as true above all doubt, this conviction can have 
no other use than to confirm pli3 r sicians who believe in mere local affections, 
in the bad practice of cauterizing, burning and slashing away, which is not 
in accord with the spirit of Homoeopathy. 

The external appearance of chancre varies. It may, as stated before, 
commence at the infected point as a papule or a pustule, which by degrees, en- 
larges, becomes harder, and at last ulcerates, secreting a gray, slimy pus, which 
adheres to the bottom. This sore at times remains quite superficial, at other 
times the middle of the tubercle becomes excavated, and at still other times 
the surrounding tissues become involved in a wide-spread destruction of tissue, 
when it is called phagedenic chancre. If sores form on the inside of the 
prepuce, or far back on the glans, it soon becomes impossible to retract the 
foreskin; the ensuing phagedenic process may possibly cause a destruction 
of the entire prepuce, and even of the glans, in a short time. On the mucous 
membrane of the female genitals chancres appear as simple erosions, which 
the patient hardly notices, with parchment-like thickening; real tubercular 
indurations are rare. From being constantly moistened and irritated when 
on the labia majora or minora, they are gradually transformed into moist 
hyperplastic growths — the condylomata lata. 

The syphilitic poison is contained in the primary ulcers, in the condylo- 
mata lata, in the blood of syphilitic persons, in the semen of a man with latent 
syphilis. Whether the milk, saliva, urine and perspiration of syphilitic per- 
sons be also carriers of the poison, is doubtful; but pathological secretions, 
such, for instance, as contained in the vaccine pustules, have, unfortunately, 
too often proved their infectious nature. 

The transmission of syphilis by inheritance, is another well established 
fact. It maj' be transferred by the semen to a healthy ovule; or bj- the ovule 
developed in the ovary of a syphilitic woman, or later during the time of 
gestation, if the mother acquires syphilis during that time. Whether 
syphilis be transmissible into the third generation, remains still an open 
question. 

Infection takes place when the syphilitic poison gets underneath the epi- 
dermis or beneath the epithelium of the mucous membrane of a healthy 
person. This may be effected in direct ways, by sexual intercourse, by kiss- 
ing, by wet-nurses, by vaccination, by obstetrical examinations; in mediate 
ways, by the use of articles which have been soiled by syphilitic poison, such 
as eating and drinking utensils, tobacco-pipes, cigar-holders, cigars, blow- 
pipes, surgical instruments, etc. 



CONSTITUTIONAL SYPHILIS. 629 

The susceptibility to the syphilitic poison seems in some cases to be 
diminished by previous infection, but immunity to it is by no means so ab- 
solute as Ricord claimed; neither is inherited syphilis a shield against infec- 
tion. Age does not essentially modify the susceptibility to the syphilitic 
virus. 

For practical purposes there may be made a division of the symptoms 
of syphilis into groups, according to the order in which they gradually 
develop, if not checked by proper treatment. 

The first or primary stage comprises the gradual development of the 
local symptoms at the point of infection, and the indolent swelling of glands in 
the vicinity. Some six or eight weeks from the first appearance of the 
primary affection, signs of 

Constitutional Syphilis 

or general blood-poisoning make their appearance, frequently accompanied 
by an eruptive fever. These signs of the secondary stage consist of: " super- 
ficial eruptions of the skin and mucous membrane, distributed symmetrically 
over both halves of the body; falling out of the hair and disease of the nails; 
often anaemia; lymphadenitis universalis; irritative processes in the peri- 
osteum and interstitial cellular tissue of internal organs, which subside spon- 
taneously without loss of tissue," or terminate sometimes in permanent de- 
rangements of functions through adhesions and contractions. The duration 
of this stage varies from several months to a year, being followed by an 
intermediate stage of uncertain duration, during which the disease remains 
either entirely latent or shows itself from time to time in various eruptions 
upon the skin and mucous membrane, but of less extent and intensity than 
in the previous stage. The blood-poisoning still existing, is transmissible to 
the offspring. 

The tertiary stage is characterized by ' ' local affections, for the most part 
asymmetrical, often occasioned by external causes, and consisting in cell- 
growth, having a tendency either to disintegrate or to become encysted with 
caseous metamorphosis and new formation of connective tissue. Gummata 
of the various organs, ulceration, necrosis, and caries of the skin and bone. 
General state of nutrition usually, though not always bad." Its limits are 
uncertain; in some cases it may be mixed up with the secondary stage; as a 
rule, many years intervene between the infection and its outbreak; it at last 
develops into confirmed syphilitic marasmus, where irremediable changes, as 
amyloid degeneration, destructive caseous pneumonias, dysenteric and other 
ulcerative processes, have taken place. 

Therapeutic Hints for Chancre. 

Merc. sol. Ulcer the size of a pea on the glans near the frsenum; pain- 
ful itching, sore to the touch, and discharging offensive pus; or several 
painful ulcers on the glans, on both sides of the fraenum, bleeding easily on 
retracting the prepuce or handling the parts; pain in the inguinal region on 



63O THERAPEUTIC HINTS FOR CHANCRE. 

walking or on pressure upon the parts; or, ulcer the size and shape of a small 
bean on the glans near the fraenum of some depth, and its base covered with 
a thin layer of yellow pus; painful to the touch; prepuce red and swollen. 
(A. Fellger.) 

Merc, cinnab. The ulcer on the glans is surrounded by a red-yellow- 
ish or red ring; there are lentil-sized red-yellowish, or scarlet-red spots on 
the glans and prepuce. (A. Fellger.) Also in old, neglected or badly 
treated indurated chancres, Prccc. rub. was of no avail; elevated chancres; 
exuberant granulations of the base of the ulcers; hard, callous, raised, 
indolent edges of the ulcer; mucous condylomata on the genitals, anus and 
lips; indolent buboes. 

Merc, prcec. rub. When Solubilis affects no change within eight or 
ten days; indurated, old, obstinate chancres; indurations after cauterization; 
excoriations on the glans; extuberances of the ulcers; inflamed buboes. 

Merc. prot. Painless chancres with great swelling of the inguinal 
glands, without disposition to suppurate; swelling of tonsils; affection of tes- 
ticles; also secondary eruptions. (J. H. McClelland.) 

Merc, biniod. Chancre and bubo particularly indolent; other symp- 
toms corresponding to the preceding. (J. H. McClelland.) Hard, red swell- 
ing of front of prepuce, appearing as thick and hard as a lead-pencil, with 
a hard chancre in its centre, entirely painless. (A. Fellger.) 

Merc. sub/, corr. Phagedenic chancre, secreting a thin, ichorous pus. 

Merc. ?iitr. In old obstinate cases; dry fig- warts on thread-like pedicles; 
soft, pointed condylomata. 

Mercury. Its oxide and chloride corresponds to chancres with steep, 
sharp cut edges; the bottom of the ulcer appears lardaceous; hard infiltra- 
tion of the surrounding tissue. (Von Villers. ) 

Arg. nitr. Little ulcers on prepuce, spreading and becoming covered 
with a tallowy substance. 

Arsen. Gangrenous degeneration with burning, restlessness and thirst. 

Caustic. Acrid, corrosive secretion or watery and greenish; complica- 
tion with eruptions, gout or scurvy. 

Cora//, rubr. Ulcers flat and extremely sensitive to touch, sometimes 
bleeding; chancres on any part of the penis, or scrotum, very sensitive to 
touch. (A. Fellger.) 

Hepar. Chancres secreting watery pus with diffuse borders and red 
bottoms, elevated above the surface. (Von Villers.) Is indispensable where 
Mercury has been abused. 

Kali bichr. When the ulcer is round and deep, as if chiseled out by a 
sharp instrument. 

Kreos. The prepuce becomes blue and black with haemorrhage and 
gangrene. Let the penis remain hanging in a vessel filled with water, which 
is medicated by a drop or two of the first or second dilution. 

Laches. The areola of the ulcer assumes a purplish color; phagedenic 
chancres. 



THERAPEUTIC HINTS FOR CONSTITUTIONAL SYPHILIS. 63 1 

Nitr. ac. Ulcers are painful on slightest touch as if sticks were jagging 
them. (A. Fellger. ) Chancres with raised edges and a disposition to bleed 
easily and profusely; inclined to spread in circumference with tendency to 
fungous growth; pains as of splinters; corrosive discharge; buboes threaten 
to suppurate. (J. H. McClelland.) Chancres with rhagades, characterized 
\y\ fetor. (Von Villers.) After the abuse of Mercury; unpainful ulcers, 
with gray, wasted edges, easily bleeding; or superficial or elevated ulcers, 
with zig-zag edges; or ulcers with hard, callous edges; or ulcers with a dark 
bluish, dirty basis, covered with a crust from underneath of which ichor 
issues, or with exuberant granulations, forming a red, spongy basis, like raw 
flesh; mucous, moist and other condylomata, like cauliflowers or pin- heads 
on thin pedicles; or phagedenic, ulcerated condition of the entire surface; 
fistulous ulcer into the urethra; inflamed buboes. 

Silic. Excessive discharge, foul-smelling diarrhoea, bloody and thin; 
inflamed, irritable, sore, with unhealthy granulation. 

Sulphur. Chancres with boar-like hardness of the red and swollen 
prepuce; intermediate remedy in psoric persons. 

Thuja. Round, unclean, elevated ulcers, surrounded with redness, 
usually moist and painful; condylomatous excrescences. (A. Fellger. ) Moist 
condylomata; elevated ulcers, with exuberant granulations; after Nitr. ac, 
erosions on the female genitals, with abundant mucous secretions; erosions 
and rawness between the legs and on the sides of the scrotum; constantly 
oozing of moisture; ulcers on the penis, cavity of mouth and throat. 

Besides the following are recommended: Jacara?ida caraba, Myrica 
cerifera, Phytol., Sa?iguin. 

Therapeutic Hints 

For Constitutional Syphilis. — Arg. nitr. Chancre-like ulcer on the prepuce; 
urethra swollen, hard and knotty; sexual desire gone, the genital organs 
having become shrivelled; cock's-comb-like fig- warts around the vulva; 
horn-like excrescences. 

Arse?i. Gangrenous and serpiginous ulcers; tubercular syphilitic skin 
diseases. 

Asa/. Affections of the long bones with severe nocturnal pains. 

Aur. fol. and mur. After the abuse of mercury; secondary ulcers on 
the scrotum; nightly pain in the bone; swelling of the skull-bones; swelling 
of the periosteum of the forearms and shin-bones; caries of the roof of the 
mouth and nose; ulcers on the tongue; falling out of the hair and great 
nervous weakness; utter despair and prostration of soul and body; attempts 
at suicide. 

Badiaga. Whole convolutes of hard glandular swellings; buboes. 

Card. an. Buboes becoming phagedenic; gummata; skin tubercles. 

Card. veg. Suppuration of bubo; the parts are livid and mottled; 
partial falling off of hair, with furfuraceous desquamation; 3 T ellow skin; 
pain in liver and spleen; palpitation of heart. (J. H. McClelland.) 



632 THERAPEUTIC HINTS FOR CONSTITUTIONAL SYPHILIS. 

Caustic. Fistulous ulcers; corrosive ulceration of skin tubercles; lupus; 
complication with gout and scurvy. 

Conii^vi. Syphilitic sarcocele. 

Coral/, rubr. Syphilitic erosions, exuding a thin, badly-smelliug ichor; 
constant trickling of mucus from the posterior nares into the fauces; smooth, 
copper-colored spots on palm of hand and finger. 

Coryd. Nodes on skull; ulceration of fauces; profuse secretion of mucus; 
fetid breath. 

Euphras. Old, broad condylomata at the anus, with much burning; 
especially at night. 

Ferr. iod. Recommended for mercurial cachexia. 

Fluor, ac. Skin tubercles on the forehead and face, even when ulcerat- 
ing; elevated red blotches on palms of hands; squamous eruptions on the body 
(psoriasis guttata); syphilitic erosions, mucous tubercles; exostoses and 
nightly pains in the bones. 

Guaiac. Tearing and stinging in the limbs; aching in the bones with 
swelling; tearing pains in the skull and bones of the nose; itching, tetter-like 
eruptions. 

Hecla lava. Destructive ulceration of the nasal bones. 

Hepar. After the abuse of mercury; falling out of the hair; painful 
lumps on the head, and nightly pain in the skull-bones; soreness of the nose 
on pressure, with red, inflamed eyes; eruptions around the mouth; ulcerated 
gums, with flow T of saliva; swollen tonsils and hard glandular swellings on 
the neck, with sticking when swallowing, coughing, breathing, or turning 
the neck, as though a fish-bone had stuck fast; suppurating buboes in the in- 
guinal region and axilla; green, slim}-, bloody stools; inflammatory swellings 
of the knees, hands, and fingers; ulcers, with nightly burning, throbbing 
and stinging, bleeding easily; nightly pain in the limbs, with chilliness; 
great nervous weakness. 

Iodium. Mercurial cachexia; salivation; ulcers in the throat; chronic 
buboes very hard. 

Kali bichr. Deep ulcer on the edge of the tongue; ulcer on the velum 
palati, eating through; fetid discharge from the nose; caries of the bones of 
the nose, with profuse purulent discharge from the nose; suppurating, soli- 
tary skin-tubercles, forming deep holes. 

Kali hydr. Bubo very hard with a curdy, offensive discharge, if sup- 
purating; thickening of the spermadic cord; ulceration of nose, mouth and 
throat with corroding, burning discharge; lancinating pains in throat; system 
depressed; effusion of serum into the cellular tissue; induration of liver. 
(J. H. McClelland.) After abuse of mercury; tuberculous pustules on the 
face; roseola on chest and extemities; discolored, large ulcers on the skin; 
swelling of the bones; nightly bone-pain; bloody stools, with tenesmus; falling 
out of the hair. 

Laches. Mercurial syphilis, with ulcerated sore throat, causing a con- 
stant provocation to cough, with retching; painful deglutition; regurgitation 



THERAPEUTIC HINTS FOR CONSTITUTIONAL SYPHILIS. 633 

of drink through the nose; earth}-, yellowish appearance of the face, with 
small red blood-vessels shining through the skin; coryza, nose red and sore; 
terrible headache; nighly pain in the limbs. 

Lycop. Secondary, tettery-like eruptions and ulcers in the throat of a 
dark, yello wish-gray color; cough and hoarseness, from similar affection of 
the larynx; coppery eruptions on the forehead, and cachectic appearance of 
the face; dry, pediculated, painless condylomata on the sexual organs; nightly 
pain in the limbs during wet weather; low-spirited; desponding; nervous 
weakness. 

Mercurial preparations. Compare Chancre. 

Mezer. Mercurial syphilis, with or without affection of the bones; 
chronic sore throat; dark redness of the fauces; worse every winter, with 
burning dryness extending into the larynx; hoarseness; hawking of phlegm. 

Natr. mur. If the primary sores have been burnt by nitrate of silver 
or lunar caustic. 

Natr. sulph. Granulated inflammation of the inside of the eyelids; 
swelling and suppuration of the axillary glands; ulcer on the outer side of 
the thigh; knotty, wart-like eruption on the anus, between the thighs, on the 
forehead, scalp, back of the neck and chest; swelling of the ribs near the 
sternum; stiffness of knees, and cracking of joints; pain in the bones. Com- 
pare Thuja. 

Nitr. ac. Mercurial syphilis; tonsils red and swollen, uneven, covered 
with little ulcers of the size of a pin's head; soft palate, highly inflamed; 
deep, irregular-shaped ulcer on the edge of the tongue; foul breath; single, 
moist sores on the scalp, burning; suppurating pustules all over the face, 
with broad red circumference, forming crusts; large, soft protuberance on 
the wings of the nose, covered with a crust; brown spots on the glans, of the 
size of a lentil, peeling off; squamous eruption, like psoriasis;, hard, brownish, 
little knots on the scrotum and perineum, which suppurate. 

Petrol. Brown spots on the arms, neck, chest and lower limbs; falling 
off of hair; rheumatic stiffness of shoulders and ankles. (Bell.) 

Phosph. ac. Mercurial syphilis; ulceration of the lips, the gums, and 
the soft palate; swelling of the bones; pain in the bones; condylomata; car- 
buncle-like ulcers of the skin, with a copper-colored circumference. 

Phosphor. Falling out of the hair, leaving exposed ulcers on the scalp, 
implicating the cranial bones; syphilitic psoriasis in the palms of the hands 
and the soles of the feet; syphilitic roseola; squamous eruptions; mer- curio- 
syphilitic ulcers on the prepuce; bone-pain and exostosis. 

Phytol. Sore throat; ulcers on the genitals; severe pains in the arms 
and legs, from the elbows and knees down to the fingers and toes, with cedem- 
atous swelling of the affected parts; pain aggravated by motion and con- 
tact; feet and legs covered with pale, red spots, about the size of a dime; 
more scattered on the arms, face and neck; previous use of mercury. 

Psorin. Moist, itching and burning condylomata on the prepuce; sore 
corners of the mouth; dry, tetter-like eruptions in the hollow of the knees. 



634 DIGEST TO CHANCRE AND CONSTITUTIONAL SYPHILIS. 

Sabina. Fig- warts with intolerable itching and burning; exuberant 
granulations. 

Sanguin. Roundish or oval, whitish and raised patches on the mucous 
membrane of the mouth, nose, prepuce and anus; a diphtheritic exudation, 
which, when wiped off, leaves a raw surface behind; congestion of the head; 
throbbing headache from the nape of the neck to the head; swollen veins in 
the temples. 

Sarsap. Mercurial syphilis; squamous eruptions; bone-pain. 

Sepia. Syphilitic erosions in women. 

Silk. Mercurio-syphilitic ulceration of skin and bones. 

Staphis. Mercurial syphilis; dry, pediculated fig- warts and mucous 
tubercles; nervous weakness. 

Stilliu. Extreme bone-pains; nodes on head and legs. 

Sulphur. Mercurial syphilis; itching ulcers, which are soon covered 
with a crust, discharging pus from underneath; cock' s-comb-like excrescences 
on glans, soft, spongy, easily bleeding; excoriations on the genitals, with 
burning; copper-colored spots on forehead; hard, large and inflamed 
buboes. 

Thuja. Erosions in the female genitals, with profuse gonorrhceal dis- 
charges; erosions between the thighs and on scrotum; in the fauces, with 
mucous tubercles; condylomata; tubercula mucosa; decay of teeth near 
the gums. 

Digest to Chancre and Constitutional Syphilis. 

Low-spirited, desponding: Lycop. , leaving exposed ulcers on scalp, 

Despair: attempts of suicide; prostration implicating the cranial bones: Phos- 

of soul and body: Aurum. phor. 

Nervous weakness: Aurum, Hepar, 

Lycop., Staphis. Eyelids granulated: Natr. sulph. 
Eyes red, inflamed: Hepar. 



fetid discharge from: Kali bichr. 
burning discharge from ulceration 



Congestion of head, with throbbing 

headache from nape of neck up to Nose red and sore, coryza: Laches. 

head: Sanguin. 
Headache, terrible: Laches. 

Tearing pain in skull and bones of of: Kali hydr. 

nose: Guajac. Nose, trickling of mucus from posterior 

Pains in skull-bones, in night: Hepar. nares into fauces: Corall. 

Painful lumps or nodes on skull: Coryd., , soreness of: Hepar. 

Hepar, Stilling. large, soft protuberance on wings of, 

Swelling of skull-bones: Aur. fol. and covered with a crust: Nitr. ac. 

nuir. , pains in bones of: Guajac. 

Single, moist sores on scalp, burning: , caries, ulceration of bones of: 

Nitr. ac. Aurum, Hecla lava. 

Knotty, wart-like eruption on scalp: , , , with purulent discharge: 

Natr. sulph. Kali bichr. 

Hair, falling out of : Aurum, Hepar, , roundish, whitish and raised patches 

Kali hydr.. Petrol. on mucous membrane of: Sanguin. 
, with fururceous desquamation: 

Carb. veg;. Face earthv, vellowish, with small 



DIGEST TO CHANCRE AND CONSTITUTIONAL SYPHILIS. 



635 



blood-vessels shining through the skin: 
Laches. 

cachectic: Lycop. 

, pale red spots on, and neck: Phytol. 

, tuberculous pustules in: Kali hydr. 

, suppurating pustules with broad, 

red circumference, forming crusts: 
Nitr. ac. 

, lupus: Caustic. 

Forehead, copper-colored spots on: Ly- 
cop. , Sulphur. 

and back of neck, wart-like erup- 
tions on: Natr. sulph. 

Temples, swollen veins on: Sanguin. 



Mouth, eruptions around: Hepar. 

, sore corners of: Psorin. 

Lips, ulceration of: Phosph. ac. 

— — , mucous condylomata: Cinnab. 

Gums, ulceration of: Phosph. ac. 

, , with flow of saliva: Hepar. 

, scurvy: Caustic. 

Teeth, decay of, near the gums: Thuja. 

Tongue, deep ulcer on edge of: Kali 
bichr. 

, , irregularly shaped: Nitr. ac. 

, ulcers on: Aurum. 

Tonsils swollen: Merc. prot. 

, hard, with stitching pain on swal- 
lowing: Hepar. 

, red, covered with little ulcers: Nitr. 

ac. 

Soft palate, ulceration: Phosph. ac. 

, , eating through: Kali bichr. 

, highly inflamed: Nitr. ao. 

Mucous membrane, roundish, whitish 

patches, wmen wiped off leaving a raw 

surface: Sa7iguin. 
, ulceration of, and throat: 

Thuja. 
, , with corroding, burning dis- 
charge : Kali hydr. 
Throat, lancinating pain in: Kali hydr. 

sore : Mezer. , Phytol. 

, ulcers in and salivation: Iodium. 

, , causing cough with retching: 

Laches., Lycop. 
Fauces, dark redness of, with burning 

dryness, extending to larynx, worse 

every winter: Mezer. 

, erosions: Thuja. 

, ulceration of: Coryd. 

, , and tettery-like eruptions of a 

dark, yellowish-gray color: Lycop. 



Phlegm, hawking of: Mezer. 
— — , profuse secretion of: Coryd. 
Deglutition painful, with regurgitation 

of drink through the nose: Laches. 
Breath fetid: Coryd. 
foul: Nitr. ac. 



Hoarseness: Lycop., Mezer. 

Cough from ulceration in larynx: Lycop. 



Liver indurated: Kali hydr. 

and spleen, pain in: Carb. veg. 

Stools foul-smelling, bloody and thin: 
Silic. 

green, bloody: Hepar. 

bloody, with tensemus: Kali hydr. 



Heart, palpitation of: Carb. veg. 



Genitals, chancres or ulcers on prepuce: 

Arg. nitr., Phosphor. * 
gangrenous: Arsen., Kreos. 

phagedenic: Laches., Merc. subl. 

co'rr., Nitr. ac, Thuja. 

secondary on scrotum: Aurum. 

on outer side of thigh: Natr. 

sulph. 
Basis exuberant: Cinnab., Merc, prczc. 

rub., Nitr. ac, Sabina, Silic, Thiija. 
red, elevated: Hepar. 

lardaceous: Oxide and Chloride of 

Merc. 

Basis covered with a tallowy substance: 
Arg. nitr. 

covered with a thin layer of pus: 

Merc. sol. 

dark bluish, dirty, covered with a 

crust: Nitr. ac 

Edges steep, sharp cut: Kali bichr., 

Merc oxide and chloride. 
fistulous: Caustic 

zig-zag, superficial or elevated ul- 
cers: Nitr. ac. 

hard, callous: Cinnab., Nitr. ac. 

raised, easily bleeding: Nitr. ac 

raised, gray, easily bleeding: Nitr. 

ac 

, diffuse, with red bottoms: Hepar. 

Areola of ulcer red: Thuja 

red or red-yellowish: Cinnab. 

purplish: Laches. 

Surrounding tissue hard, swollen: 
Merc, binj., Merc prase, rub., O.vidc 
and Chloride of Merc. , Sulphur. 



636 



DIGEST TO CHANCRE AND CONSTITUTIONAL SYPHILIS. 



with rhagades, characterized by 

fetor: Nitr. ac 

prepuce, black and blue, with 

haemorrhage: Kreos. 

, red and swollen: Merc. sol. 

TJlcers discharging excessively: Si lie. 

watery pus: Hepar. 

— offensive pus: Merc. sol. 

greenish, corrosive secretion: 

Caustic. 

thin, ichorous pus: Merc, sub I. 

corr., Nitr. ac. 

moisture: Thuja. 

easily bleeding: Corall. rub., Hepar, 

Merc, sol., Nitr. ac. 
painless: Cinnab., Merc. binj.,Nitr. 

ac. , Merc, pi'ot. 

painful: Merc, sol., Thuja. 

, as of splinters: Nitr. ac. 

nightly burning, throbbing, sting- 
ing: Hepar. 

sensitive to touch: Corall rub., 

Merc. sol. , Nitr. ac. 

itching: Merc, sol., Sulphur. 

Condylomata, fig-warts: Phos. ac, 
Thuja. 

— — , , and anus: Ciunab. 

, , at anus, old, broad, with burn- 
ing, worse at night: Fuphras 

, , with intolerable itching and 

burning: Sabiua. 

, , pointed: Mere. nitr. 

, , tubercula mucosa: Thuja. 

, , moist: Nitr. ac, Thuja. 

, , moist on prepuce, itching and 

burning: Psoriu. 

, , dry, pediculated: Lycop., 

Merc nitr., Staph is. 

Excrescences, cock's-comb-like around 
vulva: Arg. nitr. 

, on glans, easily bleeding: 

Sulphur. 

, like cauliflowers, or pin-heads on 

thin pedicles: Nitr. ac 

, horn-like: Arg. nitr. 

Spots, lentil-sized, red-yellowish, or scar- 
let-red on glans and prepuce: Ciunab. 

, , brown, glans peeling off: 

Nitr. ac. 

Erosions: Fluor, ac. 

, in women: Sepia: 

, , with abundant mucous secre- 
tion: Thuja. 



, exuding a thin, badly-smelling 

ichor: Corall. rub. 
■ between thighs and on scrotum, 

with mucous tubercles: Thuja. 
Excoriations, with burning: Sulphur. 

on the glans: Merc prcrc. rub. 

Patches, roundish, whitish, raised, on 

prepuce and anus: Sanguin. 
Urethra swollen, hard and knotty: Arg. 

nitr. 

, fistulous ulcers in: Nitr. ac. 

Knots, hard, brownish, suppurating on 

scrotum and perineum: Nitr. ac 
Testicles affected: Merc prot. 
and genital organs shrivelled: Arg . 

nitr. 

, syphilitic sarcocele: Conium. 

Spermatic COrd thickened: Kali hydr. 



Inguinal region painful on walking or 

pressure: Merc sol. 
Buboes inflamed: Mercprcsc. rub., Nitr. 

ac. 

inflamed, hard and large: Sulphur. 

threaten to suppurate: Nitr. ac. 

suppurate: Carb. veg. 

in inguinal region and axilla: 

Hepar. 

axillary glands: 

, with curdy, offensive discharge: 

Kali hydr. 

without disposition to suppurate: 

Merc prot. 

indolent: Cinnab. 

chronic and very hard: Iodium. 

becoming phagedenic: Carb. an, 

, whole convolutes of hard glandular 

swellings: Badiaga. 



Bones aching: Guajac, Natr. sulph., 

Phosphor., Phosph. ac, Sarsap. 
nightly: Asa/., Aur. fol. and 

mur., Fluor, ac, Kali hydr. 
, swelling, exostosis of: Fluor, ac, 

Guajac, Kali hydr., Phosphor., 

Phosph. ac 
, of ribs near sternum: Natr. 

sulph. 

, ulceration of skin and: Silic 

Periosteum of forearms and shin-bones: 

Aur. fol. and mur. 



Limbs, pain in, worse from motion and 
contact: Phvtol. 



CONDYLOMATA, SYCOSIS. 



637 



, , nightly: Laches., Lycop. 

, tearing and stinging in: Guajac. 

, gout and scurvy: Caustic. 

Shoulders and ankles, stiffness in: Pet- 
rol. 

Hands and fingers, and knees, inflamma- 
tory swelling: Hepar. 

Arms and legs, pain and oedematous 
swelling: Phytol. 

Knees, stiff, and cracking of joints: 
Natr. sulph. 

Legs, nodes on: Stilling. 



Skin yellow: Card. veg. 

swollen from effusion: Kali hydr. 

, eruptions, secondary: Merc. prot. 

squamous, like psoriasis: Fluor. 

ac, Nitr. ac, Phosphor., Sarsap. 

, tetter-like, itching: Guajac. 

, , dry in hollow of knees: 

Psorin. 

, roseola: Phosphor. 

, on chest and extremities: Kali 

hydr. 
, spots pale, red on feet, legs, arms: 

Phytol. 
, spots copper-colored, smooth, on 

palms and fingers: Corall. 
, spots brown, on arms, neck, chest, 

lower limbs: Petrol . 
, blotches, elevated, red on palms: 

Fluor, ac. 



, knotty, wart-like eruptions on anus, 

between thighs: Natr. sulph. 

, tubercles: Arsen., Card. an. 

, on forehead and face: Fluor. 

ac. 

, , mucous: Fluor, ac, Staphis. 

, , ulcerating: Caustic, Fluor. 

ac 
, , , forming deep holes: 

Kali bichr. 

, ulcers, large: Kali hydr. 

, , carbuncle-like, with copper^ 

colored circumference: Phosph. ac. 
, ulceration of skin and bone: Silic. 

Mercurial syphilis cachexia: Aur.fol. 
and mur., Ferr. jod., Hepar, Iodium, 
Kali hydr., Laches., Mezer., Nitr. ac, 
Phosphor., Phosph. ac, Phytol., Sar- 
sap., Silic, Staphis., Sulphur. 

Cauterization, after: Merc prczc. rub., 
Natr. mur., Nitr. ac. 

Psoric persons: Sulphur. 

Merc, praec. rub., when Solubilis has 
failed. 

Cinnabaris, when Merc prcsc. rub. has 
failed. 

Natrum sulph., similar to Thuja. 



Besides, the following are recommended: 
Jacaranda caraba, Myrica cerifera. 



Condylomata, Sycosis, Fig-warts. 

These excrescences are a morbid growth of the skin and mucous mem- 
brane, or, better denned, of the subcutaneous and submucous cellular tissue. 
They are of different external appearance, according to their coating. When 
they are covered by the epidermis, they appear dry, hard, horny, like com- 
mon warts; when covered with thin epithelium, or when they are entirely 
bare and excoriated, they appear soft, moist and secrete more or less of a 
slimy, acrid, badly-smelling fluid. These latter are the genuine syphilitic 
condylomata or tubercula mucosa. 

Their forms are likewise various; some are flat, upon a broad basis; 
others are conical, growing on a pedicle; others appear like a cock's-comb. 
The flat fig-warts are chiefly found around the anus, between the glutseus 
muscles; on the perineum, scrotum, external skin of the penis, glans penis 
and on the external surface of the labia in women; whilst the conical and 
pediculated are usually found in the entrance of the vagina, on the clitoris 
and even far back in the vagina, and on the neck of the womb; in males on 
the interior surface of the prepuce; also between the nates. They some- 



638 THE IXGUIXAL BUBO. 

times grow so luxuriantly that the whole vagina and interior surface of the 
prepuce is covered by them. A third kind is quite small, in the shape of 
pin-heads, which are generally found around the corona in men, and on the 
interior surfaces of the labia in women. In secondary syphilis they appear 
also in other localities, especially on the tongue, corners of the mouth, chin, 
face, forehead, eyelids, iris, scalp, meatus auditorius, axillae, nipples and be- 
tween the toes. Soon after the outbreak of this pest in the middle ages we 
read of condylomatous excrescences in the face, which were of a finger's 
length, and which caused for their bearers more ridicule than compassion. 

Therapeutic Hints. 

For the mucous tubercles the main remedies are: Cinnab., Sublim., 
Nitr. ac, Thuja. 

Fig-warts, when complicated with gonorrhoea, require Thuja, Sublim., 
Cinnab., Nitr. ac, Sulphur, Lycop. 

When complicated with chancre, Cinnab., Nitr. ac, Piwsph. ac, Staphis., 
Tluja. 

When flat, Magnes., Nitr. ac 

When exuberant, like cauliflowers or mulberries, Thuja, Staphis. 

When fan-shaped, Cinnab. 

When growing on pedicles, Lycop., Nitr. ac. 

When conical, Solub. 

When dry, Thija, Staphis., Solub., Sublim., Nitr. ac, Lycop. 

When moist, suppurating, Nitr. ac, Thuja, Sulphur, Euphras. 

When soft, spongy, Sulphur. 

When intolerably burning and itching, Sabina. 

The Inguinal Bubo 

Consists of a swelling of the inguinal lymphatic glands, with a tendency to 
form abscesses in consequence of venereal infection. As chancres may ap- 
pear on other parts than the genitals, so, also, may buboes appear in other 
parts; in the axilla, under the maxilla, on the neck. Buboes ma)* also form 
primarily (without previous chancre on the penis) by immediate absorption 
of the syphilitic virus. The period of time which elapses between the first 
appearance of chancre and that of bubo varies from eight days to six weeks. 
Svviptoms. — Before anything can be seen the patient experiences a 
painful tension in the inguinal region, which sometimes extends into the 
thigh, making walking quite difficult; soon after the patient feels feverish, 
chilly, and there appears a roundish swelling in the inguinal region, which 
is painful to contact and motion. It is usually hard, grows in the course of 
some days to the size of a pigeon's egg, and larger, and becomes dark red. 
If not arrested in this stage it soon commences to assume a more doughy feel, 
with painful throbbing; finally it fluctuates, breaks, and discharges a quan- 
tity of thick pus, which at last becomes watery; now it heals, either like any 
other abscess, or the wound assumes a chancre-like aspect, with hard, callous 



THERAPEUTIC HINTS TO INGUINAL BUBO. 639 

edges. In bad cases it ma}' even assume a phagedenic or gangrenous form, 
and cause terrible destruction of the surrounding parts. 

All buboes do not run this acute course. The so-called indolent, torpid 
or atonic buboes form quite slowly, without pain or fever, and continue so 
until they reach a certain size, which they retain in a seemingly unaltered 
condition for weeks, or even months, until they finally suppurate and dis- 
charge. The so-called scirrhous bubo may remain for years in the same 
condition. 

Its Diagnosis is easy enough, if we ascertain the pre-existence of 
chancre. It may, however, be confounded with an incarcerated testicle 
within the abdominal ring; therefore Ricord advises first to count the tes- 
ticles before pronouncing an inguinal swelling a bubo. The inguinal glands 
ma}- swell from other causes. In children scrofulous swellings of these glands 
are not unfrequent. We shall, in some cases, no doubt, have to fall back on 
the history of the case, which may tax our skill in cross-examination. 

Therapeutic Hints. 

Apis. Red, hot, shining, swelling, with great stinging pain and sensi- 
tiveness. 

Arsen. When the open bubo assumes a greenish aspect. 

Aurum. After the abuse of mercury, with nightly pains in the bones. 

Badiaga. Bubo stone-hard and uneven, a conglomeration of indurated 
glands; violent stitching pain through it at night, as though a red-hot needle 
were thrust into it. Suppressed chancre by cauterization and mercurial oint- 
ments, leaving elevated and discolored cicatrices; general cachectic appear- 
ance and rhagades of the skin, here and there. 

Card. an. For hard buboes which threaten to suppurate; it causes re- 
sorption where there is even some fluctuation discoverable; old, maltreated 
buboes, cut open or cauterized, presenting large, terrible ulcers, with callous 
edges and a secretion of offensive ichor. 

Hepar. After the abuse of mercury, for open buboes, which do not 
heal, and when there is a psoric taint of the system. 

Kali hy dr. After mercurial treatment; ulcerating bubo, with fistulous 
openings, and discharge of dark, thin, offensive and corroding ichor; scrofu- 
lous individuals. 

Laches. Old protracted syphilitic mercurial buboes; hectic fever, sore 
throat and the most violent headache, either in the back or front of the head. 

Mercurial preparations. Compare what has been said under the chapter 
on Chancre. 

Nitr. ac. After the abuse of mercury, when Card. an. has not been 
sufficient to reabsorb the swelling, and especially if the still existing chancre 
presents exuberant granulations on its base. 

Sulphur and Silic. Are especially indicated for old, discharging buboes 
which do not heal, although other syphilitic symptoms have disappeared. 

Besides these remedies, there have been recommended Buboin, Phvtol., 
Sanguin. 



640 SYPHILITIC SKIN DISEASES. 

Syphilitic Skin Diseases. 

The various affections of the skin in consequence of syphilis go under 
the name of Syphilides. Syphilides as a rule are characterized by a peculiar 
red color, which is perhaps best designated by the term " coppery red." It 
is most pronounced in persons with dark complexions; in persons with very 
pale, anaemic skin it may at first be wholly wanting, or appear only as the 
exanthem begins to wane with a yellowish color. 

The syphilides consist of a cellular infiltration proceeding from the 
blood-vessels; but developing only gradually and at different localities, they 
appear frequently in different forms, so that we see macules, papules, vesicles 
and pustules side by side in one person, at different stages of development, 
all of which may ultimately assume the form of ulcers. This polymorphous 
character, however, belongs not exclusively to syphilides, we find it also, 
though in a less degree, in eczema and scabies. 

Another characteristic mark of the syphilides is their annular form, 
similar to that observed in herpes circinatus. It is often very distinct, too, 
on the mucous membrane, especially on the tongue, on the hard and soft 
palate, and on the glans penis. 

Syphilides finally are characterized by an abscence of itching, or any 
other sensation, although exceptions do occur, especially when the exanthem 
comes on very acutely. 

The various forms of syphilides are: 

1. The Macular syphilide, or Roseola syphilitica consists of a circum- 
scribed hyperemia with but slight infiltration, and appears in perfectly even, 
rose-colored, or darker colored spots, of a size varying usually from that of a 
lentil to that of a pea, with a roundish or irregular shape. After it has ex- 
isted for several days it leaves under pressure a yellowish stain, and gradually 
assumes a coppery hue. When the spots are elevated it is called erythema 
papulatum. 

Roseola syphilitica is usually the first of all skin affections, and some- 
times the sole eruption that occurs during the earlier course of the disease. 
It may appear in only a few spots upon the sides of the chest and in the 
groin, and again it may be disseminated over the whole body like an erup- 
tion of measles. 

2. The Papular syphilide consists of a circumscribed infiltration of the 
papillary bodies of the cutis. It varies from the size of a barley-corn to that 
of a split pea, and in color from red to brownish-red; it is hard to the touch, 
but smooth upon the surface. Later its epidermis loosens and is rubbed off 
when its summit presents a dark and shining appearance, which again is 
covered by a thin crust from the oozing of a little serum. In the palms of 
the hands and the soles of the feet the papules are not very prominent on 
account of the thickness of skin, but they appear only as red circular spots, 
which become denuded of their epidermis, and which are usually designated 
bv the name psoriasis paimaris and plantaris. 



SYPHILITIC SKIN DISEASES. 64 1 

The papular syphilide may appear anywhere upon the surface of the 
skin, but is mostly seen on the borders of the scalp, on the forehead (corona 
veneris"), on the back of the neck, especially in women, and in all places 
where the skin forms folds or depressions, for instance on the chin, between 
the nose-wings and cheeks, behind the ears, on the borders of the axillae, in 
the elbows and in the hollows of the knees. Where these folds of the skin 
are in continual contact with each other, for instance on the external female 
organs, the scrotum, beneath the dependent breasts, in the navel, about the 
anus, at the preputial orifice, the angles of the mouth, between the fingers 
and toes, these papules are very apt to assume the form of condylomata lata. 

The eruption of the papular syphilide is often attended with fever, thus 
simulating somewhat an outbreak of smallpox, wherefore syphilis received 
from the French the name of verole grass or verole. It is either one of the 
first constitutional signs of syphilis or develops gradually from a roseola 
syphilitica, or does not appear until some weeks after this has disappeared. 
It is often accompanied by violent pains in the bones or iritis. 

3. The Squamous syphilide consists of a coalescence of several pap- 
ules, or a gradual enlargement of a single papule with desquamation of the 
epidermis, thus bearing close resemblance to the patches of a common psoria- 
sis. However, it is covered, especially towards the borders, with loose epi- 
dermic scales, or rather thin yellow crusts, by which it may be distinguished 
from the white thick desquamation of psoriasis vulgaris. Besides, it does 
not appear on the knees or elbows, which is the favorite seat of common 
psoriasis. 

The squamous syphilide also becomes transformed into flat condylomata 
in favorable situations. 

4. The Lichen syphiliticus consists of an infiltration of the follicular 
walls, with scanty, or no exudation in the follicles. In their simplest 
form they resemble those enlargements of the follicles which occur in many 
persons upon the dorsal surface of the upper arm, in consequence of an ac- 
cumulation and desiccation of the secretion, as hard granules like dried gum, 
which can be excavated with the finger-nail. 

The lichen appears usually in groups, at first slightly reddened, assumes 
soon a yellowish color, peals off and leaves no pigment spots behind (Miliary 
papular syphilide). When there is exudation into the follicle, groups of 
little vesicles form, which turn into pustules. These crust over and, after 
drying, leave small, dark scars behind (Herpes syphil.). Or the infiltra- 
tion spreads further around, and causes the entire surface of the skin, which 
was occupied by the papular group, to be converted into a desquamating, 
psoriasis-like group (Eczema syphil.). Or, there is an acute suppuration in 
the follicle in connection with the infiltration, causing acuminate pustules 
upon a red or copper-colored base (Acne syphilitica). This form is so 
similar to common acne that the distinction between the two must be based 
upon other syphilitic symptoms present or past. 

5. The Pustular syphilide consists of an infiltration with subepithelial 
4i 



642 SYPHILITIC SKIX DISEASES. 

suppuration and superficial ulceration. The pus in these eruptions is not 
situated in the follicles, but underneath the epidermis, independently of the 
follicles. The pustules develop rapidly in places where the skin is tender, 
namely, beside the face, in the flexor surfaces of the extremities, on the sides 
of the trunk, and in the palm of the hand where there are no follicles. They 
are also more superficial and leave only very shallow depressions, even im- 
mediately after the crusts have fallen off (Pemphigus syphiliticus). Some- 
times the epidermis is raised by a cloudy fluid, which soon becomes purulent 
and is often tinged with blood, over a reddened base. Such bullae appear in 
isolated spots, in preference on the legs below the knees (Ecthyma syphiliti- 
cum). After desiccation there forms at times superficial excoriations beneath 
the scabs, and at other times deep ulcers, which extend at the edges and oc- 
casionally assume a serpiginous form (Ecthyma superficiale and profundum). 
It is a manifestation of the later periods of syphilis and an evidence of a 
poor constitution. When the epidermis of a bulla forms a scab, while the 
ulcerative process underneath advances slowly beyond its edge, there gradu- 
ally is produced a large, dirty, brownish-green, stratified crust in the shape 
of a cone, which rests upon a flat, ulcerated surface (Rupia syphilitica). 
Such ulcers, proceeding from rupia, may continue to extend for years, and 
convert extensive tracts of skin into cicatricial tissue. 

Rupia is often manifestation of the later periods of syphilis, though it 
ma}' break out within the first six months after infection. 

6. The Tubercular syphilide consists of deep infiltration and disinte- 
gration, or a gummous formation. At the commencement only a papule is 
felt in the skin, without redness. Gradually the papillary body becomes 
likewise involved, and the tubercle approaches the surface, when it causes 
redness of the skin, desquamation of the epidermis or scanty serous exuda- 
tion, which, on drying, forms a small crust upon the summit of the tubercle. 
These tubercles often develop in groups of a circular or semi-circular form 
(Dry tubercles). Or, the epidermis above the tubercle is raised in the 
form of a pustule which quickly desiccates, while underneath ulceration pro- 
ceeds, simulating a rupia or assuming at once the form of a serpiginous ulcer. 
Or, the process of softening ma}* be similar to the development of a furuncle; 
it generally becomes bluish-red, and when it breaks discharges a grayish- 
yellow, gummy-like matter, instead of a core of connective tissue, as in the 
true furuncle. The remaining cavity gradually either granulates and cica- 
trizes, or enlarges and assumes a serpiginous character (Softening- and 
disintegrating tubercles). These forms of the syphilitic tubercles present 
a marked similarity to different forms of lupus, whence the name Lupus 
syphiliticus. The tubercular syphilide belongs to the tertiary group of 
syphilis. 

7. The Loss of hair, Alopecia, occurs without any visible change in 
the skin. The hair merely loses its lustre, becomes dry, and often discolored, 
and falls out in large quantities when combed. It is an early symptom of 
constitutional syphilis, but may not occur until in the later stages. 



SYPHILITIC AFFECTIONS OF THE MUCOUS MEMBRANES. 643 

8. Alterations of the nails, such as growing thinner, becoming fur- 
rowed or brittle, may take place without any obvious affection of the matrix; 
but deformities of the same may also be brought on by various syphilides 
attacking the matrix. 

Therapeutic Hints. 

Mercurial preparations. Nitr. ac, T/iuj'a, Aurum, Lycop., Staphis., 
Kali hydr., Laches., Sulphur, Hepar, Sarsap., Petrol., Cuprum, Corall. 
rubr., Arsen., Graphit., and many more. 

Syphilitic Affections of the Mucous Membranes. 

Some of the just described syphilides may also affect the mucous mem- 
branes, for instance: 

The Erythematous syphilide occurs in the throat in the form of a 
diffuse redness, sometimes accompanied by a slight oedema of the mucous 
membrane. 

The Papular syphilide appears as moist or mucus patches in the mouth 
and throat, bearing the greatest resemblance to the effect produced by a very 
superficial cauterization of the mucous membrane by nitrate of silver. Upon 
the tongue the S3?p>hilitic papule forms usually round level spots which often 
enlarge in circumference while receding in the centre, and thus assume the 
annular form. The same occurs on the hard palate. In the female genitals 
and in places where surfaces lie in contact with each other, the mucous 
patches become flat condylomata, which often are converted into condyloma- 
tous ulcers, simulating closely the primary affection. The secretion of the 
flat condylomata is in the highest degree infectious. 

The Squamous syphilide also becomes often transformed, in favorable 
situations, into flat condylomata. 

The Ecthyma is often accompanied with aphthous-like sores in the 
mouth, deep ulcers of the tonsils, or destructive ulcerations upon the soft 
palate. 

The Syphilitic tubercles of the mucous membrane of the mouth and 
throat are usually not seen until ulceration has taken place. The ulcers have 
sharply cut edges, a yellowish purulent base with great swelling and redness 
around them; they spread often extensively upon the posterior pharyngeal 
wall; they occur also in the large intestine, especially in the lower part of 
the. rectum and in the trachea. 

Therapeutic Hints. 

Mercurial preparations, Aurum, Kali bichr., Kali hydr., Laches., 
Lycop., Mezer., Nitr. ac, Sanguin., Thuja. 

Syphilitic Affections of the Periosteum, of the Bones and Carti- 
lages. 

They are always attended by severe pains in the bones, of a boring, 
grinding nature, and always worse at night from evening till towards morn- 



644 SYPHILITIC CONTRACTIONS. 

ing, when, with a slight perspiration, they usually abate. Gradually a struc- 
tural change is observable; the % periosteum commences to swell, forming so- 
called tophi, and when the inflammation spreads to the bones, causing swell- 
ing of the bones (exostosis), which may terminate in necrosis and caries. 
Such structural changes attack the skull-bones, which, when they are on the 
inside, ma}* cause convulsions, paralysis, amaurosis and deafness. Those 
which attack the bones of the nose cause horrible disfigurations of the face. 
It also attacks the vertebrae, destroying portions of them, and the cartilages, 
although not so frequently. The cartilage of the nose is destroyed as well 
as the bones, and so have the cartilage of the sternum and the cartilages of 
the larynx been found destroyed. 

Therapeutic Hints. 

Pain in the bones: Arsen., Aurum, Fluor, ac, Guaiac, Laches., Mer- 
cur., J\Iezer., Nitr. ac, Phosphor., Phosph. ac., Phytol., Staphis., Stilling. , 
Sulphur . 

Tophi and exostoses : Asa/., Aurum, Fluor, ac, Lycop., Mezer., Phos- 
phor., Phosph. ac, Ruta, Sabina, Silic, Staphis., Sulphur. 

Caries and necrosis: Asa/., Aurum, Calc carb. and jod., Fluor, ac, 
Hepar., Kali hydr., Lycop., Mercur., Mezer., Nitr. ac, Phosphor., Silic, 
Sulphur. 

Syphilitic Contractions of Muscles and Tendons. 

These take place in rare cases, where the syphilitic virus attacks the 
muscles and tendons, causing plastic exudation within and around them, and 
thus shortening them. 

Gummata in the Subcutaneous and Submucous Cellular Tissue. 

These usually form at a later period, and appear as little, painless, mov- 
able kernels under the skin. They grow slowly and commence finally to 
suppurate, leaving deep, cicatrized holes, or chronic ulcers. 

Arsen., Aiwum., Bellad., Calc carb., Carb. veg., China, Graphit., Mer- 
cur., Mezer., Phosph. ac, Plumbum, Ruta. 

Syphilitic Affections of Inner Organs. 

a. Brain affections. They manifest' themselves in various ways, as, 
violent headaches, hemicrania, sleeplessness, dizziness; or as hemiplegia, im- 
becility of mind, amaurosis, deafness, epilepsy, catalepsy, and are caused 
either by chronic inflammation of the membranes, or formations of tubercu- 
lar masses, or syphilitic exostoses on the inner plate of the skull-bones. 

The diagnosis is difficult. We may suspect such changes, if we find a 
right to do so from the history of the case. 

b. Lnng Affections set in frequently in consequence of suppressed 
chancres, either as ulcerative processes, as bronchitis and asthma. 

c. Liver, Spleen, Intestinal Affections are of varions kinds and have been 
spoken of under the corresponding chapters. 



SYPHILIS CONGENITA SIVE HEREDITARIA. 645 

Syphilis Congenita sive Hereditaria. 

In some cases the child is detroyed by syphilitic infection while yet a 
foetus; or it may be born alive prematurely; or be still-born at full term; or be 
born at full term apparently healthy, when some time afterwards the consti- 
tutional taint develops itself. 

The infection ma} 7 have been transmitted, as stated before, by the semen, 
by the ovule, or later during gestation. The more recent the syphilis in the 
parents at the time of conception, the greater will be the liability to abortion. 
When the foetus dies in utero, it is usually born in a state of maceration; if 
carried nearly to its full term, it shows the syphilitic'signs either on the surface 
of the body, or in internal organs, and invariably in the epiphysis of the 
long bones, where the cartilage layer is enlarged and softened, the zone of 
ossification is thickened, projecting with irregular prolongations into the 
cartilage layer, whereby the union of the two becomes less firm, so that the 
epiphysis is liable to separate entirely from the shaft of the bone, or the rib 
from its cartilage. 

When the child is born alive, it usually is small, undeveloped and pre- 
sents a peculiar oldish appearance, has a weak, plaintive voice, a stoppage 
of the nose, sore corners of the mouth, and its skin is either already covered 
with a rash, or shows, in a few days, papules or pemphigus. Such children 
perish in a short time from diarrhoea, or suppurations with all signs of 
marasmus. 

Sometimes the only apparent symptom of a seemingly healthy child is 
a nasal catarrh with stoppage of the nose, and coincident with it or following 
soon after a macular, or oftener a papular eruption, which may be limited 
to a few bright red papules upon the buttox, or cover the entire body, but 
especially the face, acquiring by degrees the coppery tint. By and by the 
nasal discharge becomes purulent and excoriates the neighboring parts, and 
in the mouth and throat mucous patches appear. Bad cases soon lead to 
destruction; mild cases ma} 7 improve, but develop a most striking depression 
or flattening of the nasal ridge and a marked prominence of the frontal pro- 
tuberances with symptoms of hydrocephalus. The children become very 
restless, cry a great deal, especially at night; later manifest themselves a 
want of proper intellectual unfoldment and striking idiosyncrasies of charac- 
ter, and the upper permanent incisor teeth appear as if they were scooped 
out at their lower surface. 

The outbreak of these symptoms is very uncertain; the latest period, as 
stated by different observers, is at from one week to several months, occurs 
most frequently, however, from the fifth to the eighth week after birth. The 
sooner the symptoms appear, the worse for the child. If it live through the 
acute stage there may occur, commonly during the period of the second den- 
tition, or at the time of puberty, especially in girls, another train of symp- 
toms of which may be mentioned: interstitial keratitis, eruptions, serpiginous 
ulcerations of the skin, or affections of the bones, epilepsy, chorea, paralysis. 
The treatment find under Constitutional Syphilis. 



646 DISEASES OF THE TESTES. 



DISEASES OF THE TESTES. 

Hydrocele. 

The testicles and epididymis are enclosed within a serous membrane, 
like the peritoneum, from which, in fact, it is a mere continuation. As such, 
it is a closed sac, and consists, like the pleura and the peritoneum, of two 
layers, the tunica vaginalis propria and the tunica vaginalis reflexa. Like 
all serous membranes, it is liable to exudation, and if that takes place, it 
constitutes what is called hydrocele or dropsy of the scrotum. 

It is either a symptom of general dropsical disposition, in consequence 
of hydraemia, as found in old age, or in consequence of tuberculosis or other 
chronic diseases, corresponding entirely to hydrothorax and ascites; or it is 
the result of some inflammatory or mechanical irritation, in consequence of 
orchitis, urethritis, or in consequence of external injuries — a bruise, a fall, a 
kick, etc. , as found in otherwise healthy and young persons, even in children, 
and then it corresponds to pleuritic and peritoneal effusions. This latter may 
become chronic, and the secretion of serum continue so that the swelling 
attains the size of a head. The scrotum then appears smooth, tense, glisten- 
ing; the testicle is compressed, becomes atrophied, and may gradually dis- 
appear; then it presents the appearance of a transparent bladder. In con- 
sequence of undue irritation, the testicle may grow larger, become indurated, 
form into cysts; the exuded fluid may coagulate, become turbid by the ad- 
mixture of blood or pus globules; adhesions may form, etc. All these are 
circumstances by which the original nature of the disease may become deeply 
concealed. The exuded fluid consists chiefly of a colorless, clear or yellowish 
fluid, which, however, now and then becomes turbid by admixture of pig- 
ment, blood, fibrine, fat, mucus, epithelium and semen, so that it assumes 
different colors, greenish, dark green, brown and even black. 

The presence of semen is a remarkable phenomenon, the solution of 
which has been found only by the latest researches of Luschka, on the ap- 
pendages of the testicles. According to Luschka, there is, under the head of 
the epididymis, a roundish vesicle of the size of a pea, w T hich stands in im- 
mediate connection with the seminiferous tubuli of the epididymis. It there- 
fore almost always contains seminal fluid. The vesicle or cyst now seems, 
under certain circumstances, to enlarge to such a degree that it forms an en- 
cysted, spermatic hydrocele; or it bursts, and diffuses its seminal fluid into 
the already-existing collection of serous fluid. 

In an ordinary hydrocele, the testicle always lies in the upper and pos- 
terior part of the scrotum, whilst the lower cavity of the scrotum is filled 
with the respective fluid. In exceptional cases, however, a previous inflam- 
mation may have caused adhesion between the testicles and the lower part of 
the scrotum; then, of course, the testicle is fastened down and the collection 
of fluids gathers above it. It is well to bear this in mind. The diagnosis 
rests on these points which have been detailed. In external appearance it 



ORCHITIS. 647 

resembles mostly a scrotal hernia; but is easily distinguished from it, if we 
compare the history of both; the neck of the hernia, which is traceable into 
the abdominal ring; the impulse which is felt in the hernia when coughing; 
the symptoms of strangulated hernia, etc. ; so that hesitation between the 
two is scarcely possible. 

Hydroceles which are dependent upon a general hydremic state of the 
blood must be treated with reference to this whole general state and its 
symptoms. Hydrocele, in consequence of a blow, require Arnica, Coninm, 
Pulsat. 

Those of unknown causes, Apis, Aurum, Calc, card., Digit., Graphit., 
Iodium, Kali hydr., Mercur., Psorin., Pulsat., Rhodod., Rhus tox., Silic, 
Sulphur. 

Orchitis, Inflammation of the Testicles. 

Pathologically speaking, the inflammation may attack the testicle itself, 
or the epididymis, or their lining, the tunica vaginalis. 

It may be caused either by external violence or by an extension of in- 
flammatory processes of related organs, such as the prostata, the neck of the 
bladder, the urethra, or, what is most frequently the case, by gonorrhoea or 
syphilis. There is also an orchitis caused by a metastasis in parotitis or 
mumps. 

The product of inflammation is either : 1, A serous exudation, especially 
in epididymitis and vaginalitis, and it is the same thing with the above- 
described acute serous hydrocele; or, 2, A fibrous, plastic exudation, which 
causes infiltration, swelling and induration of the epididymis; or, 3, A serous 
hemorrhagic exudation in acute specific inflammations; or, 4, A purulent 
exudation, which takes place in the parenchyma of the testicle itself. 

The plastic exudation generally gives rise to chronic enlargements of 
the epididymis, which may reach a considerable size and hardness. 

The purulent exudation may be reabsorbed, or may form abscesses, 
which gradually break through the scrotum. Such abscesses heal only very 
slowly, usually forming fistulous openings. 

A genuine orchitis very much resembles an incarcerated scrotal hernia. 
The pain is very acute, running along the spermatic cord, causing colicky 
pains and vomiting. We have in such cases to ascertain where the swelling 
commenced. In orchitis it grows from below upwards; in hernia it comes 
from above down. 

Sarcocele, Hydrosarcocele is a chronic inflammation of the testicles, 
with infiltration of the parenchymal substance, in consequence of which the 
tubuli seminiferi become obliterated. It is slow in growing, usually without 
pain, and may involve the epididymis or start from it. In appearance it is 
an inelastic, smooth, oval tumor which, upon pressure, does not show an}' 
sensitiveness so natural to the healthy organ. In the later stages of its de- 
velopment it is sometimes accompanied with an effusion within the tunica 
vaginalis, constituting wjiat is called hydrosarcocele. It may be the result of 



648 CARCINOMA TESTIS. 

an incomplete resolution of an acute orchitis, or the consequence of gonor- 
rhoea. The syphilitic form often attacks both testicles, one after the other. 

Therapeutic Hints. 

Inflammation in general: Aeon., Arnica, Aurum, Bellad., China, 
Clemat., Euphras., Mercur., Nuxvom., Pulsat., Rhodod., Rhus fox., Staphis., 
Spongia., Zincum; from bruises: Arnica; Baryta, Pulsat., Zincum; from 
taking cold: Cle?nat.; Pulsat., Rhus tox.; from gonorrhoea; Cannab., Clemat., 
Gelsem., Me) cur., Pulsat., looking bright red: Bellad.: dark red: Euphorb., 
Rhus tox.; chronic hardeaing and swelling: Arsen., Aurum, Baryta, Bellad., 
Calc. carb., Carb. an., Clemat., Conium, Graphit., Iodium, Kali carb., Kali 
hydr., Lycop., Nitr. ac, Plumbum, Spongia, Thuja. 

Carcinoma Testis. 

The most frequent form is the medullary cancer, which generally attacks 
young persons, even children. The fibrous cancer, or scirrhus testi ., is found 
more in old age. 

Cancer usually attacks but one testicle. Its causes are not known. 
Bellad. f Carb. an.? Co?iiumf Phosphor. ? Phytol.f Thuja? 

Varicocele. 

This consists of a varicose enlargement of the veins of the spermatic 
cord, epididymis and testicle, and gives rise to a knotty swelling, which feels 
between the fingers like a convolution of earth-worms. It gets smaller under 
compression or in a horizontal position, and enlarges again on standing up- 
right. It is almost always found on the left side, because the spermatic vein 
of that side has a longer and more tortuous course than that of the right 
side, and is also more liable to compression by accumulation of feces in the 
sigmoid flexure. The affection is therefore similar to the varicose state of 
the hemorrhoidal veins, and may have similar causes. In some cases it pro- 
duces no inconvenience; in others it is very troublesome, producing a draw- 
ing, dragging sensation, extending from the loins into the limb, especially 
w 7 hen walking or standing, and in hot weather; also weakness, prostration, 
paleness and great dejection of spirits. 

Arnica, Bellad., Calc. carb., Collins., Flour ac, Hamam., Eaches., Eycop., 
Nux vom., Pal sat., Sepia, Sulphur. 

Spermatocele 

Is a swelling of the spermatic cord and especially of the epididymis in con- 
sequence of a retention and collection of semen in persons who have been 
addicted to excesses in venere or masturbation, and suddenly stop this bad 
habit without being able to stop also their lascivious thoughts. The testicle 
is drawn up towards the abdominal ring, the epididymis and spermatic cord 
is swollen, and painful to touch, also on standing and walking. The penis 
is usually in a state of semi-erection. All may pass off in the course of sev- 



DISEASES OF THE PROSTATA. 649 

eral hours, when the mind is differently employed, but the swelling may 
become stationary by frequent repetitions, and then it is often accompanied 
with varicocele. 

Pulsat. Is often of use, also cool sitz-baths. 



DISEASES OF THE PROSTATA. 

Prostatitis, Inflammation of the Prostate Gland. 

Primarily it is of rare occurrence, but it is occasionally brought on by 
traumatic causes, as a blow, riding on horseback upon a hard saddle, or by 
sudden suppression of perspiration, excesses in venere, masturbation. 

Secondary forms are much more frequent, and are then an extension of 
inflammatory processes from neighboring organs; for example urethritis, 
stone in the bladder, gout, rheumatism. Its most frequent cause, however, 
is gonorrhea, and the abuse of irritating medicines, like cubebs, balsam co- 
paiva, turpentine, etc. 

Symptoms. — Pain in the region of the neck of the bladder; heat, press- 
ure, throbbing in the perineum and rectum; frequent stitches from the peri- 
neum into the pubic and lumbar regions and down into the limbs. Constant 
desire to urinate, with annoying, sharp pains around the corona glandis; the 
urine, after long straining, flows slowly, drop after drop, a quantity remaining 
still in the bladder, and, therefore, micturition is never attended with a feeling 
of entire relief. Severe cases cause perfect retention of urine. The dis- 
charges from the bowels are likewise painful and difficult, especially hard 
stools, on account of the swollen and inflamed gland being pressed upon by 
the rectum, where it may easily be detected by the introduction of a finger 
per anum. 

In favorable cases prostatitis ends in resolution. Badly managed cases 
suppurate and form abscesses, which perforate, either into the rectum, bladder, 
or urethra, and discharge accordingly. 

Therapeutic Hints. 
Ar?iica. After injuries. 
Arg. nitr. 

Bellad. With severe pain, or 
Atroph. sulph. If Bellad. does not relieve. 
Mercur. For promoting resolution. 
Thuja. 

Bellad., Canthar., Hoysc, Sframom., in case of retention of urine. 
(Kafka.) 

Enlargement and Tumors of the Prostata. 

The gland may, in consequence of infiltration or deposition of tubercles, 
or calcareous substances, become in whole or in part enlarged. A total 
hypertrophy may reach the size of a fist or more, whilst the normal glands is 
not larger than a Spanish chestnut; it may be so uniform that the normal 



650 THERAPEUTIC HINTS TO TUMORS OF THE PROSTATA. 

shape of the gland remains unaltered, or it may become quite considerably 
deformed. Partial hypertrophy alters in size and shape only single lobes of 
the gland. 

As the prostate gland surrounds the urethra, reaching, with its base, 
over the neck of the bladder, and with its anterior extremity to the pars 
membranacea of the urethra, it is obvious that an increase of its size or an 
alteration of its form must likewise modify the mechanical proportions and 
relations of the prostatic portion of the urethra, of the neck of the bladder 
and the ejaculatory ducts. For example, an uniform- enlargement of .the 
gland necessarily pushes the bladder further back and upwards, elongating, 
in this wa3 T , the involved part of the urethra quite considerably, which ex- 
plains the fact, that in old people sometimes the neck of the bladder is only 
with difficulty reached by the catheter. 

The enlargement of the lateral lobe, or an irregular enlargement of both 
lateral lobes, causes irregularities in the direction of the enclosed part of the 
urethra, compressing it more or less here and there, thus forming a kind of 
zig-zag passage. Or the posterior part of the enlarged lobe presses into the 
bladder, and thus shuts the neck of the bladder inside, or gives it an oblique 
turn. 

The enlargement of the middle lobe or isthmus, which is the deformity 
most frequently found in old age, is capable of closing the neck of the 
bladder partially or entirely, and preventing the passage of urine in part or 
entirely. 

Symptoms. — An examination per anum reveals the swollen gland, and, 
on introducing a catheter into the urethra, we find more or less obstruction 
in its prostatic portion. There is difficulty in urinating, which is sometimes 
possible only in a stooping posture with legs spread asunder; dribbling of 
urine, and frequent discharge of prostatic fluid during stool. The form of 
alvine discharges is often flat or irregular, instead of being cylindrical. Old 
age is particularly subject to chronic enlargement of this gland. 

Therapeutic Hints 
According to Iyippe: 

Pulsat. Inflammatery origin, painfulness in the region of the bladder; 
frequent desire to urinate; dull stitch in the region of the neck of the bladder 
after micurition spasmodic pains in the bladder, extending to the pelvis and 
thighs; feces flat, of small size. 

Thuja. Syphilitic origin, especially suppressed, or badly treated gonor- 
rhoea; stitches in the urethra from behind; also from the rectum into the 
bladder. 

Digit. Fruitless effort to urinate, or discharge of only a few drops of 
urine, and continued fullness after micturition; throbbing pain in the region 
of the neck of the bladder during the straining efforts to pass the water; in- 
creased desire to urinate after a few drops have passed, causing the patient to 
walk about in great distress, although motion increases the desire to urinate. 



DISEASES OF THE VESICUL^ SEMINAEES. 65 1 

Frequent desire to evacuate the bowels at the same time; very small, soft 
stools are passed without relief. 

Cyclam. In and near the anus and in the perineum, drawing, pressing 
pain, as from subcutaneous ulceration of a small spot, while walking or 
sitting. 

Selen. While sitting and also while walking, a drop of viscid, trans- 
parent fluid presses out of the urethra, occasioning a peculiarly disagreeable 
sensation; the same sensation is experienced shortly before and after stool. 

Caustic. Pulsations in the perineum; after a few drops have passed, 
pain in the urethra, bladder, and spasms in the rectum and renewed desire. 

Lycop. Pressing in the perineum, near the anus, during and' after mic- 
turition; stitches in the neck of the bladder and anus at the same time. 

Iodium. Hardness of the gland. (Kafka.) 

Copaiva bals. Urine is emitted by drops. 

Apis. Frequent desire and pressing down in the region of the sphincter. 

Discharge of prostatic fluid during a stool: Agnus cast., Alum., Anac, 
Calc. carb., Carb. veg., Conium, Cora/I., Hepar, Ignat., Natr. carb., Sepia, 
Silic, S tap his., Sulphur, Zincum. 

Fullness in the perineum: Alum., Berber., Bry on., Cydam., Nux vom. 

Sensation of heaviness in the perineum: Copaiva, Graphit. 

Pulsation in the perineum: Caustic. 

Continual desire to urinate: Amm. carb.\ndmur., Anac, Apis, Asar., 
Awum, Bellad., Canthar., Colchic, Copaiva, Digit., Guaiac, Ignat., Iodium, 
Mercur., Millef., Mur. ac, Phosphor., Pulsat., Scilla, Sepia, Sulphur, Sulph. 
ac, Thuja. 

Impossibility to urinate: Digit., Sepia. 

The desire to urinate continues after micturition: Bar. carb., Bovista, 
Bry on., Calc. carb., Carb. an., Caustic, Crot. tig I., Digit., Guaiac, Laches., 
Mercur., Natr. carb., Ruta, Sabina, Staphis., Thuja, Viol, trie, Zincum. 

While urinating, burning in the region of the neck of the bladder: Cha- 
mom., Nux vom., Petrol., Sulphur. 

The steam of urine is small: Graphit., Olea?id., Nitr. ac, Sarsap., 
Spongia, Staphis., Sulphur., Tax. bacc, Zincum. 

Difficulty in voiding the urine — must press a long time before the urine 
flows: Alum., Apis, Hepar., A T aphthal., Secale, Tax. bacc. 

Escape of urine involuntarily, drop by drop: Arnica, Bellad., Digit., 
Mur. ac, Petrol , Pulsat., Sepia. 

DISEASES OF THE VESICUL^E SEMINALES. 

The vesiculae are two little, oblong bladders, sometimes divided into two 
or three branches, which lie on the posterior and inferior surface of the blad- 
der, and consist of an external contractile and an internal or mucous mem- 
brane. They are receptacles of semen, whence the latter is ejaculated during 
sexual excitement. In consequence of their location near the bladder and 



652 POLLUTIOXES NOCTURNE ET DIURNiE. 

their functional relation to the sexual organs, it frequently happens, tha 
affections of the bladder, urethra, prostata and testes are communicated to 
these vesicles. They are, like all mucous membranes, prone to inflammation 
and consequent derangements. Their morbid secretions mix with the semen, 
which loses its healthy appearance and nature. A clear diagnosis of such 
affections is seldom possible during life; although bloody, yellow, involuntary 
emissions, attended with acute, cutting and burning pains, may lead us to 
suspect the existence of inflammation in these vesicles. 

Pollutiones Nocturnae et Diurnae; Spermatorrhoea. 

Inasmuch as the seminal secretion of a healthy man may naturally be 
supposed to be a continuous one, it appears as a physiological necessity, that 
there should occur from time to time an overflow of semen involuntarily, 
when not irritated voluntarily by coition or masturbation. As long as such 
discharges happen at night during sleep, with erotic dreams, accompanied 
by erection and voluptuous sensations, and followed by a sense of relief and 
buoyancy, these nocturnal pollutions are certainly within the boundaries of 
health. They do not occur regularly even in the same individual, but vary 
greatly in frequency from temporary causes, or certain constitutional pecu- 
liarities. However, if they occur too often, say several times a week or 
oftener, and are followed next day by a general dullness and weakness, 
diminution and mental activity, etc., instead of buoyancy, they can scarcely 
be looked upon as health} 7 occurrences. This is still more so if they occur 
without erection and sensation in the night during sleep. But if they occur 
even in the daytime — "diurnal pollutions" — while the individual is awake, 
without the usual mechanical causes (coition or masturbation), from any 
trifling or external cause; for instance, from dallying with a female, riding on 
horseback, during evacuation of the bowels or bladder, or from lascivious 
imaginations, then there surely exists an irritation and weakness in the sex- 
ual organs which is pathological; for a healthy man never loses semen in- 
voluntarily when awake. Such diurnal seminal losses have also been termed 
Spermatorrhoea, a rather hyperbolic expression, as a continuous flow of semen 
scarcely ever exists. And it should further be stated, that very often inex- 
perienced young men, frightened by reading miserable and designing trash 
upon this subject, take for spermatorrhoea what is no flow of semen at all, 
but a secretion from the mucous membrane of the urethra, and perhaps also 
from Cowper's glands, or a prostatic secretion; neither of which contains 
any trace of spermatozoa, the only sign of true semen. 

The principal Causes of abnormal seminal losses are masturbation and 
excessive indulgence in venere. In both ways the frequent irritation not only 
produces an excessive irritability of the sexual organs and an undue stimula- 
tion for the secretion of semen, but also an intensive excitement of the nerv- 
ous system, which by degrees grows into permanent overexcitability, so that 
ejaculations at last are not only provoked by peripheral, but also by central 



THERAPEUTIC HINTS TO POLLUTIONES NOCTURNES. 653 

stimuli, such as lascivious thoughts, etc. That actual degeneration of the 
spinal cord can be produced by sexual excess alone, is still to be proven. 

Further causes of abnormal seminal losses are: chronic inflammation of 
the neck of the bladder and the prostatic portion of the urethra, often pro- 
duced by suppressed gonorrhoea, in consequence of which a higher degree of 
irritability of the parts ensues; inflammatory affections of the bladder, but 
especially lithiasis; chronic inflammation of the seminal vesicles, especially 
when connected with gleet; great length and narrowness of the prepuce, which 
prevent thorough cleansing of the parts from smegma and promote undue ir- 
ritation; itching eczema on the scrotum or about the anus; habitual constipa- 
tion and hemorrhoidal tumors. 

The Symptoms which accompany abnormal losses of semen are not 
caused by them, but owe their origin to the same causes which produce 
them. Of these may be mentioned: a hypochondriacal mood, with despair 
of recovery, a dislike for society, and even suicidal thoughts, which are sel- 
dom executed for want of courage; or quarrelsomeness and irritableness; 
loss of energy and courage, depressed state of mind, impairment of memory; 
vertigo, headache; deafness and noises in the ears; indistinct vision; fatigue; 
stiffness in limbs and back; trembling in limbs; numbness along the spinal 
cord, in the lower extremities, or in the fingers; or hyperesthesia; coldness 
in the back or some other part; sometimes alternating with flushes of heat; 
palpitation, and shortness of breath; indigestion, with consequent disturb- 
ances of nutrition, such as paleness, emaciation, sallowness and dryness of 
skin; or pasty and bloated appearance; impotence. 

Now, this gloomy picture should not be taken as applying to all or even 
to single cases precisely; for happily these symptoms are only partially con- 
stant and severe in cases of abnormal pollutions. A hypochondriacal mood 
is perhaps the most common to all of them. 

The termination of spermatorrhoea in insanity or epilepsy is quite 
unproved. On the contrary, a hereditary disposition to insanity or epilepsy 
ma}^ be in many cases the cause of masturbation and the consequent sperma- 
torrhoea. 

The Prognosis depends upon its causes. Of these the local irritations 
are relatively the most favorable, while the psychical causes are deeper and 
more difficult to eradicate. 

Therapeutic Hints. 

First of all, remove the cause. This applies not only to sexual abuse, 
but also to those exciting causes above mentioned, w 7 hich ought to be found 
out by the physician and serve as leading symptoms for the selection of 
the remedy. 

Aur. met. or mur. Settled melancholy with suicidal mania; discharge of 
prostatic fluid from a relaxed penis, during stool or micturition; great sexual 
weakness with great lasciviousness; or strong erections which cease on the 
attempt to copulate; affections of the testicles and spermatic cords. 

Calc. carb. After pollution, headache and backache; cold, clammy 



654 THERAPEUTIC HINTS TO POIXUTIONES NOCTURNE. 

hands and feet; scrofulous subjects; shattered constitutions; sweating from 
any little exertion, especially on head. 

Cinchona. Nocturnal emissions, frequent and debilitating; lascivious 
fancies; after masturbation. 

Digitalis or Digitalin. Great irritability and weakness of the genitals; 
after an emission a sensation in the urethra as if something were running out 
of it; frequent palpitation and trembling of the limbs; in conversation wfth 
strangers he commences to stammer and becomes embarrassed. Prostatic 
troubles. 

Gclsem. Weak, irritable sexual organs; emissions without erections, 
also during stool; genitals cold and relaxed; or profuse warm sweat on scro- 
tum; after suppressed gonorrhoea, orchitis, with dragging pains in the 
testicles. 

Graphit. Nocturnal emissions, with flaccid penis and without voluptuous 
sensation; sense of weakness in the genital organs; herpetic eruption on 
scrotum; after sexual abuse. 

Lycop. Excessive and exhausting pollutions, also without erection; 
afterwards burning in urethra; itching of inner surface of foreskin; soreness 
between the scrotum and thigh; constipation; haemorrhoids. Impotence, 
with cold and shriveled penis; after masturbation. 

Nux vom. After quack-medicine, wine or coffee; sluggish action of. 
abdominal organs; constipation; haemorrhoids; suppressed gonorrhoea; mas- 
turbation. 

Phosph. ac. Debilitating emissions from weakness of the parts, with 
onanism; during stool; hypochondriacal; distressed on account of the culpa- 
bility of his indulgence. Youths who grow fast and tall; herpes preputialis, 
with tingling; urine turbid, with heavy sediment. 

Sarsap. Nocturnal emissions, with lascivious dreams, followed by pain 
from the small of the back down along the spermatic cords, in the morning, 
with general prostration; or, great anguish of mind, inability to apply him- 
self to mental work; smoky mist before the eyes, when reading in the even- 
ing; prostration; soft, flabby muscles. The least excitement causes ejacula- 
tion of the fluid without sexual feeling. (J. B. Hunt.) Offensive odor 
about the genitals; herpes on the prepuce; gonorrhoea checked by cold, wet 
weather, or by mercury, followed by rheumatism. 

Selcn. Nocturnal emissions with lascivious dreams, followed by weak- 
ness and lameness in the loins. (J. F. Greenleaf. ) Semen thin without 
normal^odor; prostatic fluid oozes while sitting, during sleep when walking 
and during stool; itching of the scrotum. 

Silic. Aching in sacrum; sweat of scrotum; heat in head; burning of 
feet with sweat; weakness and heaviness of arms; melancholy; all worse in 
forenoon and before an emission, and relieved after an emission. (\V. P. 
Wesselhceft.) 

Thuja. Painful spermatic cord; suppressed gonorrhoea; renewed gonor- 
rhoea after coition; prostatic affections; impotence; heaviness and ill-humor 
after emissions. 



IMPOTENCE. 655 

Zinc ox. With hypochondriasis, full of fears of the consequences; 
nervous system shaken; restless, sleepless and generally miserable. 

Besides compare: ( 

Arnica. When coition has been practiced in a standing position, lame 
weakness in lower extremities. 

Bellad. With gleet. 

Cap sic. Impotence; atrophy and coldness of the genitals. 

Card. vcg\ Heartburn, acidity and flatulence. 

Caustic. Memory deficient; continual loss of prostatic fluid. 

Cuprum. Great nervousness of young men; prematurely old; cramps 
in the calves of the legs and feet on trying to have a connection with a 
woman. 

Dioscorea. 

Kali brom. Want of sexual instinct. 

Kobalt. Lewd dreams; only partial or no erections. 

Mercur. After emission burning pain in the back and icy-cold hands. 

Natr. mur. Poor digestion and spinal irritation. 

Nuphar. Lascivious thoughts without sexual capacity. 

Phosphor. Nervous prostration; oppression and pain in chest; para- 
lytic or spasmodic symptoms in extremities. 

Picric acid. 

Sepia. Ejaculation too soon; semen watery; catarrhal affections; 
bloated and earthy -colored face. 

Sulphur. Erection complete, but discharge of semen before he succeeds 
in inserting the penis. 

Bloody emissions: Mercur., Cannab., Ledum., Sarsap. 

Impotence; Sterility in the Male. 

Impotence, a diminuition or complete loss of the power of sexual inter- 
course, is always associated with either incomplete, or two short, or entirely 
absent erections. It may be Caused by: certain congenital or acquired mal- 
formations and defects of the genital organs, such as: absence of the penis, or 
considerable diminution in its length, tumors of the penis, indurations and 
knots in the corpora cavernosa, loss of the testicles either by castration al- 
though cases are on record which show that the sexual act could be accom- 
plished after castration, (this quasi- virile power, however, diminished more 
or less speedily and finally disappears entirely), or such disease as is equiva- 
lent to their loss. It may be a symptom of certain acute or chronic diseases, 
such as tabes dorsales, spinal meningitis, diabetes; or the consequence of 
certain medicines, if taken in too large doses and indiscriminately, among 
which are best known: Camphor, Bromide of Potassium, Lupuline and Ar- 
senic. It may be produced by certain mental conditions, such as: bash- 
fulness, fear of failure, nervousness, or the absence of certain modes and 
ways to which they have become habituated with prostitutes and which they 
cannot indulge in with their wives. 



656 THERAPEUTIC HINTS TO IMPOTENCE. 

A very prominent cause is sexual excess and masturbation, by which a 
functional weakness of the genital organs and of the nervous apparatus con- 
, nected with them is brought about, in consequence of which only short erec- 
tions, too short even for the introduction of the penis, so-called irritable weak- 
ness, or no erections at all, are possible under any circumstance, the so-called 
paralytic form of impotence. 

A man impotent is also sterile, that is unable to procreate, even if his 
semen should be of a natural quality, because he cannot locate it where alone 
it could fructify. But sterility has other causes; which are: 

1. Aspermatism, which means not only a variety of conditions in which 
no semen is formed (as certain malformation or injuries of the genital 
organs, absence or malposition of the testes), but also those conditions in 
which the formed semen is not ejaculated, because its passage is barred by 
changes in the substance of the prostate, or in the ejaculatory ducts embed- 
ded in it, or in the urethra, from whence it is diverted into the bladder. The 
causes of this retention of semen are strictures of different places in the 
seminal passages produced by inflammatory processes mostly in consequence 
ot gonorrhoea, or wounds, or they are congenital. 

2. Azoospermism, in which copulation with ejaculation may be possi- 
ble, but in which either no seminal bodies are produced, on account of an ab- 
normal state of the testicles, or in which they are retained on account of 
strictures in the passages which conduct the semen, in consequence of bilat- 
eral inflammatory processes of the epididymis and vasa deferentia, a condition 
similar to aspermatism, only that in the latter the stricture is lower down in 
the genital passages. 

Therapeutic Hints. 

Compare the preceding chapter, especially in regard to those transient 
forms: Agar., Agn. cast., Baryta, Ca/ad., Lycop., Natr. mur., Nitr. ac, 
Phospor., Selen. 

Among the new remedies: Eupat. pur., Gelsem., Hamam., Helon., Phy- 
tol., Stilli?ig. 



FEMALE GENITAE ORGANS. 657 



FEMALE GENITAL ORGANS. 



Examination of the Parts. 

By means of palpation and percussion of the abdomen we may be able 
to detect the presence, shape and consistency of abdominal tumors, and aus- 
cultation will serve to distinguish between pregnancy and other large tu- 
mors; however, the so-called uterine souffle, which originates in the large 
arteries, is heard, but very seldom, in large fibroids, and also, but rarely, 
in ovarian tumors. 

The digital examination per vaginam consists of the introduction of the 
well-oiled forefinger through the ostium into the vagina, by which we ascer- 
tain the condition of the walls of the vagina, whether they are dry, moist, 
sensitive, encumbered by protrusions of the rectum or bladder, or by mor- 
bid growths, etc. ; the state of the anterior and posterior cul-de-sac; the po- 
sition and condition of the cervix and os uteri and of the lower part of the 
womb. In cases of vaginal occlusion or hyperesthesia, but especially in 
all kinds of retro-uterine tumors, a digital exploration per rectum is a most 
valuable aid for diagnosis. 

The bimanual examination consists in an exploration by means of the 
one hand through the abdominal walls, while the forefinger of the other 
hand within the vagina rests on the neck of the womb. In this way the en- 
tire organ may be brought between the exploring fingers of both hands, so 
that its shape, consistency and mobility, etc., or the existence of any tumor 
within the true pelvis, can easily be ascertained. This conjoined method of 
examination, as it is likewise termed, is best performed in the dorsal position 
on an unyielding couch. Care should be taken that the outside hand is only 
slowly pressed into the abdominal wall above the symphysis pubis, which is 
best done by taking advantage of each expiration; and by inserting the 
hand not too close to the symphysis, in order to avoid the pushing back- 
ward of the uterus. 

Examination by means of the uterine sound (of which those most in use 
are the steel, Simpson's and Skene's sounds) consists in the introduction of a 
curved metallic instrument into the cavity of the womb, guided by the fore- 
finger which has been inserted into the vagina. This exploration gives a 
measurement of the length of the uterine cavity, discloses the course taken 
by it and the sensitiveness of its walls, and tells whether the uterus is empty 
or not. This sort of examination should never be resorted to so long as 
there exists the slightest doubt as to the possibility of pregnancy. 
42 



658 OVARIES. 

Ocular examination requires vaginal specula in order to bring the 
os and cervix uteri into view. There are bivalvular, trivalvular and tubular 
specula, of which those most in use are Cosco's or Wocher's bivalve, Nel- 
son's trivalve and Ferguson's or Mayer's tubular speculum, all of course of 
different sizes. For retracting the posterior wall of the vagina we have 
Sim's duckbill, also his folding speculum and Dowson-Sim's improved spec- 
ulum, instruments which the specialist may need for certain operations. 

There are undoubtedly cases where an examination by either of these 
means is absolutely necessary. But it is certainly beyond the lines of 
even medical decency to subject every woman who shows any signs of uterine 
disturbances at once to digital or ocular examination, especially if that 
woman be a virgin. It is a curse of vanity to show one's ability to handle 
or mishandle an instrument at the expense of an innocent or inexperienced 
person, and it is the highest degree of ignorance to look or feel for something 
which by better information we would not expect to find there, or which we 
should know to find without fingering. It is therefore not to be wondered 
at that many thoughtful medical gentlemen have condemned the use of these 
physical examinations almost in toto. Almost — for the helping hand and 
the seeing eye will even here be needed in certain cases as anywhere 
else. 

OVARIES. 
Oophoritis, Ovaritis. 

This affection has its seat either in the parenchyma (the Graafian fol- 
licles), or in the connective tissue, or in the peritoneal covering, of the 
ovary. 

If in the glandular part (parenchyma) the mature Graafian follicles 
have a milk} 7 turbidity, and the cells of the membrana granulosa are in a 
state of cloud} 7 swelling and subsequently break down into fine granules; the 
layer of the stroma surrounding the follicle is likewise inflamed. This form 
of inflammation occurs frequently in acute febrile diseases in which we also 
meet with parenchymatous inflammation of other abdominal glands; it may 
cause destruction of all the follicles and so result in sterility. 

If in the connective tissue there is hyperemia, swelling and infiltration 
of this tivssue which may terminate in the formation of abscesses, generally, 
however, results in cicatricial shrinking with consequent sterility. It is most 
frequently found in the puerperal period, or as an extension of a peritonitis, 
and in consequence of suppression of the menses. 

If in the peritoneal covering (Perioophoritis), it leads to pseudomem- 
branous deposits upon the ovary and to adhesions with neighboring organs. 
Its Causes are : taking cold ; getting w T et during menstruation ; sexual 
intercourse during the menstrual period ; onanism ; or, secondarily, in- 
flammatory processes of neighboring organs — the peritoneum, or the uterus; 



THERAPEUTIC HINTS TO OVARIES. 659 

gonorrhoea. It is therefore most frequently found in serving girls, who are 
exposed to all kinds of rough influences (scrubbing of pavements, washing, 
etc.), in prostitutes and other lewd women. Women who have once had an 
attack are liable to a repetition during their menstrual periods. After the 
cessation of menstruation, the disposition to it ceases likewise. 

Its Symptoms are not at all well marked, when the connective tissue 
alone is the seat of the disease. We meet with symptoms of partial peritoni- 
tis, however, if the serous covering becomes inflamed; violent, sharp, colicky 
pains, vomiting, fever, etc. ; and so also may the bursting of a Graafian fol- 
licle be attended with inflammatory symptoms. As the ovaries lie deep in 
the lesser pelvis, covered completely by the small intestines, pressure down- 
wards from above the symphysis pubis will reach the sore spot only when 
the abdominal walls are greatly relaxed. Bimanual examination or an ex- 
ploration per annum may become necessary in chronic cases. We may, how- 
ever, diagnosticate an acute attack pretty safely when the above-mentioned 
symptoms have set in during menstruation, after an exposure to cold or wet, 
followed by a sudden cessation of the menstrual flow. Where the inflamma- 
tion spreads over adjoining organs, we find it accompanied by painful urging 
to urinate and to evacuate the bowels; by utero- vaginal blenorrhceas, or a 
numbness in the lower extremity of the affected side. 

An acute attack rarely lasts longer than eight days, generally subsiding 
within twelve to twenty-four hours. In unfavorable cases it becomes chronic, 
and may terminate in the formation of serous cysts, induration of the ovary, 
or in suppuration. 

Therapeutic Hints. 

Aeon. Headache, backache, colic, fever, great restlessness and tossing 
about ; after exposure to cold winds or a sudden fright during the monthly 
period, by which the flow ceases ; painful urging to urinate and to evacuate 
the bowels. 

Ant. cmd. When menstruation has been checked by taking a bath. ; 
nausea and vomiting, white tongue ; great thirst at night ; alternate costive- 
ness and diarrhoea. 

Apis. Right side; swelling, with stinging pains, from sexual intercourse 
during the monthly period ; numbness in the right side of the abdomen, 
extending into the thigh, or upwards to the ribs ; scanty urine, retarded 
stool ; cough, with soreness in the upper portion of the left chest. 

Arsen. Drawing, stitching pain from the region of the ovary into the 
thigh; which feels numb and lame, worse from motion, bending or sitting 
bent ; burning pain in the back while lying quietly upon it ; the menses con- 
sist of a thin, whitish, badly-smelling discharge; pale, yellowish face; ema- 
ciation; febrile action; thirst, with drinking little at a time; restlessness. 

Bellad. Hard swelling of the ovary, with stitching, throbbing pains; 
constant bearing down, as if everything would issue out; fever, with perspir- 
tion; glistening eyes; red face and delirium; after child-birth. 



660 THERAPEUTIC HINTS TO OVERIES. 

Bryon. Stitching pain, worse from the slightest motion and contact; sup- 
pression of the menses, with[bleeding from the nose; inclined to constipation 

Canthar. Stitches, arresting the breathing; or violent pinching pains, 
with bearing down towards the genitals; or great burning pain in the ovarian 
region; constant urging and straining to urinate, with painful discharge of 
but a few drops of urine, which sometimes is blood}-; after suppressed gonor- 
rhoea. 

Coloc. Cramp-like pain in the left ovarian region, as though the part 
were squeezed in a vise; colicky pain all over the abdomen, which causes the 
patient to bend double; pain in the left foot; worse before menstruation, 
w T hich is more profuse. 

Conium. Chronic cases; induration; lancinating pains; pain in the 
mammae before the menses, which are feeble; smarting, excoriating leucor- 
rhcea; giddiness when turning in bed; intermitting flow of urine. 

Hamam. After a blow, the ovary swollen, with a diffuse agonizing 
soreness over the whole abdomen; menses irregular, very painful, with ex- 
acerbation of all the sufferings at the catamenial epoch; retention of urine. 

Hepar. When suppuration takes place, indicated by frequent chills. 

Ignat. Disappointed love; constant running of thoughts in that direc- 
tion; sighing, despondency; leucorrhcea, which passes off with labor-like 
pains. 

lodium. When indurated. 

Laches. Left ovary; tensive, pressing pains and stitches; inability 
to lie on the right side, on account of sensation as if something were rolling 
over to that side; menses scanty, with labor-like pressure from the loins 
downward; swelling of the ovary; suppuration. 

Mercur. Stitching, pressing pains in the lower region of the abdomen, 
left side; upper portion of the abdomen distended; stool with great tenes- 
mus; constant urging to urinate, with scanty emission of a thick, brown-red 
urine, causing burning in the urethra; perspiration without relief; great 
weakness and emaciation; nightly aggravation and restlessness; menses 
suppressed. 

Nux vom. After previous use of different allopathic drugs. 

Platina. Excessive sexual desire, from an incessant tickling within the 
genitals; painful pressing toward the genital organs, as if the menses would 
make their appearance; profuse or suppressed menses, with palpitation of 
the heart, headache, restlessness and weeping; haughtiness. 

Pulsat. After getting the feet wet; suppression of the menses, with 
nausea, coldness of the body, chilliness and trembling of the feet; pressure 
on bladder and rectum; thirstlessness, weeping, meek disposition. 

Rhus tox. After getting wet, straining or lifting. 

Zincum. Boring pain, relieved by pressure and during the menstrual 
flow. 

Compare A urum, China, Clcmat., Hedeoma, lodium, Phosph. ac, Phy- 
tol., Podoph., Sabina, Sepia, Staphis., Thuja. 



HYDROPS OVARII. 66 I 



Hydrops Ovarii, Ovarian Dropsy; Formation of Cysts in the 

Ovaries. 

Most of these cysts originate, according to some authors, out of a de- 
generation of the Graafian follicles, which become distended, in rare cases, 
even to the size of a child's head; containing a clear, yellowish, serous, or 
thick, limpid fluid. There may be one or several of such cysts. 

The multiloeuiar tumors consist of a formation of multiple- cysts, growing 
out of the parenchyma of the ovaries. They sometimes attain an enormous 
size and contain either a serous or jelly-like fluid, which is dark if mixed 
with blood. 

The alveolar degeneration of the ovary destroys all the original structure 
of that organ; its whole substance becomes transformed into larger and 
smaller cavities, which are separated by a fine tissue. Some of these cavities 
attain the size of a fist, while others remain quite small. At first the organ 
retains its roundish shape; later, by the extension of some of these cavities, 
it becomes uneven. The contents of these cavities is mostly a yellowish, 
tough, honey-like substance, though the larger ones sometimes contain a 
thinner fluid. This degeneration is often complicated with cancer of the 
ovaries. 

There are yet cysts to be mentioned, which, instead of a fluid, contain 
hair, teeth and bones; their interior walls present a structure which is quite 
similar to that of the cutis, having an epidermis with sudorific and sebaceous 
glands, and sometimes a hairy growth. Such cysts are called dermoid cysts; 
they sometimes attain the size of a walnut, or even a fist. They are, per- 
haps, products of ovarian conception. 

There are also fibrous, cartilaginous and osseous tumors of the ovary 
which, like the purely cystic, may be the consequence of subacute inflamma- 
tor}^ action in these organs. 

The Symptoms of ovarian cysts, in the first stage, may be identical with 
those of an oophoritis; but usually all such signs are wanting, and the cysts, 
as long as they remain small, give no inconvenience whatever. When at- 
taining a certain size, however, they exercise a pressure upon the bladder and 
the rectum, causing difficulties in micturition and defecation. When pressing 
upon the nerves, which run down on the posterior wall of the lesser pelvis, 
they cause pain in the small of the back, or pain and numbness in the lower 
extremities; and when pressing upon the veins in the pelvis, they cause cede- 
matous or varicose swellings on the lower extremities. At the same time 
we observe, in some cases, a swelling of the mammae and a darkening of the 
rings around the nipples, with sympathetic vomiting and general malaise, thus 
simulating very closely the commencement of pregnancy. When the cysts 
grow further, they rise out of the pelvic cavity, and most generally the patient 
feels relieved of those symptoms which are caused by their pressure upon the 
pelvic organs; in some cases, however, all these symptoms continue, as the 



662 THERAPEUTIC HINTS TO HYDROPS OVARII. 

cysts or portions of them within the pelvic cavity still continue to exercise 
the same compression upon the pelvic organs. 

Increasing still more, they gradually fill the abdominal cavity, press 
against the diaphragm and compress the abdominal organs; the natural con- 
sequences of which are: vomiting, shortness of breath, palpitation of the 
heart, bronchial catarrh, disturbed secretion of urine, deficient nutrition, 
and consequently anaemia and hydraemia, which ends in general marasmus. 

Their growth is not a steady one; they are frequently observed to increase 
and decrease in size periodically; the first taking place generally before and 
the latter after menstruation. As frequently intervening symptoms may be 
mentioned those of peritonitis, which are the more severe the more rapidly 
the cysts grow. If a cyst bursts, either by its own excessive distention or by 
external violence, its contents issue into the abdominal cavity and cause a 
general peritonitis; or it may in consequence of previously formed adhesions 
and inflammatory processes, find its way into another of the abdominal or- 
gans, and be thence discharged. 

Physical Signs. — As long as the tumor remains in the true pelvis, it 
may be diagnosed by an examination per vaginam or rectum, where it is felt 
as a well-defined swelling, which dislocates the uterus in one or another di- 
rection, according to its position. The less the tumor takes part in the mo- 
tions of the uterus the more sure is its diagnosis. 

When the tumor rises out of the true pelvis there appears a painless, 
well-defined swelling over the horizontal ramus of the pelvic bones; later it 
inclines more towards the middle line of the abdomen, and yields, more or 
less, a sense of fluctuation; the distended abdomen appears arched and 
changes its form scarcely any during different positions of the body. 

Percussion gives a complete flat sound, where the tumor touches the 
parietal walls, being dullest wdiere the swelling is most prominent; thus it 
differs from ascites, which gives a full sound, where the distended abdominal 
w r alls appear highest; for underneath that place lie, in ascites, inflated in- 
testines; and furthermore, the fluctuation of a cystic tumor never extends 
further than that portion of the abdomen which yields a flat percussion 
sound, because the fluid is confined in a sac, while in ascites the fluctuation 
is felt also where there is no flat percussion sound, because the fluid is driven 
further on within the peritoneal cavity by the concussion of the palpating 
hand. 

Therapeutic Hints. 

Compare Oophoritis and Peritonitis. 

Apis. Sudden stitches, like bee-stings, in the tumor, or sharp, cutting 
pains, with scanty urine and constipation; bearing down, and pain in the 
small of the back, as if the menses would come on; numbness of the cor- 
responding lower extremity; thirstlessness; pale skin; oedema; right side. 

Arsen. Burning pain; restlessness; anxiety; oppression; sinking of 
strength; great thirst, but little drinking at a time; dropsical swelling all 
over; pain in the corresponding leg; cannot keep the foot still. 



UTERUS. 663 

Calc. card. Distention and hardness of the abdomen; pressure in the 
rectum, and bearing down in the womb; profuse and too early menses. 

Canthar. Burning pain; great sensitiveness of the abdominal walls; 
constant, painful urging to urinate and defecate; tenesmus in the bladder 
and rectum; wretched, sickly appearance. 

China. After great loss of fluids; general anasarca; meteorism. 

Coloc. A firm, elastic tumor occupies the space between the uterus and 
the vagina anteriorly and the rectum posteriorly, completely occluding the 
vagina and rendering defecation very difficult. Paroxysms of acute pain 
across the hypogastrium, in the sacral region and around the hip- joint when 
attempting to walk; the pain extends down the groin and along the femo- 
ral nerve; it is relieved by flexing the thigh upon the pelvis, and always 
induced or aggravated by extending the thigh; but there are frequent and 
severe paroxysms without any provocation. (C. Dunham.) 

G rap hit. 

I odium. Pressing, bearing down towards the genitals; constipation; 
acrid leucorrhcea, corroding the linen; dwindling and falling away of the 
mammae; strumous constitution. 

Lil. tigr. Bearing down in the uterine region, worse walking, better 
holding up the abdomen with the hands; tenderness of the swollen left ovary; 
stinging, burning pains from ovary up into the abdomen and down the thigh; 
shooting pains from left ovary across the pubes; urine causes a smarting sen- 
sation; prolapsed and sensitive uterus. (E. A. Farrington.) 

Lycop. Painful boring stitches in the left ovarian region; pressure on 
the rectum and bladder; pain in the sacral region, especially when rising 
from a seat; red, sandy sediment in the urine; ascites; varicose veins on 
the legs. 

Plumbum. The patient wants to stretch the upper and lower limbs 
during ovarian pains. (Young.) 

Podoph. Tumor on right side ; pain and numbness extending down the 
corresponding thigh. (Hawley.) Pains extend upward to the shoulder. 
(Seward. ) 

Stramon. Tumor attended with some lancinating pains and hysterical 
convulsions. During the convulsions the patient shrinks back with fear on 
seeing any one. (Miller.) 

In cases where proper homoeopathic treatment fails to show any influence 
in staying the growth of such tumors, or in improving the general health of 
the patient, operative surgery (tapping with subsequent iodine injections, 
electrolysis, ovariotomy) is indicated. 

UTERUS. 
Endometritis, Catarrh of the Uterus, Leucorrhcea. 

Always at the time of the catamenial period the mucous membrane of 
the uterus is found in a hyperaemic state, its overfilled blood-vessels burst 



664 UTERUS. 

and occasion what is called the menstrual flow ; this normal hyperemia 
might be called the physiological catarrh of the uterus. It becomes patho- 
logical when it occurs at a time when no ripe ovula are cast off. A predis- 
position to uterine catarrh lies, therefore, between the time when menstrua- 
tion begins and until it ceases. 

Exciting Causes are, all such disorders which cause a stagnation in the 
proper circulation of the blood, as heart and lung diseases ; chronic constipa- 
tion, etc. ; direct irritations, such as sexual excesses, masturbation, pessaries, 
etc. ; or a general weakness of the system and general morbid conditions, such 
as typhus, cholera, small-pox and other infectious diseases; chlorosis ; scrofu- 
losis ; tuberculosis, etc. 

Its Pathological features are like those of any other catarrh ; hyper- 
emia, swelling, decreased at first, and afterwards increased secretion of mucus. 
When becoming chronic, the mucous membrane thickens and hypertrophies, 
and is sometimes studded with polypous excrescences ; its color turns brown- 
ish or slate-colored ; the secretion attains a more or less purulent character ; 
the follicles of the portio vaginalis swell on account of the closure of their 
excretory ducts, while secretion inside is still going on ; ithey form little 
round bodies of the size of a hemp-seed or larger, and are known under the 
name of ovula Nabothi. Furthermore, w T e find, if the process lasts long 
enough, diffuse catarrhal erosions, mostly on the posterior lip of the mouth of 
the womb ; or follicular ulcers, which originate in the bursting and suppura- 
tion of the above-named ovula Nabothi ; and also granulating ulcers, which 
differ from the rest by their exuberant granulations, which bleed easily. 

Symptoms. — An acute attack is characterized by drawing pain in the 
small of the back and in the inguinal region, a feeling of fullness and heavi- 
ness in the pelvis, dysuria and tenesmus. External pressure upon the lower 
part of the abdomen is painful. There is more or less fever. After three or 
four days the patient observes a discharge from the genitals, which at first is 
transparent and sticky, staining the linen grayish ; by and by it becomes 
opaque and more or less purulent. In the further course of eight or ten 
days the fever gradually subsides, and after that the discharge diminishes 
until it finally ceases. 

In chronic cases, the commencement is not easily ascertained. The pa- 
tients have had, long before the} r attach much importance to it, a discharge 
from the womb, which varies considerably in different cases. Still it is of 
the same nature as that above-mentioned, staining the linen grayish, and 
making it stiff ; sometimes, even, clots of a gelatinous mass issue forth. That 
is characteristic of a uterine catarrh. A purulent discharge is just as liable 
to have its source in the vagina ; and if the discharge be corrosive, the pre- 
sumption is that it originates there. In some cases, the os uteri closes, owing 
to the sticky discharge and the swollen state of the neck of the uterus ; and, 
in consequence, a collection of large masses of mucus within the uterus takes 
place, which are finally expelled by labor-like contractions of the uterus — 
uterine colic. The longer the catarrh exists, the more it changes the mucous 



UTERUS. 665 

lining of this organ, and the greater, of course, must be its effect upon the 
monthly period. In some cases, the now is very profuse, and in others, very 
scanty ; almost always it is attended with more or less pain. Conception is 
not necessarily prevented, if the catarrh does not extend to the tubes or 
causes them to be closed ; but it has been observed that women suffering with 
chronic uterine catarrh are very prone to miscarry. A chronic uterine ca- 
tarrh may be endured for a long time ; but it finally betrays itself by pale- 
ness and an earthy color of the face, weakness and relaxation of the muscles, 
anaemia and hydrsemia. The most frequent expressions of chronic uterine 
catarrh are hyperesthesia, neuralgic and spasmodic complaints; all of which 
we find united under the popular expression of hysteria. The progress of 
the disease is always slow ; and among its complications we find a chronic 
parenchymatous metritis, inflections of the uterus, and closure of the cervical 
canal of this organ, which results in hydrometra. 

In regard to the diagnosis of the various leucorrhceal discharges, the 
following may be said : 

Watery discharges appear during the greater part of pregnancy, without 
being injurious to the fcetus ; also in connection with hydatid moles, where, 
after a certain time, moderate discharges repeat themselves off and on, ac- 
companied by bearing-down pains; in connection with cauliflower excrescences, 
where the serous discharges are often quite copious and of a brown color; in 
connection with uterine polypi, where the watery discharges alternate with 
blood} 7 ones, and profuse menstruation; in connection with adhesion of an 
ovarian cyst to the Fallopian tube, where the fluid of the cyst enters the tube 
and discharges slowly through the vagina. 

Mucous or purulent discharges are more or less opaque, gluey or gelati- 
nous, creamy or quite fluid. They all arise from the mucous membrane either 
of the neck of the womb, or of the uterine cavity, or of the vagina, or of the 
three combined. The discharge from the cervix is gluey, creamy and more 
profuse; from the womb it looks soapy or like glassy pieces of coagulated 
mucus; from the vagina it is coagulated, has an acrid reaction and contains 
tesselated epithelium. 

Continuous purulent discharges originate in the vaginal mucous mem- 
brane, in the cervical glands of the uterus, on the surface of a cancerous or 
other ulcer; in suppurating membranes remaining after an abortion, in re- 
tained placenta or membranes. Gonorrheal discharges are also continuous 
and often difficult to diagnose from leucorrhcea, if the history is wanting. 

Interrupted purulent discharges take their origin in the uterine cavity, 
in suppurating polypi, in abscesses seated in the neighborhood of the vagina. 

Sanious discharges consist of a reddish, bloody fluid, arising from tumors 
inside of the uterine cavity, from organic diseases of the uterus, such as 
fungoid degeneration of the uterine mucous membrane, malignant ulceration 
of the os, from pelvic hematocele, when a communication exists between cyst 
and vagina. 

Foul-smelling discharges occur where the leucorrhcea is profuse and 



666 THERAPEUTIC HINTS TO UTERUS. 

purulent, accompanied by hectic fever and general loss of strength, and 
where the secretion is retained for some time in the vagina by a contraction 
of the ostium vaginae. In uterine cancer the discharge is always fetid. 
In giving the 

Therapeutic Hints, 

I shall unite both uterine as well as vaginal catarrh. Both are known under 
the popular name, leucorrhcea or whites, as the most prominent and some- 
times the only symptom of the two. 

sEsc. hipp. Pain in the small of the back and hip, with a lame feel- 
ing; the pain extends from the abdomen to the small of the back, which 
makes it almost impossible to get up and to walk after sitting; constipation 
and piles. 

Alet.far. In cases of debility from protracted illness, loss of fluids, 
defective nutrition, etc.; great disposition to abortion. 

Alum. Profuse, purulent, yellow, corroding discharge, worse before 
and after the menses; during the day only; vertigo, constipation. 

Ambra. Discharge only at night; thick mucus with stitches in the 
vagina before the discharge; pieces of bluish-white mucus. 

Amm. carb. Watery, burning discharge from the uterus; profuse, 
acrid or milky leucorrhcea; menses every fortnight, black, coagulated, pro- 
fuse ; weight in stomach; urine reddish ; flow often interrupted ; flushes. 

Amm. mur. Leucorrhcea with distention of the abdomen, without ac- 
cumulation of wind; discharge like the white of an egg, after previous 
pinching around the navel; brown, slimy, painless leucorrhcea, after every 
discharge of urine; stools hard, crumbling, 

Aralia rac. Offensive discharge, with pressing-down pains in the 
uterus. 

Arsen. Discharge, dropping out while standing, and passing flatus; 
burning, corroding; weak persons; old women; nervous restlessness. 

Aur met. and mur. Chronic metritis with malposition; induration; 
excoriation, with great sensitiveness of vagina; utter despair. 

Bapt. tinct. Acrid, fetid discharges; ulceration of the os uteri and 
vagina; debilitated state of the system. 

Bellad. Acute catarrh; bearing down as if all the contents of the 
abdomen would issue through the genitals, which is followed by a discharge 
of white mucus; colicky pains coining and going suddenly. 

Berber. Burning and smarting after micutrition, with a constant sore- 
ness along the urethra. (F. Baker.) 

Borax. Midway between the menses; albuminous discharge; cannot 
bear downward motion. 

Bovista. After the catamenia; while walking, thick, slimy, tenacious 
mucus, like the white of an egg; also yellow, green, acrid, corrosive; during 
the night only. 

Calc. cai-b. Milk-like discharge during micturition, or flowing pro- 



THERAPEUTIC HINTS TO UTERUS. 667 

fusely only in spells; or purulent discharge with soreness and swelling of the 
vulva; too early and too profuse menstruation; paleness of the face; weak 
feeling in the chest, especially when talking; weakness in the knees; emacia- 
tion; constant cold, damp feet.. 

Card. veg. Discharge only in the morning, when rising; soreness and 
rawness in the pudendum; cold knees in bed; flatulence. 

Cauloph. Profuse secretion of mucus in the vagina; yellowish spot on 
the forehead, commonly called "moth;" bearing down with tardy or absent 
menses; drawing pains in the lower extremities. 

Caustic. Weakening leucorrhcea, with too scanty or too profuse menses; 
discharge, particularly at night; yellow face; disinclination to coitus, 

China. Leucorrhcea instead of the menses; painful pressing towards the 
groins and anus; bloody discharge, occasionally clots of black blood; or 
fetid, purulent matter, with itching and spasmodic contraction of the inner 
parts; great weakness from loss of blood. 

Coccul. Flesh-colored, watery discharge, instead of the menses, mixed 
with a purulent and ichorous liquid; on bending or squatting down, the fluid 
gushes out; distention of the abdomen and pain, as of a heavy stone; on 
sitting down, bending, treading or any other motion, a pain, as of internal 
ulceration; great debility. 

Collins. Leucorrhcea in connection with pruritus, obstinate constipation, 
and dysmenorrhcea. 

Conium. White discharge, burning, smarting, excoriating; suppression 
of the menses; itching at the vulva; contractive, labor-like colic, from both 
sides of the abdomen; weaknes and lameness in the small of the back and 
subsequent lassitude; old maids; hysteric paroxysms, swelling and indura- 
tion of glands. 

Ferrum. In chlorotic patients, thin, watery discharge, at first smarting 
and corroding; palpitation of the heart; earthy, yellowish face; painfullness 
of the vagina during an embrace; swellings and indurations in the vagina. 

Gelsem. White discharge; feeling of fullness in the hypogastrium; 
aching across the sacrum. 

Graphit. Perfectly white discharge, very profuse, especially in the 
morning on rising from bed, also in gushes by day or night; scanty menses; 
irritable skin; weakness in the back and small of the back when walking 
or sitting. 

Ha?nam. Especially in those profuse discharges which simulate a haem- 
orrhage and constitute a drain on the system as severe as a bleeding; sore- 
ness of the abdomen. 

Helon. Has been recommended in cases of general atony, anaemia and 
torpid condition of the system. 

Hydrast. Tenacious discharge; erosions and superficial ulceration of 
the cervix uteri and vagina; great sinking and prostration at the epigas- 
trium, with violent and continued palpitation of the heart. 

Ignat. Violent, crampy pressing in the region of the womb, resembling 



668 THERAPEUTIC HINTS TO UTERUS. 

labor-like pains, followed by a purulent, corrosive discharge; mild disposi- 
tions who bear sufferings, even outrages, without complaining. 

Iodium. Old leucorrhcea, most abundant at the time of the menses, 
rendering the thighs sore and corroding the linen; dwindling and falling 
away of the mammae; goitre; induration of cervix and womb. 

Kreasot. Leucorrhcea before and after the menses, especially when 
standing and walking, not when lying or sitting the yellow discharge is 
acrid and corroding, offensive, causing redness and itching in the vulva; 
menses too early, too profuse and too long. 

Laches. Leucorrhcea before the menses, copious, smarting, slim} 7 , stif- 
fening and staining the linen greenish; the menses appear at the regular 
time, but are too short and too feeble; the abdomen is hot and tender to 
touch; feels bad after sleeping. 

Lil. tigr. Abundant, thin, excoriating discharge, staining the linen 
brown, worse p. m. ; bearing down relieved in lying down or sitting, or press- 
ing with the hand against the parts; frequent micturition with smarting or 
burning in urethra afterwards; depression of spirits; pain, distress and flut- 
tering of heart; menses flow as long as she keeps moving; sometimes come 
on too early and are scanty; feels all the time in a hurry without accom- 
plishing anything. 

Lycop. Profuse, greenish, thick discharge, not constantly, but in 
spells, which are always preceded by a sharp cutting pain in the hypogas- 
trium; pale face, with frequent flushes of circumscribed redness of the 
cheeks; discharge of gas from the vagina; the least quantity of food fills 
her up to the throat; jerking of the lower extremities. 

Magn. mur. Early in the morning after urinating and after stool; 
constipation. 

Mercur. Inflammation of the genitals; discharge of variable nature, 
always worse at night; gonorrhoea; syphilis. 

Murex purp. Watery, greenish, or thick bloody discharge; profuse 
and too earl) 7 menses; increased sexual desire. 

Natr. mur. Leucorrhceal discharge after contractive colic, pressing 
downwards, early in the morning, at night, when walking; itching and sore- 
ness of the genitals; cutting pain in the urethra after micturition; yellow- 
ness of the face; and especially after local application of nitrate of silver. 

Nitr. ac. Mucus — which can be drawn out — flesh-colored, greenish, 
cherry-brown, fetid; after mercurial treatment; worse after menses. 

Nux vom. Fetid discharge, tinging the linen yellow; after all sorts of 
allopathic nostrums. 

Pallad. Pain in the right ovary; urgency to urinate, with scanfy emis- 
sion, and sensation of weight and bearing down in pelvis, relieved by lying 
down; prolapsus uteri; forgets every pain in society, but is worse next day; 
attaches great weight to other people's opinion; likes to be flattered. 

Phosphor. In consequence of chlorosis; watery slime, especially during 
or instead of the menses; acrid, smarting, corrosive, drawing blisters. 



DIGEST TO LEUCORRHCEA. 



669 



Platina. During daytime; genitals excessively sensitive; can't bear 
to be touched; will go into spasms from an examination; will almost faint 
during intercourse; or excessive sexual desire; haughty disposition, or low- 
spirited. 

Podoph. Discharge of thick, transparent mucus, attended with con- 
stipation and bearing down in the genitals; .prolapsus uteri and ani. 

Puhat. Burning discharge, thin and acrid; milky, thick and white, 
without pain ; when lying, or before and during the menses, which are 
scanty ; inclination to looseness of the bowels ; chilliness ; thirstlessness ; 
peevishness ; sadness ; mild and tearful. 

Sepia. In the climacteric period ; during pregnancy ; during puberty, 
when there is a sense of pressure and bearing down in the pelvis, stinging 
pain in the ovarian region, frequent urging to urinate, and itching in the 
genital organs ; painful coitus, little sexual desire ; the discharge is of a 
varied nature, thick, creamy or yellowish, bland or excoriating, offensive, 
worse during the day and after coitus. 

Silic. Acrid, excoriating discharge ; or milky, in paroxysms, with cut- 
ting in the umbilical region ; frequently, also, discharge during mictur- 
tion. 

Sulphur. Discharges of all sorts, mild or excoriating; in most chronic 
cases, just as in all other chronic catarrhal affections ; burning of the soles 
of the feet, and heat in the crown of the head ; too much animal heat ; feel- 
ing of faintness, with strong craving for nourishment, about eleven o'clock 
every forenoon ; vulva sore, burning and smarting. 



Digest to IyEucoRRHceA. 



DISCHARGE. 

Abundant, copious, profuse: Alum., 

Amm. carb., Cauloph., Graphit., Lil. 

tigr., Lycop., Laches. 
, simulating haemorrhage with drain 

on system: Hamam. 
Thin: Ferrum, Lil. tigr., Palsat. 
Watery: Amm. Carb., Coccul., Ferrum, 

Murex, Phosphor. 
Thick: Ambra, Bovista, Lycop., Murex, 

Podoph., Pulsat., Sepia. 
Milky: Amm. carb., Pulsat. 

, during micturition: Calc. carb. 

Creamy: Sepia. 

Slimy: Amm. mur., Bovista, Laches., 

Fhosphor. 
Mucus: Ambra, Bellad., Cauloph. 

, tenacious: Bovista, Hydrast. 

, can be drawn out: Nitr. ac. 

, transparent: Podoph. 

White of an egg, like: Amm. mur., 

Borax, Bovista. 



Purulent: Alum., Calc. carb., China, 

Coccul., Lgnat. 
Fetid, offensive: Aral, rac, Baptis., 

China, Kreos., Nitr. ac, Nux vom., 

Sepia. 



Bloody: China, Murex. 
Brown: Amm. mur. 

, staining linen: Lil. tigr. 

Cherry-brown: Nitr. ac. 
Bluish- white: Ambra. 
Flesh-colored: Coccul., Nitr. ac. 
Green, greenish: Bovista, Lycop., 

Murex, Nitr. ac. 
, stiffening and staining linen: 

Laches. 
White: Bellad., Conium, Gelsem., 

Graphit. 
Yellow: Alum., Bovista, Kreos., Sepia. 
, tinging linen: Nux voin. 



Acrid: Amm. carb., Baptis., Bovista, 
Kreos., Phosphor., Pulsat., Silic. 



670 



DIGEST TO EEUCORRHCEA. 



Burning": Amm. card., Arsen., Con- 
ium, Pulsat. 

Corrosive: Alum., Arsen., Bovista, Fer- 
rum, lgnat., Kreos., Phosphor. 

, causing redness: Kreos. 

, rendering thighs sore, and corrod- 
ing linen: Iodium. 

, drawing blisters: Phosphor. 

Excoriating: Conium., Lil. tigr., 
Sepia, Si lie., Sulphur. 

Smarting: Conium., Ferrum., Laches , 
Phosphor. 

Bland, mild: Sepia, Sulphur. 

ACCOMPANYING SYMPTOMS: 

Forgets every pain in society, but is 

worse next day; attaches great weight 

to other people's opinions; likes to be 

nattered: Pallad. 
Feels all the time in a hurry without 

accomplishing anything: Lil. tigr. 
Nervous restlessness: Arsen. 
Sadness: Pulsat. 
Depression of spirits: Lil. tigr., Pla- 

tina. 
Hysteric paroxysms: Conitim. 
Utter despair: Aurum. 
Mild and tearful: Pulsat. 
dispositions who bear sufferings, 

even outrages, without complaining: 

Lgnat. 
Peevishness: Pulsat. 
Haughty disposition: Platina. 



Vertigo: Alum. 

Heat in crown of head: Sulphur. 



Face pale: Calc. card. 

with frequent flushes of circum- 
scribed redness of the cheeks: Lycop. 

yellow: Caustic, Natr. mur. 

, earthy, yellowish: Ferrum. 

Yellowish spots, "moths," on forehead: 
Cauloph. 



Thirstlessness: Pulsat. 

Faint, hungry feeling in stomach about 
11 a. M. : Sulphur. 

Sinking feeling at stomach with palpi- 
tation of heart: Hydras t. 

Least quantity of food fills her up to the 
throat: Lycop. 



Pain from abdomen to small of back, 
cannot get up to walk: ^sc. hipp. 

, colicky, coming and going sud- 
denly: Bellad. 

, labor-like colic from both sides of 

abdomen: Conium. 

, pinching around navel, before dis- 
charge: Amm. mur. 

, and distention, as of a heavy stone: 

Co ecu I. 

, pressing towards groins and anus: 

China. 

Distention of abdomen without accumu- 
lation of wind: Amm. mur. 

Flatulence: Card. veg. 

Soreness of abdomen: Hamam. 

Hot and tender to touch: Laches. 

Constipation: Alum., Collins, Magn. 
mur. 

, and piles: ^Esc. hipp. 

Stools hard, crumbling: Amm. mur. 

Looseness, inclined to: Pulsat. 



Urgency to urinate with scanty emis- 
sion: Pallad. 

Frequent urging to urinate, with sting- 
ing in ovarian region: Sepia. 

micturition with smarting and burn- 
ing afterwards: Lil. tigr. 

After micturition, burning and smarting: 
Berber. 

, cutting in urethra: Natr. mur. 

Constant soreness along urethra: Berber. 

Urine reddish: Amm. carb. 



Fullness in hypogastrium: Gelsem. 



Bearing, pressing down: Aral, rac, 
Bellad., Cauloph., Podoph., Sepia. 

, better by lying down: Lil. tigr., 

Bellad. 

, better by sitting or pressing with 

the hand against the parts: Lit. tigr. 

Like labor-pains before discharge: 
China, Lgnat., Natr. mur. 

Cutting pain before discharge: Lycop. 

in umbilical region: Silic. 

Pain in right ovary: Pallad. 

Chronic metritis with malposition; in- 
duration: Aur. met. and mur. 

Disposition to abortion: Alet.far. 

Wind from vagina: Lycop. 

Prolapsus uteri: Pallad. 

and ani: Podoph. 

Soreness and rawness in pudenda: Carb. 
veg. 



DIGEST TO EEUCORRHCEA. 



671 



Ulceration of os and vagina: Baptis., 
Hydrast. 

Excoriation with sensitiveness of va- 
gina: Aur. met. and mur. 

Induration of cervix: /odium, Aur. 
met. and mur, 

in vagina: Ferrum. 

Swelling and soreness of vulva: Calc. 
card. 

Inflammation of genitals: Merc. sol. 

Acute catarrh of genitals: Bellad. 

Gonorrhoea; syphilis: Mercur. 

Sense of internal ulceration, on sitting 
down, reading, bending or any other 
motion: Coccul. 

Soreness in genitals: Calc. card., Card, 
veg., Natr. mur., Sulphur. 

Itching: China, Collins., Conium, 
Kreos., Natr. mur., Sepia. 

Stitches in vagina before discharge: 
Ambra. 

Burning and smarting: Sulphur. 

Sensitive, excessively; cannot be 
touched: Platina. 

Painfulness during an embrace: Fer- 
rum, Platina, Sepia. 

No desire to coitus: Caustic, Sepia. 

Excessive sexual desire: Platina. 

Increased sexual desire: Murex. 

Menses, suppressed: Conium. 

, tardy or absent: Cauloph. 

, too scanty: Caustic, G7'aphit., 

Laches., Li I. tigr. 
, too early: Amm. card., Calc. carb., 

Kreos., Lil. tigr., Murex. 
, too profuse: Amm. carb., Calc. 

carb., Caustic, Kreos. 

, and too long: Kreos. 

, black, coagulated: Amm. carb. 

, flow interrupted : Amm. carb. 

, as long as she keeps moving: 

Lil. tigr. 
Dysmenorrhea: Collins. 



Weak feeling in chest when talking: 

Calc. carb. 
Palpitation of heart: Ferrum. 
Pain, distress and fluttering of heart: 

Lil. tigr. 
Weakness in back and small of back, 

when sitting or walking: Graphit. 
and lameness in small of back: 

Conium. 



Aching across sacrum: sEsc hipp., Gel- 

sem. 
Jerking of lower extremities: Lycop. 
Drawing pain of lower extremities: 

Cauloph. 
Weakness in knees: Calc. carb. 
Cold knees in bed: Carb. veg. 

damp feet: Calc carb. 

Burning of soles of feet: Sulphur. 

Chilliness: Pulsat. 

Too much animal heat: Sulphur. 

Skin irritable: Graphit. 

Glands swollen and indurated: Co?iium. 

Goitre: L odium. 

Dwindling and falling away of mammae: 

L odium. 
Debility: Alet. far., Arsen., Baptis. 

Coccul. 

from loss of blood: China. 

Atony, anaemia: Helon. 
Chlorosis: Ferrum, Phosphor. 
Emaciation: Culc. carb. 



Cannot bear downward motion: Borax. 
Feels bad after sleep: Laches. 

WORSE: 

Before menses: Alum., Kreos., Laches., 
Pulsat. 

During menses: Lodium, Phosphor., Pul- 
sat. 

Instead of menses: China, Coccul., Phos- 
phor. 

After menses: Alum., Bovista., Kreos., 
Nitr. ac 

Midway between menses: Borax. 

In the morning: Magn. mur., Natr. 
mur. 

, when rising: Carb. veg., 

During the day: Graphit., 
Sepia. 

only: Alum. 

In afternoon: Lil. tigr. 

In night: Caustic, Graphit., 

Natr. mur. 

only: Ambra, Bovista. 

In spells: Calc. carb., Lycop. 
By gushes: Graphit. 
When lying: Kreos. , Pulsat. 

bending or squatting: Coccul. 

walking: Bovista, Kreos., Natr. 

mur. 
urinating: Silic 



Graphit. 
Platina. 



Mercur 



Silic 



672 PARENCHYMATOUS METRITIS. 



After urinating: Amm. mur., Magn. 
mur. 

stool: Magn. mur. 

While passing flatus: Arsen. 

Not while lying" or sitting: Kreos. 



climacteric period: Sepia. 

Old maids: Conium. 
Old women: Arsen. 



Chroni3 cases with other catarrhal affec- 
tions: Sulphur. 
During" puberty with bearing down: After Nitrate of silver: Natr. mur. 

Sepia. mercurial treatment: Nitr. ac. 

pregnancy: Sepia. all kinds of nostrums: Nux vom. 

Parenchymatous Metritis. 

In its acute form it is of rare occurrence, and consists of an inflammatory 
process of the entire substance of the womb, including often both the mucous 
lining inside and the peritoneal covering outside. The uterine substance is 
tumefied, infiltrated with serum and hyperaemic. 

Its most frequent causes are irritating applications, injections of too hot 
or too cold water into the vagina, or intra-uterine injections, pessaries, the 
introduction of the sound, etc. ; also, " catching cold," especially during the 
menses, etc. 

Commencing with a chill which is followed by fever-heat, it is character- 
ized by a deep-seated pain in the region of the uterus and an acute pain in 
the peritoneal covering, greatly increased by pressure, or movements, such 
as turning, walking, standing, coughing or straining at stool. Manual ex- 
aminations are scarcely endurable. If it commences during the menstrual 
period, it causes suppression of the flow, or at times flooding. It is often 
associated with ischuria, diarrhoea and tenesmus, nausea and in rare cases 
with vomiting. Uncomplicated cases may pass over in the course of several 
days ; a termination in an abscess is of rare occurrence. 

The chronic form of parenchymatous metrititis is also known under the 
name of infarction of the womb, and consists of a hyperplasia of the connective 
tissue of the uterus, out of its muscular tissue ; it is accompanied by a vari- 
able degree of sensitiveness. The womb is always enlarged ; its substance 
succulent and reddish, tumefied and hypersemic ; the os is generally broad, 
and the lips are swollen and elongated, often ulcerated. 

Its Causes are of a widely different nature. Only rarely it develops 
out of the acute form, and then only when the organ, by some cause or the 
other, has been prevented from undergoing a complete restitution into its 
normal state. By far the most frequent origin lies in a defective retrograde 
evolution of the puerperal uterus in consequence of too early leaving the bed 
and assuming household duties; or in consequence of retained secundines, or 
too early sexual intercourse, etc. This applies also to miscarriage and crimi- 
nal abortion; (sub-involution). 

Another variety of causes must be looked for in all these irritations 
which produce active hypersemia of the uterus, such as excesses in venere, 
fraudulent cohabitation and mastubation; also cauterization of the os by 
nitrate of silver or other means; and in all those conditions which produce a 



THERAPEUTIC HINTS TO PARENCHYMATOUS METRITIS. 673 

venous stasis in the organ, such as retroflexion and prolapsus, adjacent tu- 
mors, retention of urine in the bladder, etc. 

Its Symptoms are not in all cases very characteristically developed; but 
as a rule we meet with frequent repetitions of acute and subacute exacerba- 
tions of at least some of the following symptoms: pain in the sacral region, 
in the abdomen, a sense of weight and bearing down in the pelvis, leucor- 
rhcea, menorrhagia, constipation and frequent urging to urinate; pain during 
stool, or coitus. During the menstrual period all the symptoms are aggra- 
vated. Gradually digestion and appetite begin to fail, and a whole train of 
hysterical symptoms develop, such as various kinds of pain in the lumbar 
region and lower extremities, vaginodynia, coccygodynia, paralysis of differ- 
ent organs, etc. 

It may bring on sterility, but not necessarily; is often complicated with 
endometritis, ovaritis, perimetritis and displacements, and terminates after 
the age of fifty at times in cicatricial induration of the womb. By means 
of the conjoined examination the uterus is found to be enlarged and its sensi- 
tiveness increased, especially during the periods of aggravation. The sound 
reveals an elongation of the uterine cavity. 

The disease is very tedious, but not dangerous to life. If the uterus 
cannot be entirely restored to its normal state, the sufferings at least can be 
greatly relieved by Homoeopathic treatment. 

Therapeutic Hints. 

Compare Uterine Catarrh, Peritonitis and Displacements. 

Aeon. High fever; dry skin; intense thirst; great restlessness; fear of 
death, and predicting the hour of death. 

Arnica. When induced by external violence. 

Arsen Burning pain; indescribable anguish and restlessness; sudden 
sinking of strength; burning thirst, drinks often, but little at a time; cold 
drinks make her worse; burning in the veins; aggravation about midnight, 

Bellad. Violent pains by spells; clutching pains, as if fingers with 
nails were clawing the intestines together; meteorism, with eructations; great 
sensitiveness and heat in the abdomen; painful bearing down in the pelvis 
towards the genitals and the rectum, with constant, ineffectual desire for 
stool; suppression of the lochial or menstrual discharge, or else vitiated, 
fetid discharge. Congestion of the head, with delirium, redness of face, and 
throbbing of the carotid arteries; drowsy dozing with startings, or drowsiness, 
with inability to go to sleep. 

Bryon. Wants to lie perfectly still; the slightest motion causes pun; 
in the head splitting pain; in the bowels, limbs and body stitch-like pain; 
great dryness in the mouth, without thirst, or else great thirst, drinking 
tumbler after tumbler; perspiration in short spells, and only on single parts 
of the body; constipation. 

Calc. carb. Fat persons, and those whose menses are too profuse and 

43 



674 THERAPEUTIC HINTS TO PARENCHYMATOUS METRITIS. 

return too soon; they sweat easily about the head, and are troubled con- 
stantly with cold and damp feet. Chronic infarction of the womb. 

Canthar. Constant painful urging and tenesmus of the bladder; like- 
wise, in worst cases, when the patient lies unconscious with her arms stretched 
out along the side of her body, interrupted by sudden starting up, screaming, 
throwing about the arms and even convulsions; all signs of erosions and ul- 
ceration of internal organs. 

Cauloph. Insomnia; paraplegia; atony and relaxed condition of the 
uterus; hysterical spasms; irregular menstruation; excessive uterine haemor- 
rhage. (M. M. Eaton.) 

Chamom. Great agitation of the nervous system; she seems beside 
herself, with red face and heat all over; she is ill-humored, and can scarcely 
restrain herself to treat people with civility; sometimes one cheek red and 
the other pale; after fits of passion. 

Coloc. Colicky pains in the bowels, with deadly color of the face and 
bending double; worse after eating or drinking; partial heat and partial 
coolness of the skin, with quick pulse, vomiting and diarrhoea; bitter taste 
in the mouth; after indignation. 

Conium. Swelling of the breasts; stitches in the breast, mostly at night; 
induration of the cervix, with sharp pains in the part; acrid leucorrhcea; 
prolapsus uteri. (M. M. Eaton.) 

Crocus. Black stringy discharge; rolling and bounding in the abdomen, 
as from a foetus; stitching in the abdomen arresting respiration. 

Gelsem. Hystery; hyperesthesia of a part of the body; tendency to 
hemiplegia; confusion of mind; sleeplessness; spasms; fever, without thirst, 
intermitting; nervous exhaustion. (M. M. Eaton.) 

Hyosc. Typhoid state; either complete apathy, or else great excit- 
ability, spasms, jerkings, delirium, wild staring, throwing off bedclothes, 
leaving herself naked; bright red clots after child-birth. 

Kreos. Putrid state of the womb after child-birth; confounding ideas; 
loss of memory; thinks herself well; discharge of dark, offensive blood from 
the womb. 

Laches. Constantly lifting the bedclothes from the abdomen, on ac- 
count of uneasy feeling caused hy it; the pain in the uterus is relieved by a 
flow of blood for the time being, but returns soon afterwards; in bad cases, 
unconsciousness, livid face, repeated shaking chills; skin alternately burning 
hot and cold; abdomen distended; lochial discharge thin, ichorous; stool and 
urine suppressed. 

Mercur. Inflammation of the genital organs and ulcers; moist, soft 
tongue, showing the imprints of the teeth, accompanied occasionally with 
great thirst; profuse sweat without relief; all worse at night. 

Nux vom. After taking cold, or using various kinds of drugs; in 
chronic cases, with bearing down into the vagina and towards the os sacrum; 
constant urging to urinate; constipation. 

Phosphor. Fair, graceful women; after frequent pregnancies; pyaemic 
state and inflammation of the veins. 



HYDROMETRA, H^MOMETRA. 675 

Pulsat. After getting the feet wet; frequent chilliness; thirstlessness; 
deficiency of milk; suppression of the lochial discharge; mild, tearful dis- 
position. 

Rhus tox. Constant restless moving; can't lie still; dry tongue, with 
red tip; red rash on the breast; powerlessness of the lower limbs; the lochial 
discharge turns bloody again; typhoid symptoms. 

Sabina. In metritis hemorrhagica. 

Secale. Putrescence of the uterus; abdomen distended, not very pain- 
ful; discharge from the vagina, brownish, offensive; ulcers on the external 
genitals discolored and rapidly spreading; burning hot fever, interrupted by 
shaking chills; small, sometimes intermittent pulse; great anguish; pain in 
the pit of the stomach, vomiting decomposed matter; offensive diarrhoea; 
suppressed secretion of urine; the skin is covered with petechial and miliary 
eruptions, or shows discolored, inflamed places, with a tendency to mortifica- 
tion; the patient lies either in quiet delirium, or grows wild with great anx- 
iety and a constant desire to get out of bed. 

Sepia. Painful stiffness in the uterine region; bearing down; sense of 
weight in anus; sense of goneness in abdomen; yellowish spots in the face. 

Sulphur. Frequent weak, faint spells, especially before noon; bearing 
down, especially on standing; leucorrhoea; soreness of genitals. 

Ver. alb. If commencing with violent fits of vomiting and diarrhoea; 
hot body; cold extremities and deadly pale face, covered with cold perspira- 
tion; delirium and great anxiety; suppressed lochial discharge; nympho- 
mania. 

Ver. vir. Congestion of pelvic organs, tenderness of uterus; fever; 
heat; restlessness; palpitation of heart; local or general hyperesthesia. (M. 
M. Eaton.) 

For the chronic form, Baton recommends: Ars.jod., Merc, jod., Phytol., 
Ferrum, Merc, cor r. , Kali hydr., Nux vom., Ars. alb., Secale , Ignat., Iris 
vers., Hyosc, Ver. vir. 

Hydrometra, Hsemometra, Partial or Total Closure of the Womb. 

In consequence of the above considered inflammatory processes, it hap- 
pens now and then that exuberant granulations of the mucous lining or 
cicatrization of ulcers form adhesions within the neck of the uterus and thus 
cause a partial or total closure of its mouth. The same result may be pro- 
duced by pseudo-formations within the womb, or certain flexions of the cervix 
uteri. In such cases it is obvious that any secretion within this organ either 
cannot escape at all, or only with great difficulty, and under certain favorable 
circumstances. The secretion collects and distends the uterus sometimes to 
a very considerable size. This distention causes the mucus lining to grow 
thin, and its glandular structure, which naturally secretes mucus, to disap- 
pear; it now approaches the nature of a serous membrane, and secretes a 
serous fluid instead of mucus. Thus originates Hydrometra or dropsy of 
the womb. 



676 DISPLACEMENTS OF THE WOMB. 

Hsemometra it is called, when blood, instead of serum, collects in the 
womb, in consequence of a partial or total closure of its mouth. This takes 
place in women who still menstruate; or the occlusion is a congenital imper- 
foration of the organ. In the first instance it is always attended with con- 
tractions of the womb, labor-like pains, or uterine colic at the period of men- 
struation, which may succeed in cases of a partial closure, to press the col- 
lected fluid out in gushes; in the latter case the menstrual discharge does 
not take place at all. The existing trouble may be suspected when repeated 
menstrual periods pass without any flow, although the patient feels all the 
symptoms of it: periodical colicky contractions; bearing-down sensation; and 
all the rest of the symptoms of amenorrhcea and dysmenorrhcea. The ab- 
domen commences to enlarge above the os pubis. Only by a physical ex- 
amination can we discover the occult complaint. 

Therapeutic Hints. 

It is clear that, if homoeopathic treatment of those inflammatory pro- 
cesses could not prevent adhesions and closure, medicines will not be likely 
to unclose them. Such cases require surgical treatment. 

Displacements of the Womb. 

The womb is by no means fixed immovably within the pelvic cavity; 
its fundus has almost entire freedom of motion antero-posteriorly ; the round 
ligaments having their insertion in soft parts, allow very considerable ex- 
cursions backwards. The cervix is more firmly connected, but only to the 
unstable bladder in front and to the rectum behind. The vagina too gives 
no firm support, 'but follows the movements of the cervix. Only considerable 
lateral motion is prevented by the lateral ligaments. It is, therefore, not 
very strange that displacements of this organ should frequently occur. Even 
within the boundaries of physiological correctness its position is greatly in- 
fluenced by the varying contents of the bladder and rectum. A full bladder 
presses it back, an empty bladder allows it to fall forward, and so also has 
the full or empty rectum, though in less degree, a certain influence upon its 
position. 

Anteversion and Anteflexion. 

In anteversion the entire organ inclines forward, has, so to say, fallen 
upon the bladder which it compresses, while neck and mouth point straight 
backward. There is but slight bending between neck and bod}', or none 
at all. This form is always complicated with metritis, and when it exists in 
an\ T considerable degree, it is accompanied by pain in the abdomen, haem- 
orrhages, leucorrhoea, urinary difficulties, neurose of the rectum and 
hysteria. It is easily detected by digital per-vaginam and conjoined ex- 
amination. 

In anteflexion the body and cervix form an angle, the body having 



RETROVERSION AND RETROELKXION. 677 

fallen down and forward upon the bladder, while the cervix retains its posi- 
tion in the vagina, or is slightly pointing backwards. This form is usually 
attended with dysmenorrhea, in consequence of the obstruction to the 
menstrual flow at the point of flexion. The pain begins before the ap- 
pearance of the menstrual discharge, which has to be driven out by strong 
contractions of the womb, causing violent colicky pains, ending usually 
with a copious flow. There is usually difficulty of conception, the semen 
being prevented from entering the womb at the point of flexion; also fre- 
quent desire to pass water on account of the pressure of the womb upon the 
bladder. It may be complicated with metritis, perimetritis and endometritis. 
Here too digital and conjoined examination will reveal the nature of the 
disorder. 

Retroversion and Retroflexion. 

In retroversion the uterus dips backward towards the rectum and its 
neck and mouth point forward toward the symphysis, and in its most exag- 
gerated form the uterus may be completely turned over, the os looking 
directly upward. Slight degrees of this form may be free of symptoms; in- 
veterate cases may be complicated with chronic inflammation. 

In retroflexion the body and cervix form an angle, the body having 
fallen backward toward the rectum, while the cervix retains its position in 
the vagina or is slightly pointing forward towards the symphysis. This form 
is more apt to be attended by haemorrhages than by dysmenorrhea, and oc- 
curs as a general thing most frequently in women who have borne children ; 
it is further characterized by a pain in the lower part of the spine; by para- 
lytic or neuralgic symptoms of the lower extremities or elsewhere, in con- 
sequence either of direct pressure upon the motor nerves, or in consequence 
of reflex action ; by great irritation of the nervous system, showing itself as 
emotional, moral, or intellectual disturbances ; by urinary troubles, and dis- 
turbances in the function of the rectum. 

The Diagnosis of retroversion and retroflexion can usually be made 
out by digital examination per vaginam et rectum and by the conjoined 
method; only rarely it will be necessary to introduce the sound, which by no 
means is so free of danger as seems to be supposed by many. 

Prolapsus and Procidentia. 

In prolapsus the uterus slips downward into the vagina, approaching 
gradually with its os the mouth of the vagina. The uterus standing in its 
normal position about four inches above the vaginal entrance, its descent is 
one of degrees before it reaches the mouth of the vagina, and as it is fas- 
tened to adjoining parts, it drags along in its course downward the bladder, 
the ovaries, the Fallopian tubes, the small intestines, the walls of the vagina, 
and in some instances the rectum and portion of the colon. 

I am entirely of the same opinion as is expressed by Dr. Guernsey in 
his work on obstetrics, that " the peritoneum is the true uterine supporter," 



678 INVERSION OF THE WOMB. 

and ' ' that the uterus can sink in the pelvis only so far as it is permitted by 
the relaxation of the peritoneum, its grand suspensory ligament." Recent 
authors come nearer and nearer to this same view. So says Schroeder> "the 
predisposing cause will almost invariably be found to consist in a relaxation of 
all the pelvic viscera," and M. M. Eaton : " the uterus is sustained mainly 
by the folds of the peritoneum constituting the broad ligaments, the cellular 
tissue surrounding it and the vagina, and by atmospheric pressure coming in 
through the vagina." 

The predisposing relaxation of the peritoneum being present, usually in 
consequence of some general weakness of the system or a sudden fright, any 
pressure from above, such as tight lacing, straining or heavy lifting, long- 
continued standing, the puerperal condition, etc., or insufficient support from 
below, such as lacerations of the perineum, will no doubt facilitate the de- 
scent of the womb. 

Symptoms. — In those rare cases where from a violent cause a sudden 
descent takes place, we have severe abdominal pain, fainting and profound 
nervous shock. The gradual descent causes: bearing and dragging down 
pain in the pelvis with pain in the small of the back, which is worse on 
standing, walking, lifting or doing any kind of bodily work, and better on 
lying down and resting; frequent desire to urinate and often inability to do 
it on account of the bladder being dislocated also; difficulties in defecation, 
and a number of nervous symptoms known under the name of hysteria. 
Digital examination reveals the organ more or less far down in the vagina, 
resting in some cases upon the perineum. 

In procidentia, which is a complete prolapse, the uterus escapes through 
the vagina and lies either in part or wholly outside of the external genitals 
between the thighs. The vagina having become inverted, covers the pro- 
truded organ, and drags down in its cavity the bladder and rectum, in con- 
sequence of which a retention of urine in the drawn down portion of the 
bladder (diverticulum) and difficult defecation are necessarily produced. 

The Diagnosis of this trouble can hardly fail to be correct, if an ex- 
amination by inspection and palpation is properly conducted. 

Inversion of the Womb. 

By this we understand a turning inside out of the uterus. It can only 
take place when the organ is greatly enlarged, for instance, during parturi- 
tion, when the foetus is suddenly expelled, or afterwards upon undue pulling 
at the cord to deliver the placenta, or in cases of tumors, polypi, etc., at its 
fundus, which have softened the fundus and by their weight draw it down 
within the uterine cavity, dragging, by degrees, the uterine walls after, until 
at last a complete eversion is established. This process is often accelerated 
by uterine contractions to expel the foreign bod}'. In the normal, unimpreg- 
nated uterus inversion never takes place. 

The degrees of inversion are as varied as those of prolapse, from a mere 



THEEAPEUTIC HINTS ON DISPLACEMENT OF THE WOMB. 679 

depression of the fundus into the uterine cavity, to a complete turning inside 
out and protrusion of the entire organ outside of the vulva. 

Its Symptoms are usually grave haemorrhages, shock and urinary diffi- 
culties, but in some cases it is borne without any remarkable disturbance of 
the system. 

Therapeutic Hints. 

Many cases of these various kinds of displacements require, like hernia 
and other dislocations, taxis to reinstate the organ into its natural position; 
others yield easily to well chosen remedies. If taxis is necessary, it ougt to be 
executed with the utmost care and gentleness, and, if possible, by the hand 
alone. It is not necessary, nor even likely, in many cases, that we should 
succeed in one effort at restoration ; it took time for displacement; allow time 
also for replacement. With several gentle efforts, persistently followed up at 
reasonable periods, much more may be gained, than by one grand attack with 
ether and chloroform, and all kinds of instruments. He is the greatest artist 
who accomplishes most b}^ the simplest means. In anteversion or anteflexion, 
place the patient on her back, and elevate the pelvis; steady with one or two 
fingers of the left hand, introduced into the vagina, the cervix, and with the 
right hand try to get under the fundus above the pubis through the re- 
laxed abdominal walls, and force it gently upward and backward. In ret- 
roversion or retroflexion, place the patient on her left side or in the knee- 
chest position, raise the uterus gently by the introduced fingers of the right 
hand, and exercise at the same time upon the neck, which points towards 
the pubis, a steady pressure in a backward direction. The other hand may 
help either per rectum or through the abdominal walls in forcing the fundus 
forward. In prolapsus and procidentia, place the patient on her side or back, 
with the pelvis elevated, and push the organ gently upwards and in the 
direction of the natural curve of the pelvis, lest it might result in an arti- 
ficial retroflexion by being forced against the sacrum. In inversion, the 
fundus of the womb must be pressed back again through the os, and the entire 
organ replaced — a work sometimes very difficult to accomplish, especially in 
chronic cases, when it properly belongs in the domain of surgery. 

Some chronic cases of displacement are irreducible in consequence of 
adhesions with neighboring organs. In all cases of displacement, one of the 
first requirements for success is the removal of all pressure upon the womb 
from above, as is exercised by corsets, tight lacing, etc. ; supports from below 
by pessaries and supporters of all kinds have seldom proved themselves of 
great use, and often decidedly injurious; rest, in a suitable position, with hips 
elevated, and continued for some time after replacement, is often all that is 
needed. 

To secure the staying in place of the womb, we must so select a remedy 
that it fits the peculiarities of the individual case; it will certainly restore 
the necessary tonicity of the peritoneum. 



68o special hints to displacements of the womb. 

Special Hints. 

Drs. Guernsey and Eggert have made valuable contributions here. Com- 
pare them, if the following do not suffice. 

Aeon. After a sudden fright; also when inflammatory symptoms pre- 
vail. Agonizing pain during the menses, with tossing about. Fear of death. 

Agar. muse. Prolapsus after cessation of menses; bearing-down pain, 
almost intolerable. 

A mm. mur. Pain as from sprain in the groin, obliging one to walk 
rrooked; menses appear too soon, with pain in the belly and small of the 
back; they flow more abundantly in the night; discharge of quantity of 
blood with the stool during the catamenia. 

Arctium lappa. Especially in old cases of prolapsus and procidentia. 
(S. A. Jones.) 

Alstonia constricta. i. Great debility, with loss of appetite from weak 
digestion. Tongue generally coated a dirty white, aggravated on toward 
the base, although it may be clean. Debility, dependent on a lack of diges- 
tive power of stomach or assimilative power of system. Not in debility of 
nervous type, or in consequence of la grippe. 

2. Menses, aggravated mornings before breakfast, or at irregular times 
especially when depending on reflex irritation from pelvic organs. 

3. An empty, gone feeling in stomach, or else in the whole abdomen, 
coming at irregular times, with bearing and dragging down sensation in the 
hypochondrium. Dr. W. G. Dietz, Hazleton, Pa. — Hahnemannian Monthly 
Note, 1890, p. 765. 

Argent. Pain in the small of the back, which extends towards the front 
and downwards; pain in the lett ovary and loins. 

Arg. ?iitr. Prolapsus, with ulceration of os or cervix uteri; painful 
coition, with bleeding from vagina. 

Arnica. After a bruise or concussion, which leaves a bruised and sore 
feeling in the lower part of the abdomen, so that she cannot walk erect. 

Aurum. After lifting a heavy load, a sense of weight in the pelvis, with 
ischuria and constipation, worse at each menstrual period; great dejection 
of spirits; longing for death, increasing to a desire for self-destruction; or 
vehement, the least contradiction excites her wrath. 

Bellad. Pressing early in the morning, as if all the contents of the 
abdomen would issue through the genital organs; drawing pain in the small 
of the back downwards; flow of blood between the periods; great dryness of 
the vagina; frequent, unsuccessful desire to urinate or to evacuate the 
bowels; only a few drops of urine are discharged from the bladder, and 
some mucus from the rectum; the uterus comes down when straining at 
stool; or while urinating, and rises again on walking about; back aches as 
if it would break; dizziness; roaring in the ears; congestion to the head. 

Calc. carb. Pressing on the uterus; aching of the vagina; stinging in 
the os uteri; the menses appear too soon, and are too profuse; milk-like 



THERAPEUTIC HINTS TO DISPLACEMENTS OE WOMB. 68 1 

leucorrhoea; inclination to perspire easily abont the head, great liability to 
strain a part by lifting; easily tired by bodily exertions; in walking up stairs 
she feels dizzy and entirely exhausted; even talking makes her weak; great 
inclination to sigh; she cannot get her breath long enough; great suscepti- 
bility to catch cold; the feet feel most of the time damp and cold, or else 
the soles of the feet are burning hot; great desire for hard-boiled eggs; big- 
belliedness; scrofulous diathesis. 

Calc phos. Every cold causes pains in the joints, and in other places 
where the bones unite and form a symphisis or suture. 

Cauloph. Retroversion; menstrual colic; congestion and irritability of 
uterus; leucorrhoea profuse, mucus. 

Chamom. Abortus; colicky pain and bearing down, with frequent 
desire to urinate; frequent discharge of coagulated blood, with tearing pains 
in the veins of the legs, and violent labor-pains in the uterus; she is inclined 
to be quarrelsome and angry; can hardly stop talking about old vexatious 
things. 

China. General weakness in consequence of loss of vital fluids, either 
by haemorrhages, profuse diarrhoea, or debilitating illness; great disposition 
to sweat during motion and sleep; feels worse from exposure to the slightest 
current of air; all pains are worse from slightest touch. 

Conium. Pain in the mammae before the menses; pressure from above 
downwards, and drawing in the legs during the menses; feeble or suppressed 
menses, sterility; smarting, excoriating leucorrhoea; the flow of urine sud- 
denly stops; cough during pregnancy; cough worse at night, and when 
lying down; vertigo, worse when lying down, or looking round, or going 
down stairs; indurations in the mammae or other glands. 

Ferrum jod. Retroversion and consequent pressure upon the rectum, 
that she can neither stand nor walk; constant tenesmus, with frequent white 
slimy stools; scanty, deep-colored urine; nervous and hysteric spasms; scrofu- 
lous diathesis. 

Hydrast. Nosebleed before menses; backache and headache before 
and during menses; discharge like white of egg after menses for ten days 
with great sexual desire, although coition is painful; after these ten days fol- 
lows acrid, corroding leucorrhoea with great irritableness and aversion to 
coition; at times profuse discharge of hot water from the womb. Constant 
desire to pass water, with relief after passing it; constipation, dry, lumpy 
feces are followed by a matter like white of egg. After eating, regurgitation 
of food by the mouthful without nausea, with nervousness, irritability and 
headache; epigastric region tender to touch and a feeling as of a tight band 
around the waist, worse at night than in the morning; cannot sleep until 
after midnight. Prolapsus uteri with indurated os. (C. W. Boyce.) 

Ignat. Violent crampy pressing in the region of the uterus, resembling 
labor-pains, followed by a purulent, corrosive leucorrhoea; the menses are 
scanty, black and of a putrid odor; she seeks to be alone, is brooding to her- 
self and full of grief; all her pains are aggravated by drinking coffee or 
smelling tobacco smoke; gone feeling in pit of stomach. 



682 THERAPEUTIC HINTS TO DISPLACEMENTS OF THE WOMB. 

Kali card. Pain in the small of the back, as though it were pressed in 
from both sides, with labor-like colic and leucorrhoea; also during the 
menses; the pains in the bowels are apt to recur about three o'clock every 
morning: bloated face in the morning, especially between the eyebrows and 
upper lids; great dryness and itchiness of the skin; great tendency to start 
when being slightly touched. 

Laches. Just as patients with a Lachesis sore throat cannot bear any- 
thing touching their neck, so do women afflicted with womb diseases con- 
stantly pull their dress from off the abdomen; violent labor-like pressing 
from the loins downwards during the menses, which are scanty; palpitation 
of the heart with numbness in the left arm; constant feeling of something in 
the throat which she cannot swallow down; feeling of a ball rolling in the 
bladder or abdomen, or in both places; climacteric period. 

LiL tigr. Feels as though she would drop asunder, must press with 
hand against vulva; worse in standing and sometimes when recumbent; fre- 
quent ineffectual urging to urinate and defecate. Menses scanty, flowing 
only as long as she is moving about; leucorrhoea profuse and corroding; she 
feels always in a hurry, yet cannot accomplish anything. 

Lycop. Chronic dryness of the vagina; pressing through the vagina on 
stooping; chronic suppression of the menses after fright; incarcerated flatu- 
lence; varicose veins on the lower extremities; jerking and twitching of 
single limbs or of the whole body, sleeping or waking; always wakes up 
very cross. 

Mercur. Peculiar weak feeling in the abdomen, as though she had to 
hold it up; close above the genital organs a sensation as if something heavy 
were pulling downward, accompanied hy a pulling pain in both thighs, as if 
the muscles and tendons w T ere too short. During the menses red tongue, 
with dark spots and burning; salt taste in the mouth; sickly color of the gums, 
and the teeth are set on edge; great tendency to perspire; all the symptoms 
worse at night; inexpressible feeling of some internal, insupportable illness. 

A T atr. Mur. Pressing and pushing from the side of the abdomen to- 
wards the genital organs early in the morning; she has to sit down to pre- 
vent a prolapsus uteri; dryness of the vagina and painful embrace; burning 
and cutting in the urethra after micturition; headache on waking every 
morning; faint, weak voice, and exhaustion from talking; after abuse of 
quinine, or the local application of nitrate of silver. 

A T itr. ac. Violent pressing in the liypogastrium, as if everything were 
coming out at the pudendum, with pain in the small of the back, through the 
hips and down the thighs; she feels so weak that she loses breath and speech. 
Inclined to looseness of the bowels; most violent, cutting pain after an evac- 
uation, lasting for hours; she feels, on the whole, better when riding in a 
carriage. 

Nux vom. Prolapsus after straining by lifting, or after miscarriage; 
constant, painful pressing and burning in the uterine region; pressive pain 



SPECIAL HINTS TO DISPLACEMENTS OF THE WOMB. 683 

in the small of the back, worse when turning in bed; drawing in the thighs; 
constant, unsuccessful urging to stool and constant desire to urinate; the 
patient wakes after midnight and lies awake for hours, then falls into a 
heavy sleep again, constanth T dreaming until late in the morning, when she 
feels disinclined to rise. Always the first remedy after allopathic drug- 
ging. 

Platina. Great heaviness, pressing in the genitals, extending through 
the groins as far as the small of the back; profuse menses; great sensitive- 
ness of the parts, with pressing from above down; internal chilliness and ex- 
ternal coldness; constipation; feeling of numbness and rigidity here and 
there; also with trembling and palpitation of the heart; haughty dispo- 
sition. 

Podoph. Prolapse from overlifting or straining and often parturition; 
great costiveness; frequent micturition; weakness and soreness of back, es- 
pecially after washing; prolapsus ani. 

Pulsat. Chilliness and paleness of face; bad taste in the morning and 
dry tongue without thirst; is easily moved to tears. 

Rhus fox. After a strain of hard labor; she feels worse after any long 
walk; the pain in the small of the back is relieved by lying on a hard couch. 

Secale. After parturition; weakly, thin women. 

Sepia. Pressing in the uterus, oppressing the breathing, from above 
downwards, as if everything would come out of the vagina, accompanied 
with colic; she has to cross her limbs to prevent it, followed by a discharge 
of jelly-like leucorrhcea; sense of weight in the rectum not relieved after 
stool, slow and difficult evacuations from the bowels, although the excre- 
ments are soft; pot-belliedness; yellow saddle across the bridge of the nose; 
gone feeling in the pit of the stomach, great weakness, tiredness, despon- 
dency and disinclination to move, 

Sulphur. Weak feeling in the genital organs and pressure on the parts; 
troublesome itching of the pudendum, with pimples all around and burning 
in the vagina; she was scarcely able to sit still; the menstrual blood is thick, 
black, and so acrid that it makes the thighs sore; burning and smarting 
leucorrhcea; sudden, imperative urging to urinate to prevent an involuntary 
flow; weak, fainty, between 11 and 12 A. m., must have something to eat; 
restless and sleepless nights; or a heavy sleep which exhausts her; heat on 
the top of head with cold feet; always feels too hot, especially her feet, which 
compels her to put them from under the cover; walks stooping; all the symp- 
toms worse while standing; psoric diathesis. 

Ver. alb. After great fear of fright, with cold sweat, exhausting vom- 
iting and diarrhoea. 

Zincum. Usually feels best during menses; fidgety of feet. 

Besides compare the chapter on Iyeucorrhcea. 



684 



DIGEST TO DISPLACEMENTS OF THE WOMB. 



Digest to Displacements of the Womb. 



LOCAL SYMPTOMS. 

Prolapsus Uteri, when straining at stool 

or urinating; rises again when walking 

about: Bel lad. 
, after cessation of menses: Agar. 

muse. 
, with ulceration of os and cervix: 

Arg. nitr. 

, with indurated os: Hydrast. 

, with stinging in os: Calc. carl). 

Hetroversion : Cauloph., Ferr. jod. 
Bearing", pressing down : Agar., Calc, 

card., Chamom., Laches., Platina, Sul- 
phur. 
Pressing down, as if everything would 

come out: Bel lad., JS T il. ac, Sepia. 

, has to cross her limbs: Sepia. 

, must press with hand against vulva: 

Lil. tigr. 
, feels as though she had to hold it 

up: Merc. sol. 
through the vagina on stooping: 

Lycop. 

from loins down: Laches. 

from small of back down towards 

front: Argent. 
from side of abdomen early in morn- 
ing; has to sit down: Natr. mur. 
Pressing down, with burning in uterine 

region: Nux vom 

, with sensitiveness of parts: Platina. 

and drawing in legs during menses: 

Coniuni. 
and tearing pains in the veins of the 

legs: Chamom. 

and pulling in both thighs: Mercur. 

, extending through groins as far as 

the small of the back: Platina. 
Sense of weight in pelvis after lifting a 

a heavy load: Aumim. 
Labor-like, colicky pains: Chamom. 

pains during menses: Laches. 

and leucorrhcea: Lgnat., Kali 

card. 
Congestion and irritability of uterus: 

Cauloph. 
Inflammation : Aeon. 
Pain in left ovary and loins: Argent. 
in groin; has to walk crooked: Amm. 

mur. 
Pressure upon rectum, that she can 

neither stand nor walk: Ferr. jod. 



Vagina dry: Bellad., Lycop. 

, and painful embrace: Natr. mur. 

, aching: Calc. card. 

, burning and itching and pimples 

around pudendum: Sulphur. 
, bleeding from, after painful coition: 

Arg. nitr. 



Before menses, nosebleed: Hydrast. 

, pain in mammae: Conium. 

During menses, pressing down from 

loins: Laches. 
, agonizing pain, with tossing about: 

Aeon. 

, colic: Cauloph. 

, red tongue, with dark spots and 

burning: Mercur. 
Menses, scanty: Conium, Laches., Lil. 

tigr. 
, , black and of putrid odor: 

Lgnat. 

, thick, black and acrid: Sulphur. 

flow more abundantly in the night : 

Amm. mur. 
Menses flow as long as she is moving 

about: Lil. tigr. 
too soon, with pain in small of back 

and in belly: Amm. mnr. 

and too profuse: Calc. card. 

, profuse: Platina. 

, suppressed after fright: Lycop. 

, ; sterility: Conium. 

Flow of blood between the periods: 

Bellad. 
Frequent discharge of coagulated blood: 

Chamom. 
Profuse discharge of hot water from 

womb: Hydrast. 



Leucorrhcea, jelly-like: Sepia. 

, milk-like: Calc. card. 

, mucous, profuse: Cauloph. 

, like white of egg, with great sexual 

desire, although coition is painful: 
Hydrast. 

, smarting, burning, excoriating: Co- 
nium, Hydrast., Lgnat., Sulphur. 

, , , , with aversion to 

coition: Hydrast. 

, with pain in small of back: Kali 

card. 



DIGEST TO DISPLACEMENTS OF THE WOMB. 



68 5 



GENERAL SYMPTOMS. 

Desire to be alone, brooding to herself, 
full of grief: Ignat. 

to self-destruction: Aurum. 

Always in a hurry, without accomplish- 
ing anything: Lil. tigr. 

Disinclination to move: Sepia. 

Easily moved to tears: Pulsat. 

Despondency : Sepia. 

Dejected, longing for death: Aurum. 

Fear of Death : Aeon. 

Irritability and nervousness: Hydrast. 

Can hardly Stop talking about old vex- 
atious things: Chamom. 

Vehement, least contradiction excites 
her wrath: Aurum. 

Quarrelsome and angry: Chamom. 

Haughty : Platina. 

Inexpressible feeling of some internal 
illness: Mercur. 

Headache on waking every morning: 
Natr. mur. 

and backache: Hydrast. 

Congestion: Bellad. 

Heat on top of head, with cold feet: 

Sulphur. 
Dizziness and roaring in ears: Bellad. 

on walking up stairs: Calc. card. 

when lying down, looking around, or 

going down stairs: Conium. 



Paleness of face: Pulsat. 

Bloated, especially between eyebrows 

and upper lids: Kali carb. 
Yellow saddle across bridge of nose: 

Sepia. 



Red tongue, with dark spots and burn- 
ing during menses: Mercur. 

Taste salty: Mercur. 

• bad in morning, dryness without 

thirst: Pulsat. 

Desire for hard-boiled eggs: Calc. carb. 

After eating, regurgitation of food by 
the mouthful without nausea: Hydrast. 

Gone feeling in pit of stomach: Ignat., 
Sepia. 

between 11 and 12 a. m.: Sulphur. 

Voice weak, faint and exhausted from 
talking: Natr. mur. 

Feeling of something in throat which 
she has to swallow: Laches. 



Epigastrium tender to touch: Hydrast. 



Abdomen tender to touch; pull their 

dress or cover from off the: Laches. 
Feeling as of a tight band around waist,, 

worse at night: Hydrast. 
as of a ball rolling in abdomen or in 

bladder: Laches. 
Pains recur about 3 a. m. : Kali carb. 
Incarcerated flatulence : Lycop. 
Pot-belliedness : Calc carb., Sepia. 
Constipation : Platina, Podoph. 
, dry, lumpy, feces, followed by mat- 
ter like white of egg: Hydrast. 
and ischuria, worse during menses: 

Aurum. 
Looseness, inclined to: Nit. ac. 
Urging, unsuccessful: Bellad., Lil. tigr. y 

Nux vom. 
Tenesmus, constant, with frequent white 

slimy stools: Ferr. jod. 
Weight, sense of, not relieved after stool: 

Sepia. 
Slow, difficult stool, although soft: Sepia. 
Stool with blood during menses: Amm. 

mur. 
After stool, cutting in rectum for hours: 

Nitr. ac. 
Prolapsus ani: Podoph. 



Desire, unsuccessful, to urinate: Bellad. „ 
Lil. tigr., Nux vom. 

Urging, sudden, imperative: Sulphur. 

, frequent: Chamom., Podoph. 

, constant, with relief after passing 

water: Hydrast. 

Ischuria, worse during menses: Aurum. 

The flow Of urine suddenly stops: Co- 
nium. 

A few drops are only discharged and 
some mucus from rectum: Bellad. 

Scanty, deep-colored urine: Ferr. jod. 

Burning and cutting in urethra after 
micturition: Natr. mur. 



Cough at night when lying down and 

during pregnancy: Conium. 
Inclination to sigh, cannot get the 

breath deep enough: Calc. carb. 
Bearing-down pains take her breath 

away: Sepia. 
Induration in mammas and other glands: 

Conium. 
Palpitation of heart, with trembling: 

Platina. 
, with numbness of left arm: Laches. 



686 



MORBID GROWTHS WITHIN THE WOMB. 



Back aches as if it would break: Bell ad. 

sore and weak, especially after wash- 
ing: Pod o ph. 

Small of back, pain in, as though it were 
pressed in from both sides: Kali card. 

, drawing downwards: Bel lad. 

, pressing, worse when turning in 

bed: Nux vom. 

Small of back, pain in, through hips 
down the thighs: Nitr. ac. 

, pain in, relieved by lying on a hard 

couch: Rhus tox. 



body, 



Thighs, drawing in: Nux vom. 
Limbs, jerking of, or of whole 

sleeping or waking: Lycop. 
Feet, fidgety of: Zincum. 

damp and cold: Calc. card. 

cold or burning hot: Sulphur. 

Numbness and ridgidity here and there: 

Plalina. 
Varicose on lower extremities: Lycop. 



Heavy sleep exhausts her: Sulphur. 

Sleepless before midnight: Hydrast. 

and restless at night: Sulphur. 

Wakes after midnight and lies awake 
for hours; later heavy sleep with 
dreams till late in the morning: Nux 
vom. 

Wakes Tip very cross: Lycop. 

Peels bad after sleep: Laches. 



Heat especially of feet, which she un- 
covers: Sulphur. 

Tendency to perspire: Mercur. 

about head: Calc. card. 

during motion and sleep: 

China. 

Cold sweat, vomiting and diarrhoea: 
Ver. alb. 



Dryness and itchiness of skin: Kali card. 
Scrofulous diathesis: Calc. card., Ferr. 

jod. 
Weakness, loses breath and speech: 

Nitr. ac. 

from loss of fluids: China. 

Weak and tired: Sepia. 

Nervous and hysteric spasms: Ferr .jod. 



After fright : Aeon., Ver. aid. 

After Straining, lifting, parturition: 
Arnica, Aurum, Calc. card., Chamom., 
Nux vom., Pod op h., Rhus tox., Secale. 

Worse from bodily exertions: Calc. card. 

from too long walk: Rhus tox. 

from talking: Calc. card. 

from standing: Lil. tigr., Sulphur. 

from touch: China. 

from taking cold: Calc. card., Calc. 

phosph., China. 

at night: Mercur. 

Climacteric age: Laches. 

Better during menses: Zincum. 

when riding in a carriage: Nitr. ac. 



Chilliness: Pulsat. 

and external coldness: Platina. 



After the use of quinine and local appli- 
cation of caustics: Natr. mur. 
allopathic drugging: Nux vom. 



Morbid Growths Within the Womb. 

Mucous polypi are usually an outgrowth of chronic catarrh, and con- 
sist of enlarged follicles, which elevate the loosely textured mucous mem- 
brane, gradually forming club-shaped bodies, which hang on a slender pedicle 
or stem from the fundus down towards the os, or if situated near the cervix, 
protrude through the external os. Their covering membrane being very 
vascular, gives them a cherry-red color, and they bleed easily and often pro- 
fusely; their size varies from that of a pea to that of a hazel-nut, seldom 
much larger. 

Fibrous polypi consist of submucous fibroids, which project into the 
cavity of the uterus, and are covered by the mucous membrane which they 
push forward. They arise from the body of the womb, and remain more or 
less continous with the same by means of a more narrow or broader pedicle. 
Their size varies greatly, and mav attain to the dimensions of a child's head 



CANCER OF THE WOMB. 687 

and over. Such growths should properly be called submucous fibroids, but 
are best known under the name of uterine fibrous polypi. If these morbid 
growths take during their development an outward direction towards the 
peritoneal covering, which they naturally push before them, they are called 
subserous fibroids, and if they develop within the uterine wall itself, consti- 
tuting a portion of the same, they are called interstitial, intraparietal or in- 
tramural fibroids. 

It is often the case that all three kinds of fibroids are associated with 
each other. These tumors do not direct^ endanger life, but may become 
dangerous through haemorrhage or suppuration and ichorous degeneration, 
and constitute at best a constant interference with the enjoyment of life. 

Therapeutic Hints. 

As the most important remedies compare Calc. carb., Calc. phosph., 
Co?it2tm, Lycop., Nitr. ac, Phosphor., Sanguin., Silic, Staphis., Teucriitm, 
Thuja. Many others may be indicated in individual cases. In case of 
haemorrhages compare the respective chapter. Operative means belong into 
the domain of surgery. 

Moles are fleshy bodies of various sizes, to which is attached a sac filled 
with fluid resembling the amniotic fluid; they are embryos not normally 
developed. The cause for this failure of normal development may lie in the 
ovum, being from some cause or the other incapable of a normal development 
ab initio, or in the semen, being not healthy enough to insure a normal 
growth, or, according to Eaton, in the too small number of spermatozoa, 
which penetrate the ovum. This latter may be the result of using a syringe 
after connection, or of withdrawing the penis before ejaculation, or of con- 
triction of the cervical canal in consequence of flexion, preventing the free 
ingress of semen into the uterus. 

Its Symptoms are usually those of pregnancy; and when the abnormal 
mass is expelled by the efforts of nature, the indications for remedial aid 
correspond to those of abortus. 

Hydatids are numerous cysts or vesicles attached to each other like a 
bunch of grapes, filled with a transparent fluid like water. Upon micro- 
scopical examination they were found to contain the heads of echinococci, 
and as hydatid developments are not confined to the uterus, but have been 
found also in the liver, lungs, testicles and mammae, they cannot be con- 
sidered as the result of imperfect impregnation. 

Cancer of the Womb. 

Carcinoma is, according to Waldeyer, " developed by normal pavement 
or glandular epithelium penetrating with its ramifications into the depths of 
the tissues in all directions like plugs, destroying the other tissues in all 
directions by pressure, and forcing apart the bundles of connective tissue- 
fibres, so as to form for itself a framework of connective tissue and an alveo- 
lar structure for the whole tumor. ' ' 



688 THERAPEUTIC HINTS TO CANCER OF THE WOMB. 

1 ' According to the preponderance of either this connective tissue frame- 
work, or the nests of cancerous epithelium, we distinguish the harder forms 
as Schirrus and the softer as Medullary caacer." 

The degeneration begins almost always at the vaginal portion, rarely 
extends to the fundus, is, however, very apt to spread down the vagina, over 
to the bladder and rectum, causing, at the period of its decay, a most horrid 
destruction of these parts. Its most important Symptoms are pains in the 
small of the back, loins and groins, which grow more and more violent; 
haemorrhages, at first only during the menstrual periods, later at any time; 
and leucorrhoea, which becomes more and more water}', corroding and 
offensive. 

The Cauliflower excrescence is a cancroid hypertrophy of the papillae 
in the mouth of the womb, which sometimes attains to an enormous size in the 
shape of cauliflowers. It looks bright red, bleeds easily and is prone to can- 
cerous degeneration, in which state it undermines the general constitution by 
pain and loss of blood, like cancer of the womb, to which it is similar in all 
its symptoms. A Differentiae Diagnosis between the two can be gained 
only by an examination with the speculum. 

Therapeutic Hints. 

Arsen. Great exhaustion; restlessness and fits of anguish, with terri- 
ble, sharp, burning pains; all worse about midnight; acrid, corroding and 
burning discharges, watery, light or dark colored, often very offensive. 

Ars.jod. (Wells.) 

Aw. mu? . Stinging, cutting, pressive pains in the uterine region; 
very offensive discharges; belching up of wind; craves nothing but sour 
things. 

Bel lad. Painful bearing down in the pelvis, as though everything 
would fall out of the genitals; a similar pain in the small of the back; fre- 
quent, transient stitches in the region of the womb; haemorrhages from the 
womb, profuse, often very offensive. 

Bromium. Eight cases. (Williams.) 

Calc. carb. Burning soreness in the genital organs; aching in the 
vagina; profuse menstruation; flow of blood between the monthly periods; 
cold feeling on the top of the head; great sensitiveness to cold air and 
liability to catch cold; scrofulous diathesis. 

Carb. an. Burning in the abdomen, extending into the thighs; labor- 
like pain in the pelvis and small of the back, extending into the thighs, with 
discharge of slim}', discolored blood; irregular menses; uterus swollen and 
hard; cachectic appearance of the face; earthy color of the skin; great 
weakness. 

Carb. vcg. Paroxysmal spells of burning in the uterine region; vari- 
cose veins on the external genital organs; cold knees in bed. 

Conium. Stitching pain in the womb, accompanied by such symptoms 
as accompany pregnancy; nausea and vomiting; craving sour or salt things; 



THERAPEUTIC HINTS TO CANCER OF THE WOMB. 689 

pain and swelling of the mammae during the menses; dejection of spirits, 
etc. 

Graphit. Cauliflower excrescence; burning, stitching pains, like elec- 
tric shocks, through the womb, extending into the thighs; great heaviness in 
the abdomen when standing, with increased pains and faintness; menses only 
every six weeks, with a discharge of black, clotted, offensive blood, and an 
increase of all the sufferings; constipation; earthy color of the face; frequent 
chilliness; sad, desponding. 

Iodium. Cutting in the abdomen, with pains in the loins and small of 
the back; uterine haemorrhage at every stool; indurations of the uterus; 
painfulness and feeling of heaviness in both mammae; they hang down, re- 
laxed and lose their fat; dwindling and falling away of the mammae; the 
patient feels worse from external warmth; after abuse of mercury. 

Kreos. Cauliflower excrescence; awful burning as of red-hot coal in 
the pelvis, with discharge of clots of blood having a foul smell; bearing down 
and sense of weight in the pelvis; drawing pains in the small of the back 
and uterine region, extending to the thighs, intermingled with stitching 
pains; the vagina is swollen and burning hot; long-standing leucorrhoea, 
becoming more and more watery, acrid, bloody and ichorous all the time; 
frequent haemorrhages from the womb; dwindling and falling away of the 
mammae, with small, hard, painful lumps in them; wretched complexion; 
great debility; sleeplessness. 

Laches. Pain in the parts as if swollen, they do not bear contact, and 
have to be relieved of all pressure; coughing or sneezing causes stitching 
pains in the affected parts; tenacious and acrid menstrual flow with labor- 
like pains; discharge of a few drops of blood from the nose before menses, 
which are scanty and delaying; especially indicated during the climacteric 
period with frequent uterine haemorrhages. 

l^ycop. Drawing in the groin; burning and gnawing; chronic dryness 
of the vagina; pressing through the vagina on stooping; discharge of wind 
through the vagina; pain in the small of the back, extending down to the 
feet; incarcerated flatulence, with rumbling in the left hypochondriac region; 
red, sandy sediment in the urine; jerking of single limbs awake or asleep; 
feels worse in general from four to eight o'clock p. m. 

Magn. mur. Scirrhous induration of the womb; uterine spasms ex- 
tending to the thighs and occasioning leucorrhoea; discharge of black clots 
of menstrual blood, more when sitting than when walking; large, hard, diffi- 
cult stools which crumble off as they are expelled. 

Merc. sol. Syphilitic taint, prolapse of the vagina; swelling of inguni- 
nal glands. 

Mur ex purp. A* lively, affectionate disposition has turned to melan- 
choly from the effects of the disease; frequent, profuse menstruation, and 
strong sexual desire; soreness in the region of the cervix, or a feeling as 
though something was pressing on a sore spot in the pelvis; with pain in the 
right side of the uterus going into the abdomen or thorax; watery greenish 
44 



690 HYSTERALGIA. 

leucorrhoea, irritating the parts; dragging and relaxation in the perineum; 
pains in the hips, loins, and down the thighs, worse from exertion. (B. F. 
Betts. ) 

Nitr. ac. Irregular menstruation in shorter or longer intervals; during 
the intervals a profuse, discolored, brownish and offensive leucorrhoea; 
great debility, nervousness, and depression of spirits; haemorrhoidal ten- 
dency; great pain in the rectum after stools, lasting for hours, even worse 
after a diarrhceic evacuation; the urine is very offensive. During a ride in 
the carriage they feel much better. 

Natr. card. Induration of the neck of the womb; the os uteri is out of 
shape; pressing in the hypogastf^um towards the genital organs, as if every- 
thing would come out; metrorrhagia; putrid leucorrhoea; headache in the 
sun and from mental labor; she gets nervous from playing on the piano, and 
feels great anxiety during a thunder-storm. 

Phosphor. Frequent and profuse metrorrhagia, pouring out freely and 
then ceasing for a short time; heat in the back; chlorotic appearance; in- 
stead of menses, watery, slimy or acrid discharge, causing blisters. 

Phytol. Menses too frequent and too copious; mammae painful; ster- 
ility; constipation; syphilitic taint. 

Rhus fox. Great soreness in vagina preventing an embrace; the men- 
stual flow, being profuse, protracted and of light color, causes biting pain 
in the vulva. 

Sepia. Induration colli uteri or vaginae; painful stiffness in the uterus; 
pressing from above downwards, oppressing the breathing; must cross her 
thighs, in order to get relief; pot-belliedness; yellow saddle across the bridge 
of the nose; feels worse while riding in a carriage. Menses scanty; aversion 
to coitus; sad and indifferent. 

Silic. She feels nauseated during an embrace; diarrhoea or else great 
costiveness before the menses, increased menses, with repeated paroxysms of 
icy coldness over the whole body at the time of their appearance; indurations 
of the mammae; most of the symptoms make their apprarance about new 
moon. 

Tarant. Cancerous ulcer of os, induration of neck and fundus, chronic 
vaginitis with granulations. (Nunez.) 
Thuja. Cauliflower excrescences. 

Besides compare: Apis, Calc. carb., China, Clemat., Coccul., Hydi-ast., 
Sabina, Sfaphis., Sulphur and others. 

Hysteralgia. 

Under this term we understand a neuralgia uteri, or as it was formerly 
called, an irritable uterus, which consists of severe, oftentimes even excrucia- 
ting pains in the region of the womb, without our being able to prove the 
existence of corresponding changes in the uterus by our present methods of 
investigation. Hysteralgia, therefore, excludes all those cases where the 
existing pain can be traced to morbid alterations objectively demonstrable. 



METRORRHAGIA. 69 1 

These attacks of neuralgic pains are prone to remissions and aggravations, 
greatly influenced by the state of the atmosphere, by mental or emotiona 
excitements, by indigestion, etc., and are generally found in women of a 
nervous temperament. 

Therapeutic Hints. 

Here, too, as in all neuralgias, the number of remedies which may be 
indicated is very large. 

In pains running upward: Laches., Lycop., Phosphor., Sepia. 

Downward: sEscid., Ipec., Nnx vom. 

From os ilii forward and downward : Bryon. 

From groins outward and backward : Sepia. 

From groins to back : Sulphur. 

From back to groins: Sabina. (J. C. Morgan.) 

Dreadful bearing-down, dragging-out feeling : Secale. (Burnett.) 

Compare the chapters on Abnormal Menstruation, especially Dysmenor- 
rhcea. 

Metrorrhagia, Haemorrhage from the Womb. 

We understand by metrorrhagia a more or less profuse flow of blood 
from the womb at any other time than that of the menstrual period. 

1. It may occur in the not pregnant state of the womb, in consequence of 
abnormal fluxion to .that organ, or in consequence of morbid growths in the 
womb and disorganizations of the organ, as shown in the previous chapters, 
or (and that is, perhaps, its most frequent occurrence) in consequence of those 
conditions which lead to the so-called ' ' change of life ' ' in the female organ- 
ism; here it is, perhaps, not always distinguishable from a mere profuse 
menstruation. 

2. It may occur during pregnancy. With some women it is almost a 
rule, that the menstrual period is repeated several times after conception, 
without apparent injmy to the child. In others, however, a haemorrhage 
during the first months of pregnancy is the forerunner of abortion. Haemor- 
rhages during the second half of pregnancy are often signs of a placenta 
previa, or likewise forerunners of miscarriage. 

3. It may occur after the expulsion of the child, whether it is full- 
grown or not. Such bleedings are generally of great importance. They 
are almost always (if not occasioned by mechanical injuries) the conse- 
quence of insufficient contractions of the womb, the causes of which consist 
either of protracted or exhausting labors, or a too rapid expulsion of the 
child, or a partially- adhering placenta, or large blood coagula within the 
womb. 

4. When occurring later, during the lying in time, the haemorrhages 
are usually not so profuse and happen chiefly in women who do not nurse 
the child. Sometimes, however, they may be caused by an inflammatory ir- 
ritation of the womb. 



692 THERAPEUTIC HINTS TO METRORRHAGIA. 

5. It may occur during an attack of typhus, variola, cholera, etc. 

Metrorrhagia sets in frequently with chilly spells. The bleeding is either 
in gushes, or a continuous flow of bright red or dark blood. The face turns 
pale, the extremities grow cold; there is anxiety, restlessness, labor-like 
pains or colic; sometimes difficulty in breathing; vomiting and even convul- 
sions. A great loss of blood brings on the signs of anaemia; coldness and 
deadly paleness of the face, chills; cold perspiration; darkness before the 
eyes; ringing in the ears; faintness. drowsiness, weak pulse, convulsions. 

Therapeutic Hints. 

Apocyn. cann. The flow is either continuous or paroxysmal; the blood 
fluid or clotted; there is nausea, vomiting, palpitation of the heart, great 
prostration and fainting when raising the head from the pillow. 

Arse?i. Pale, hippocratic face; sunken, lustreless eyes, and icy-cold ex- 
tremities, spots and blisters on the skin, with oozing of blood. 

Arnica. After difficult labor or external injuries; head hot; remaining 
body cool. 

Bellad. Great bearing down, as if everything would be pressed out, or 
a pain from the sacrum through the pelvis to the pubis; the blood feels hot; 
headache; loss of consciousness; darkness before the eyes; enlarged pupils; 
cold nose; oppression, groaning, 3^awning, jerkings of the arms; convulsive 
clenching of the thumbs. 

Calc. carb. Climacteric period; chronic; mixed with leucorrhcea; pre- 
viously always inclined to profuse and protracted menses. 

Cauloph. Threatening abortion, and with spasmodic bearing-down 
pains; great vascular excitement; passive haemorrhage after abortus or con- 
finement; tremulous weakness of the whole system. 

China. At the commencement or actual presence of the above described 
symptoms of anaemia. 

Chamom. Threatening abortus or actual abortion; labor-like pains from 
the small of the back extending to the genitals; blood dark and clotted. 

Crocus. Dark, viscid, stringy blood, in black clots; feeling as if some- 
thing alive were in the abdomen; nervous excitement; palpitation of the 
heart; fearfulness; after being overheated, straining and lifting; after abortus 
and delivery; worse from slightest motion; yellowish, earthy color of the 
face. 

Eriger. Uterine haemorrhage, with violent irritation of the rectum and 
bladder; after abortion, with diarrhoea and dysuria. 

Ferrum. Parti}- fluid and partly black, clotted blood; labor-like and 
colicky pains; fiery red face; frequent short shudderings; headache and dizzi- 
ness; constipation and hot urine. 

Hamam. Passive haemorrhage, with anaemia; soreness of the abdomen. 

Hyosc. Continuous flow of bright red blood, or in bright red clots, 
with spasmodic jerkings of the body and great vascular excitement; nausea; 
vomiting; hiccoughing. 



THERAPEUTIC HINTS TO METRORRHAGIA. 693 

Ignat. After the abuse of chamomile tea; after mental excitement and 
depression; gone feeling in the pit of stomach. 

Ipcc. Especially after child-birth or the taking away of the placenta; 
the flow is continuous, and the patient gasps for breath and is deadly pale. 

Kreosot. Black blood in large quantities and of an offensive smell, dur- 
ing the climacteric period. 

Kali card. Threatening abortus and consequences of it; great weak- 
ness in the small of the back and lower extremities; pain in the small of the 
back as though it were broken; dry, hacking cough; obstinate sweating, 
with feverish chilliness; chronic inflammatory states of the womb, with 
nausea and vomiting. 

Ladies. Climacteric period. 

Lycop. Partly black, clotted, partly bright red blood, and partly bloody 
serum, with labor-like pain, followed by swooning; distention of the abdo- 
men in different places, changing localities; pain in the small of the back, 
extending into the thighs; worse in the afternoon from four o'clock, com- 
mencing with chilliness; restless sleep; dreams of falling down from a height; 
especially for women who habitually menstruate profusely. 

Mercar. Frequent fainting; profuse, cold perspiration on the face; 
collection of slime in mouth and throat; external swelling of the genitals. 

Nitr ac. After miscarriage or confinement; diarrhoea, with cutting 
pain in the rectum after stool; urine of an intolerably strong smell. 

Nux vom. During the climacteric period, and especially if such per- 
sons have been drugged previously by allopathic nostrums, or have used 
much coffee or alcoholic drinks, or too highly seasoned food; if they lead a 
sedentary life, complain much of costiveness and headache, suffer with 
piles, etc. 

Phosphor. Between the menses and during pregnancy; lame and 
bruised feeling in the small of the back; dry cough and tightness in the 
chest, worse before midnight; great heat on the top of the head or in the 
spine; a great deal of vertigo; chronic looseness of the bowels, worse in the 
morning, or else chronic constipation with dry, narrow stools. 

Plaiina. During pregnancy; after confinement; after great mental 
emotions; dark, thick, not coagulated blood; pressing pain from the small 
of the back downward upon the pelvic organs, as though they would come 
out, with great sensitiveness of the external organs, and nymphomania; 
sometimes a feeling as if limbs and body were growing larger. 

Plumbum. During the climacteric period; dark clots, alternating with 
fluid blood or bloody serum, with a sensation of fullness in the pelvis and 
slight bearing-down pains from the small of the back to the front; skin dry, 
pale, yellowish; here and there " liver spots;" great debility, short breath on 
going up stairs; depressed spirits. Poisoning with lead brings on abortus. 

Pulsat. Dark, coagulated blood emitted in paroxysms; worse in the 
evening, with labor-like pains; habitual looseness of the bowels; ordinarily 
rather scanty menses; yielding disposition. 



694 MENSTRUAL ANOMALIES. 

Rhus tox. Bright red blood; threatening abortus, induced by strain- 
ing or lifting; trembling sensation in the middle of the chest; contractive 
pain around the hypochondria; drawing, tearing in the back, loins and hips; 
cramp-like contraction of the thighs; aching all over, worse during rest; 
heavy, unref reshing sleep, full of dreams. 

Sabina. Blood bright red or dark, also in clots, sometimes alternating, 
now dark, coagulated, and then, again, thin and bright red; flows mostly in 
paroxysms, which are brought on by the slightest motion; or it ceases when 
walking about; drawing, cutting, pressing pains from the small of the back 
to the genitals and into the thighs; women who menstruate early and almost 
always profusely; gout}' diathesis; when the patient feels better in cool and 
worse in warm temperatures; threatening abortus; after miscarriage a"d 
confinement. 

Secale. Atonic haemorrhages during the critical age; after confinement; 
dark, seldom coagulating blood, sometimes fetid; no pain, or only slight 
bearing down; or dreadful bearing-down and dragging- out feeling; flooding, 
worse from the slightest motion; trembling, convulsive jerkings of the limbs; 
cramps in the calves of the legs; general coldness. 

Sepia, Climacteric age, or during pregnancy, especially during the fifth 
and seventh months; congestion of the head; fullness and pressure in the 
chest; spasmodic contractions in the abdomen, with terrible bearing down; 
induration of the womb; varicose veins; yellow, sallow complexion. Such 
patients are very irritable, and faint from any little exertion. 

Sulphur . In chronic cases, when other remedies do not prevent its re- 
turn; psoric taint of the system; eruptions here and there, or previously 
suppressed eruptions; looseness of the bowels early in the morning, or else 
great constipation; fits of gnawing hunger before dinner; the patient com- 
plains of great heat, or flushes of heat; has sleepless nights, seemingly with- 
out cause, or on account of a tormenting itching all over the body; itching 
about the anus and genitals; chronic leucorrhcea, etc. 

Trillium. Gushing of bright red blood at least movement, at times 
dark clots; frequent desire to urinate. Sallow face with white lips and 
tongue; tossing in bed from evening until after midnight, with a feeling as if 
hips and small of back were falling to pieces and a desire to bind them up 
tightly. (F. G. Gilchrist.) 

Ustilago. At the climacteric period; active and constant flowing with 
frequent clots. 

Digest see under Menorrhagia. 

MENSTRUAL ANOMALIES. 
1. Menorrhagia 

Is, like metrorrhagia, a profuse flow of blood from the womb; only with the 
difference that it occurs at the time of the menstrual period. This period may 
keep regular time, or it ma} 7 come too soon, or it may last too long; in some 



THERAPEUTIC HINTS TO MENSTRUAL ANOMALIES. 695 

cases the menses are too profuse, too early and lasting too long. Its causes 
are various. We may trace it to different structural changes and morbid 
growths of the uterus; to stagnation of the blood in the uterine veins, de- 
pending upon heart and lung diseases; to fluxions to the womb, brought on 
by sexual excesses, or sexual excitements by loose literature or onanism; to 
haeinorrhagic diathesis, as in scurvy, purpura hsemorrhagica, hemorrhagic 
smallpox, measles, typhus, etc. Such cases, however, are of rare occurrence. 
The blood is either fluid or coagulated, and may differ greatly in color and 
character. Strong, plethoric women ma}^ endure monorrhagia for a long 
time; weak, feeble women soon show signs of anaemia. 

Therapeutic Hints. 

Compare the preceding chapter on Metrorrhagia, and likewise those 
which treat of its causes as stated above. 

Amm. card. Premature and very copious flow, especially at night, 
when sitting or riding, and after a ride in the cold air; with spasmodic pains 
in the belly and hard stools with tenesmus; cholera-like symptoms at the 
commencement of the flow. 

Arg. 7iitr. Congestion of the uterus; cutting pains in the small of the 
back and groins; cramp in the stomach; great debility of the lower limbs; 
vertigo and enlarged feeling of the head. 

Bryon. Menses premature and too profuse; dark red blood; tearing in 
the limbs; splitting headache from the least motion, even on moving the 
eyes; white-coated tongue; great thirst; bilious vomiting; tearing in the 
limbs; constipation; stools as if burnt; or diarrhoea in the morning. 

Calc. carb. Profuse, too early and lasting too long; anaemic symptoms 
and congestion of the head and chest; leucorrhoea afterwards; scrofulous 
diathesis. 

Calc. phosph. Menses every two weeks, black and clotted; before their 
appearance, griping and rumbling in the bowels; leucorrhoea; stitching pains 
in the left side of the head; sleepiness during the day. 

Cann. ind. Violent uterine colic; great nervous agitation and sleep- 
lessness; or cold hands and feet. (W. C. Richardson.) 

Chamom. Profuse discharge of dark, almost black, coagulated blood, 
with drawing, clawing pains from the small of the back to the os pubis; 
irritable; fainting spells; cold extremities. 

Cimicif. Profuse and too early; dark, coagulated blood; aching in the 
limbs; severe pain in the back, down the thighs, and through the hips, with 
heavy pressing down; weeping mood; nervousness; hysteric spasms; great 
pain in the head and eyeballs, increased by the slightest movement of the 
head and eyeballs. 

Coccul. Profuse and too often; when rising upon the feet it gushes out 
in a stream; paralytic feeling of the lower extremities. 

Cocc. cacti. Flow only in the evening after lying down, not when stirring 



696 THERAPEUTIC HINTS TO MENSTURAL ANOMALIES. 

about; urging to urinate but cannot pass water until a clot of blood is dis- 
charged; nausea, vomiting. (C. B. Knerr.) 

Collins. Menorrhagia in connection with constipation and piles. 

Crocus. Profuse and lasting too long, but coining at the right time; 
dark, clotted, string}' blood; wretched, pale, yellowish color of the face; pal- 
pitation of the heart on going up stairs; great debility. 

Cyclam. " The flow almost ceased as long as she was moving about at 
work, but as soon as she sat down quietly in the evening the flow reappeared 
and continued after she went to bed." (H. Ring.) 

Digit. Venous, passive congestion, with pale or livid color of the face; 
coldness of the skin; swelling and painfullness of the feet; all in consequence 
of some cardiac anomalies. 

Eriger. Profuse and too frequent, with violent irritation of the rectum 
and bladder. 

Ferrum. Profuse, too frequent, and lasting too long; with a fiery-red 
face, whilst at other times the face is pale and earthy looking. 

Gelse??i. Almost continuous flow, without any pain. 

Hyosc. Piofuse, with delirium; convulsive trembling of hands and feet; 
silly manners, rage. 

Ignat. Profuse, too frequent and lasting too long; after great mental 
troubles, grief or fright; empty feeling in the pit of the stomach; great sen- 
sitiveness of mind without complaining. 

Iodum. Profuse and too early; ovarian region painful, or sensitive to 
pressure; emaciation, notwithstanding a good appetite; chronic catarrh of 
the lungs. 

Ipec. Very profuse, with heavy breathing; constant nausea. 

Kreos. Profuse and last too long; great distention of the abdomen 
before the menses, so that she appears as though she were pregnant; blood 
offensive; leucorrhcea between the menstrual periods; headache before 
menses; is very stubborn and irritable. " Worse in lying, better from walk- 
ing about . " ( Von Villers . ) 

Lycop. Profuse and lasting too long; sadness and melancholy before 
the menses; yellowish color of the face; frequent jerkin gs of the limbs; in- 
carcerated flatulence. 

Nux voni. Profuse and too early; great sensitiveuess of the nervous 
system; can't bear light or noise; is put out of patience when spoken to; 
gets angry and violent without any provocation; is head-strong and self- 
willed; or gets frightened easily, and is almost beside herself from the least 
thing that may happen; she shuns the fresh air. After coffee, liquors, high- 
seasoned food, drugs, sedentary life. 

Phosphor. Profuse, too early and lasting too long; or too late, but very 
copious; afterwards great weakness, blue rings around the eyes; losing of 
flesh and great fearfulness; tender, sensitive women, with frequent heat in 
the back, and cold legs. 

Platina. Profuse, too frequent and long lasting; dark blood; pressing- 
down pains; excited sexual desire. 



DIGEST TO METRORRHAGIA AND MENORRHAGIA. 



697 



Secale. Profuse dark, without pain, lasting too long, being aggravated 
by the slightest motion or mental emotion. Spitting of blood before the 
menses; leucorrhcea three da5 T s after menstruation; ischiatic pains better 
from bending the limb. 

Sepia. Profuse,, either too early or at the right time; venous congestion 
of the head; one-sided headache, with nausea and vomiting; loathing of all 
food; pot-belliedness after confinement; constipation; yellow spots on the 
face. 

Trillium. Menses every fourteen days, lasting seven and eight days; in 
the intervening time profuse leucorrhcea of a yellowish color and creamy 
consistence. The blood is at first bright red, but owing to anaemia, grows 
pale. 

Veratr. Profuse and too early; commencing with vomiting and diar- 
rhaea; sensation upon the top of the head as if ice lay there; nose, hands and 
feet cold; irritable, weeping mood. 

Digest to Metrorrhagia and Menorrhagia. 



Blood black: Calc. card., Chamom., Cro- 
cus, Ferrum, Kreos., Lycop., Plum- 
bum. 

and clotted: Calc. phosph., 

Chamom., Crocus, Ferrum, Lycop., 
Plumbum. 

dark: Chamom., Crocus, Platina, 

Sabina, Secale. 

and clotted: Chamo7n., Cimic, 

Platina, Plumbum, Pulsat., Sabina, 
Trillium. 

dark red: Bryon. 

clotted or fluid: Apoc. cann., Fer- 
rum, Plumbum, Ustil. 

fetid or offensive: Kreos., Secale. 

hot: Bellad. 

bright red: Hyosc, Lycop., Rhus 

tox., Sabina, Trillium. 

and clotted: Hyosc. 

stringy: Crocus. 

thin: Sabina. 

Bloody serum: Lycop. 
Flow continuous: Apoc. cann., Gelsem., 
Hyosc, Lpec, Ustil. 

paroxysmal: Apocyn., Pulsat., Sa- 
bina. 

Passive: Cauloph., Hamam. 

Chronic, mixed with leucorrhoea: Calc. 



Menses habitually profuse: Calc. carb., 
Lycop., Sabina. 

scanty: Laches., Pulsat. 

at the right time: Crocus, Sepia. 



too early: Amm. carb., Bryon., Calc. 

carb., Cimic, Iodium, Nux vom., 
Phosphor., Sabina, Sepia, Veratr. 

too often, frequent: Coccul., Eriger., 

Ferrum, Ignat., Platina. 

every two weeks: Calc. phos., Tril- 
lium. 

too long protracted: Calc. carb., Cro- 
cus, Ferrum, Lgnat., Kreos., Lycop., 
Phosphor., Platina, Secale, Sepia. 

lasting seven and eight days: Tril- 
lium. 

commencing with vomiting and 

diarrhoea: Amm. carb., Ver. alb. 

ACCOMPANYING SYMPTOMS. 

Loss of consciousness: Bellad. 
Delirium, silly manners, rage: Hyosc. 
Depressed spirits: Plumbum. 

Sadness and melancholy before menses: 

Lycop. 
Weeping mood: Cimic, Ver. alb. 
Fearfulness: Calc carb., Phosphor. 
Easily frightened: Nux vom. 



Irritable: Chamom., Kreos., Sepia, Ver. 

alb. 
Angry, violent, out of patience, without 

provocation: Nux vom. 
Stubborn: Kreos. 

Head-strong, self-willed: Nux vom. 
Yielding disposition: Pulsat. 
Tender: Phosphor. 



698 



DIGEST TO METRORRHAGIA AXD MENORRHAGIA. 



Sensitiveness, nervousness: Cimic, Nux 
vom.i Phosphor. 

, without complaining: Ignat. 

Nervous agitation and sleeplessness: 
Cann. ind. 

Dizziness, vertigo: Ferrum, Phosphor., 
Pulsat. 

, , and enlarged feeling of head: 

Arg. 7ii tr. 

Headache: Bel lad., Ferritin, Nux vom. 

before menses: Kreos. 

, splitting, from motion, even of 

eyes: Br yon. 

and pain in eyeballs, worse from 

motion: Cimic. 

, stitching in left side: Calc. phosph. 

, one-sided, with nausea and vomit- 
ing: Sepia. 

Congestion: Sepia. 

of head and chest: Calc. card. 

, venous: Sepia. 

Heat of head, remaining body cool: Ar- 
nica. 

of top of head, or in spine: Phos- 
phor. 

Coldness, as of ice, on top of head: Ver. 
alb. 

Darkness before eyes; enlarged pupils: 

Be/lad. 
Cannot bear light or noise: Nux vom. 
Blue ring's around eyes: Phosphor. 
Sunken, lustreless eyes: Arsen. 
Cold nose: Ver. alb. 
Face pale or livid: Digit. 

deadly: Ipec. 

yellowish: Crocus. 

earthy, with pain and fiery-red: Fer- 

rnm. 

hippocratic: Arsen. 

sallow r : Sepia, Trillium. 

yellowish: Lycop. 

yellowish, earthy: Crocus. 

, yellowish spots: Sepia. 

White lips and tongue: Trillium. 
Profuse cold perspiration: Ver. alb. 



White coated tongue and great thirst: 

Br yon. 
Collection of slime in mouth and 

throat: Mercur. 
Loathing of all food: Sepia. 
Nausea, constant: Ipec. 
and vomiting: Apec. conn., Cocc. 

cad., //rose. Kali carb. 



Vomiting, bilious: Bryon. 

and diarrhoea at the commencement 

of the flow: Amm. carb., Ver. alb. 
Hiccoughing: Hyosc. 
Fits of gnawing hunger: Sulphur. 
Empty, gone feeling in pit: Ignat. 
Cramp in stomach: Arg. nitr. 
Contractive pain around the hypchon- 

dria: Rhus tox. 



Spasmodic pains in belly: Amm. carb. 

, with bearing down: Sepia. 

Labor-like pain: Ferrum. 

, followed by swooning: Lycop. 

, from small of back to genitals: 

Chamom. 
Colicky pains: Ferrum. 

in uterus: Cann. ind. 

Griping and rumbling before menses: 

Calc. phosph. 
Soreness of abdomen: Hamam. 
Flatulence, incarcerated: Lycop. 
Distention of abdomen: Kreos. 

, changing places: Lycop. 

Something alive, as if, in abdomen: 

Crocus, {Thuja). 
Pot-belliedness 

Sepia. 



after confinement : 



Constipation: Bryon, Nux vom., Sepia. 

, stools as if burnt: Bryon. 

, chronic, with dry, narrow stools: 

Phosphor. 

, with tenesmus: Amm. carb. 

and piles: Collins. 

and hot urine: Ferrum. 

Irritation of rectum and bladder: 

Eriger. 
Looseness of bowels, habitual: Pulsat. 
Diarrhoea, worse in the morning: 

Bryon., Phosphor., Sulphur. 
, with cutting pain in rectum after 

stool: Nitr. ac. 

and dysuria: Eriger. 

Itching about anus and genitals: Sul- 
phur. 
Piles: Nux vom. 

Frequent desire to urinate: Trillium. 
Urging, but cannot pass water until a 

clot of blood is discharged: Cocc. cact. 
Urine of intolerable strong smell: Nitr. 

ac. 
Womb, with chronic inflammation of: 

Kali carb. 



DIGEST TO METRORRHAGIA AND MENORRHAGIA. 



699 



, congestion of: Arg. nitr. 

, induration of: Sepia. 

Ovarian region painful, sensitive to 

pressure: Iodum. 
Bearing", pressing down; Cauloph., 

Cimic, Platina, Plumbum, Secale, 

Sepia. 
, , as if everything would be 

pressed out: Bel lad., Sepia. 

, , dragging out feeling: Secale. 

Labor-like pain: Cann. ind., Chamom ., 

Per rum, Lycop., Pulsat. 
, from small of back to genitals: 

Cham oi)i. 

, to front: Plumbum. 

, upon pelvic organs: Platina. 

External organs sensitive: Plalina. 

swollen: Merciir. 

Sexual desire, nymphomania: Platina. 

Leucorrhcea: Calc. phosph. 

, chronic: Sulphur. 

between menses: Kreos., Trillium. 

after menses: Calc. carb., Nitr. ac. 



Lungs, chronic catarrh; Iodium. 
Chest, fullness and pressure in: Sepia. 

, tightness in: Phosphor. 

, trembling sensation in middle of: 

Rhus tox. 
Cough, dry, hacking: Kali carb. 

, , worse before midnight: Phos- 

■ phor. 

Oppression, groaning: Bellad. 
Breathing heavy, gasps for breath: 

Ipec. 

short on going up stairs: Plumbum. 

Yawning: Bellad. 
Palpitation of heart: Apocyn. 

on going up stairs: Crocus. 

Cardiac anomalies: Digit. 



Back, heat in, and cold legs: Phosphor. 
, drawing, tearing in, and loins and 

hips: Rhus tox. 
Small of back, pain as if broken : Kali 

carb. 

, bruised and lame: Phosphor. 

and hips, as if falling to pieces, 

with desire to bind them up tightly: 

Trillium. 
, drawing, cutting, pressing from, to 

genitals: Sabina. 
, , clawing from, to os pubis: 

Chamom. 



, cutting from, and groins: Arg. nitr. 

, pain from, through hips and down 

the thighs: Clinic. 

, , to thighs: Lycop., Sabina. 

Pain from sacrum through the pelvis to 

the pubis: Bellad. 



Arms, jerking of: Bellad. 

Hands, convulsive trembling of, and 
feet: Hyosc. 

Thumbs, convulsive clenching of: Bel- 
lad. 

Lower limbs, debility of : Arg. nitr. 

, paralytic feeling of: Coccul. 

Cramp-like contraction of thighs: Rhus 
tox. 

Cramps in calves of legs: Secale. 

Varicose veins: Sepia. 

Swelling and painfulness of feet: Digit. 

Limbs, aching in: Cimic. 

, , and all over, worse in rest: 

Rhus tox. 

, tearing in: Bryon. 

, jerkings of: Lycop., Secale. 

, trembling of: Secale. 

, cold: Arsen., Cann. ind., Chamom., 

Ver. alb. 
and body feels as though they were 

growing larger: Platina. 



Itching all over .body, preventing sleep: 

Sulphur. 
Eruptions here and there, or suppressed 

eruptions: Sulphur. 
Skin dry, pale, yellowish; liver-spots: 

Plumbum. 
Spots and blisters on skin, with oozing of 

blood: Arsen. 



Chilliness, with obstinate sweating: 

Kali carb. 

from 4 p. m. 

Shudder ings : Ferrum . 
Coldness of skin: Digit. 

, general: Secale. 

of hands and feet: Cann. ind. 

of extremities: Chamom. 

Heat, or flushes of heat: Sulphur. 
Perspiration cold on face: Mercur. 
, obstinate, with chilliness: Kali 

carb. 



Sleepiness during day: Calc. phosph 



'OO 



AMENORRHEA. 



Sleep heavy, unrefreshing, full of 

dreams: Rhus tox. 
restless, with dreams falling from a 

height: Lycop. 
Sleepless and nervous agitation: Cann. 

ind. 
, tossing in bed from evening until 

after midnight: Trillium. 
on account of itching: Sulphur. 



Vascular excitement: Cauloph. 

and spasmodic jerkings of body: 

Hyosc. 

Nervous excitement: Crocus. 
Anaemia: Calc. carb., China, Hamam. 
Debility: Apoc. cann., Cauloph., Crocus, 

Plumbum. 
Fainting": China, Mercur. 

when raising head from a pillow: 

Apoc. cann. 

from little exertion: Sepia. 

Losing flesh: Phosphor. 

, notwithstanding good appetite: 

Iodium. 
Hysteric spasms: Cimic. 
Scrofulous diathesis: Calc. carb. 
Psoric taint: Sulphur. 
Gouty diathesis: Sabina. 

CAUSES. 

Abortus, threatening or actual: Cauloph., 
Chatnom., Eriger., Kali carb., Plum- 
bum, Rhus tox., Sabina, Trillium. 

Abortus or confinement: Bellad., Cau- 
loph., Ci'ocus., Ipec, Nitr. ac, Sabina, 
PI a tin a. 



, after taking away placenta: 

Ipcc. 
Difficult labor, or external injury: 

Arnica. 
Straining, lifting: Rhus tox. 

, , overheating: Crocus. 

During" pregnancy, Phosphor., Platina. 

, at fifth or seventh month: Sepia. 

Climacteric age: Calc. carb., Kreos., 

Laches., Nux vom., Plumbum, Secale , 

Sepia, Us til. 
Between menses: Phosphor. 



After mental excitement, emotions: 

Ignat., Platina. 
After abuse of chamomile tea: /gnat., 

Pulsal. 
coffee, liquors, high-seasoned food, 

drugs; sedentary life, etc.: Nux vom. 



Worse from slightest motion: Crocus, 

Sabina, Secale, Trillium. 
rising upon the feet, gushing: Coc- 

cul. 

walking: Sabina. 

when lying down: Amrn. carb., 

Cocc. cad., Cyclam., Kreos. 
Better, when moving about; Cocc. cact., 

Cyclam , Kreos. 
Worse in evening: Pulsat. 

at night: Amm. carb. 

after riding in cold air: Amm. carb. 

in warm temperature: Sabina. 

in cold: Nux vom. 

Better in the cold: Sabina, Secale. 



2. Amenorrhoea 

Consists of the absence of menstruation in women between the ages of puberty 
and climaxis, with the exception of the periods of pregnancy and nursing. 
The non-appearance of the menses at the age of puberty has its cause chiefly 
in chlorosis, scrofulosis, tuberculosis and rachitis. Rarer are those cases in 
which it depends upon a degeneration of the ovaries; more frequent those 
depending upon chronic infarctions or catarrhal processes of the womb in 
consequence of the above-stated constitutional diseases. It has been ob- 
served, likewise, as a consequence of spinal diseases, imperforation of the 
hymen, and closure of the os uteri. 

The cessation or suppression of the menses is usually a consequence of 
inflammatory processes, the causes of which have been detailed under the 
head of Metritis. 

Vicarious menstruation is that peculiar anomaly of the menstrual func- 



THERAPEUTIC HINTS TO AMENORRHCEA. 701 

tion, by which, at the regular monthly period, haemorrhage takes place, not 
from the womb, but by way of some other mucus membrane (nose, lungs, 
bowels, eyes, ears), from wounds, and from telangiectasias. The reality of 
such abnormal action is established beyond any doubt. 

The Symptoms of amenorrhcea consists chiefly of headache, especially on 
the top or on one side; heaviness of the feet; dyspnoea; dyspepsia; lassitude; 
sadness; sleepiness in the daytime; oedema; palpitation of the heart; epis- 
taxis; haemoptysis; haematemesis; swelling of the veins on the lower ex- 
tremities, in combination with all the constitutional signs upon which the 
whole disturbance rests as a basis. 

Therapeutic Hints. 

Aco7i. During puberty frequent bleeding of the nose; great palpitation 
of the heart; congestion of the head. After fright or taking cold. 

Apis. In young girls, who are constantly busily engaged in this or that, 
but do nothing right; who let everything fall out of their hands or break it, 
and laugh over it; also great congestion of the head, and even delirium; 
©edematous swelling of the lower extremities. 

Apoc. In young girls, attended with bloating of the abdomen and ex- 
tremities. 

Bellad. Haematemesis instead of the monthly discharge; congestion to 
the head. 

Bryon. Bleeding of the nose instead of the monthly flow. 

Calc. carb. In young girls of a plethoric habit, or a scrofulous diathe- 
sis, with different complaints, as if the menses would set in, but do not; sup- 
pression of the menses from working in water, with anasarca. 

Carb. veg. At the time the menses should appear, violent itching or 
old tetter y eruptions. 

Caustic. Epileptic fits during the time of puberty. 

China. After suppression by chagrin; secretion of milk in the breasts. 

Cimicif. In suppression from a cold, mental emotions and febrile 
symptoms; when rheumatic pains in the limbs, or intense headache, or uter- 
ine spasms are present. 

Coccul. Instead of the monthly flow: cramps deep in the abdomen; 
pressure in the chest; dyspnoea; groaning and moaning; great weakness, so 
that the patient is scarcely able to speak; paralytic feeling in the lower ex- 
tremities. 

Cyclam. Chlorotic state; great dizziness and headache. 

Cuprum. Typical paroxysms of the most violent cramps in the abdo- 
men, extending up into the chest, with nausea, retching and vomiting; con- 
vulsive motions of the limbs, with piercing shrieks. 

Digit. Age of puberty; dark, red, bluish color of the face; distended 
veins on eyes, ears, lips and tongue; constant yawning; irregular action of 
the heart; suffering feeling in bed; frequent desire to urinate; leucorrhoea; 



702 THERAPEUTIC HINTS TO AMENORRHCEA. 

painful and swollen feet and limbs, with paralytic feeling in them. Bloody 
expectoration or nosebleed. 

Graphit. After Pulsat.; congestion of the head and chest; dark red- 
ness of the face; constriction of the chest, when lying, with anxiety; itching 
between the fingers, and tetters; nails grow thick and crooked; the limbs 
upon which she lies go to sleep. 

Hamam. Vicarious bleeding from nose or stomach, with great con- 
stipation and varices on the legs. 

Kali card. Age of puberty; spasms of the chest; swelling of the face 
especially over the eyes; stiffness and pain in the small of the back; dryness 
of the skin; is easily frightened; sleepless after 3 o'clock a. m., feeling worse 
in all respects at that time. Spitting of blood before the menses; corroding 
leucorrhcea; pain in the anterior part of the thigh. 

Laches. Nosebleed and cardialgia instead of menses. 

Lycop. Suppression from a fright; great agitation of the blood in the 
evening, or a feeling as though circulation had ceased; great desire for sweet 
things; sour belching; great fullness in the stomach and bowels; liver spots 
on the chest. 

Mercur. Cessation of the menses for several months; headache; weak- 
ness of sight; nervous trembling of the hands; earthy color of the face; pro- 
lapsus uteri; diarrhoea with tenesmus; oedematous swelling all over; tearing 
in the limbs, worse at night in bed, with constant sweating. 

Millef. Haemoptysis. 

Natr. mur. Age of puberty; melancholy and sadness, or hastiness and 
impatience; awakes with headache; has frequent fluttering of the heart; the 
tongue is covered with small blisters, or shows the appearance of a so-called 
map-tongue; the bowels are costive and move with great difficulty, and there 
is cutting pain in the urethra after urination. 

Phosphor. Menses too late, or dot appearing; tight feeling in the 
chest, with dry, tight cough, and spitting of blood, worse before midnight; 
bloatedness below the eyes; a great deal of vertigo; leucorrhcea during the 
menses. 

Platina. Menses suppressed after a voyage. 

Pidsai. Age of puberty, or suppression, especially from getting the 
feet wet; nervous, timid, tearful disposition; always anxious about domestic 
affairs; pale, yellowish color of the face; dyspeptic feelings from eating pork 
or anything fat; inclined to looseness of the bowels; thirstlessness and chilli- 
ness; always feels w r orse in a warm room; haemoptysis, haeniatemesis. 

Rhus tox. Suppression from getting wet. 

Senedo gracilis. Suppression; inability to sleep, nervous irritability; loss 
of appetite; coated tongue; bowels constipated; constant feeling of lassitude; 
disinclined to move about; wandering pain in back and shoulders. Is 
called ' ' the female regulator. ' ' 

Sepia. Age of puberty or later; headache, with nausea; jerking with 
the head; paralytic sinking down of the eyelids; yellowness around the 



DYSMENORRHEA. 703 

mouth, across the cheeks and nose; loathing of all food, even the smell of 
cooking nauseates her; nausea when riding in a carriage; diarrhoea after 
drinking milk; cold hands and cold feet, with frequent flushes of heat to the 
head and face; pot-belliedness. Spitting of blood before the menses; leucor- 
rhoea three days after menses. 

Sulphur, Great congestion to the pelvic organs and to the head; cold 
feet, and heat on the top of the head; the patient is very irritable, and in- 
clined to religious reveries; chronic inflammation of the eyelids, or other 
psoric eruptions; dreads to wash with cold water; feels exhausted from talk- 
ing; all worse when standing; sleepy in the daytime; sleepless at night; great 
agitation of the blood in the whole bod}'. 

Xanthox. After getting the feet wet; nauseated by the sight of food; 
constipated, nervous, discouraged; shortness of breath; legs swollen. (J. 
W. Davis.) 

Digest see under Dysmenorrhcea^ 

3. Dysmenorrhoea, Menstruatio Difficilis. 

We nnderstand by this, painful menstruation, without regard to the 
quantity of blood discharged, though in most cases the menstrual flow is 
scanty. 

The different complaints accompanying it set in either before or at the 
time when the menstrual discharge begins, and generally last a day or two, 
and sometimes through the whole menstrual period. 

We distinguish, according to its causes, three forms of dysmenorrhoea; 

1. Dysmenorrhoea in consequence of strictural changes or flexions of 
the uterus, which has been termed by some writers mechanical dysmenorrhoea; 
compare the related chapters. 

2. Dysmenorrhoea in consequence of congestion in the uterus, or con- 
gestive dysmenorrhoea; it usually commences with all the signs of congestion 
to the pelvic organs — strong action of the heart, congestion of the head, and 
febrile motions in general. These symptoms continue one, two, or three 
da} r s, until a more profuse discharge of blood has taken place. Not only 
plethoric individuals are prone to it, but also weakly and anaemic individuals. 
It is possible that, in some instances, this congestive state is induced by a 
thickened state of the peritoneal covering of the ovaries, and the consequent 
difficult perforation of a Graafian follicle. Very violent congestion may 
cause an exudate between the mucous lining and the parenchyma of the 
uterus, in consequence of which portions of the loosened membrane are 
thrown off and discharged — membranous dysmenorrhoea. 

3. Dysmenorrhea in consequence of a morbid sensibility of the ner- 
vous system in general and the uterine nerves especially, or neuralgic dys- 
emenorrhcea. This manifests itself as a disturbance in the healty equilibrium 
of the mind's action and a dejection of spirits, which commences even before 
the menses; the menses are attended at their beginning with distressing pains 
in the uterine region, in the back and lower extremities, or with neuralgic 



704 THERAPEUTIC HINTS TO DYSMENORRHEA. 

pains in more distant organs, or with cramps, spasms, etc. It is quite possi- 
ble that in some cases the violent, spasmodic, labor-like pains in the womb 
are caused by a spasmodic closure of the os uteri. 

Therapeutic Hints. 

Compare the following chapters, and likewise those on Metritis and 
Displacements of the Womb. 

A ton. Congestive type, with violent headache; labor- like pressing in 
the womb; headache; restlessness; necessity to bend double on account of 
pain, but finds no relief in any position; tossing about. 

Amm. carb. Cramp-like pain in the womb before the flow, with pallor 
of face. (Talbot.) 

Apis Congestive type; violent, labor-like, bearing-down pains, followed 
by discharge of scant}*, dark, bloody mucus; stinging pain in the ovaries; 
scanty, dark urine; wax-colored skin. 

Arsen. Attended with various kinds of complaints; lancinations from 
the rectum to the anus and pudendum; toothache; restlessness; fear of being 
left alone; the pains are worse about midnight, seem intolerable, drive to 
despair and frenzy; external application of warmth relieves. 

Asdep. syr. Neuralgic type; intermitting, bearing-down, labor-like 
pains, accompanied with a copious discharge of urine. 

Bel lad. Congestive and neuralgic type; violent bearing down, as if 
everything would issue out; violent throbbing headache, better from external 
pressure; throbbing toothache; enlarged pupils; throbbing carotids, drowsi- 
ness and inability to go to sleep; spasmodic twitchings; delirium; rage; 
frenzy; wants to bite; tries to escape, etc. 

Bromium. Violent contractive spasms some hours after the commence- 
ment of the menstrual flow, with subsequent soreness of the abdomen; loud 
emissions of flatulence from the vagina; hard swelling in the ovarian region; 
blue-eyed persons. 

Bryon. Congestive tj-pe; tearing in all the limbs, aggravated by motion; 
great thirst, white tongue; constipation, or diarrhoea in the morning; great 
irascibility. 

Calc. carb. Various complaints; toothache after the menses; nervous 
debility; pale bloatedness of the face; cannot bear anything tight around the 
waist; stiffness of the nape of the neck; pain in the back; cold hands and feet; 
sensitiveness to cold air; bad consequences from washing; scrofulous indi- 
viduals. 

Calc. phosph. When during puberty the patient has not been careful; 
and dysmenorrhoea has resulted from these causes. (J. T. Kent.) 

Cact. grand. Menstruation with most terrible pains, causing her to cry 
out aloud and to weep; the pains come on periodically, mostly in the evening; 
the menses are scanty and cease flowing when lying down; constrictive pain 
in the region of the heart, a feeling as if the heart were grasped and com- 
pressed, as by a band of iron. 



THERAPEUTIC HINTS TO DYSMENORRHCEA. 705 

Caidoph. Painful contractions, congestion and irritability of the womb; 
scant} 7 flow; sympathetic cramps in the bladder and rectum; hysterical 
spasms of chest and larynx. 

Cliamom. Neuralgic type; drawing, clawing pain from back towards 
front, with discharge of dark, clotted blood; great impatience, with crying 
and screaming; bloated, red face, or one side red and the other pale; hot, 
sticky perspiration on the torehead; after chagrin. 

Cimicif. Aching in the limbs; severe pains in the back, down the 
thighs and through the hips, with heavy pressing down; labor-like pains, 
weeping mood; nervousness; hysteric spasms, cramps; tenderness of the 
hypogastric region; scanty or profuse flow of coagulated blood; between the 
menses, debility, neuralgic pains, tendency of prolapsus. 

Coccul. Cramp-pain deep in the bowels, instead of the monthly, with 
pressure in the chest, and anxiety, sobbing, moaning and groaning; great 
weakness and fainting spells; convulsive motions of the limbs whenever she 
wants to use them; after night-watching. 

Collin. When complicated with obstinate constipation, piles and pro- 
lapsus. 

Coloc. She draws the lower limbs up to the abdomen, to relieve the 
colicky pain; diarrhoea after indignation. 

Coniiim. Scanty menses; pressing downwards and drawing in the 
thighs; pain in the mammae; suppressed sexual instinct; globus hystericus; 
vertigo, especially when turning the head or lying down. 

Cuprum. Typical paroxysms of terrible cramps in the stomach, extend- 
ing to the chest, with nausea, retching and vomiting; also, general epilepti- 
form spasms, with piercing shrieks; great thirst; on swallowing any fluid 
there is an audible clucking noise in the throat, like that of emptying a 
bottle. 

Graphit. Scanty menses, with crampy pains in the bowels and chest, 
and labor-like pressing in the small of the back; she is full of despairing 
grief, with weeping; always wavering and hesitating; has vertigo unto fall- 
ing, and headache unto fainting, in the morning; pimply eruptions on the 
face about the monthly period; tettery eruptions, especially between the 
fingers, with great itching. 

Hamam. Severe pains through the lumbar and hypogastric regions, 
and down the legs; fullness of the bowels and brain, with severe pain through 
the whole head, resulting in stupor and deep sleep; varicosed veins on the 
legs; vicarious menstruation. 

Laches. Tearing in the abdomen, beating in the head, pain in the small 
of the back, and bruised feeling in the hips; all relieved by a full flow; bleed- 
ing of the nose before the menses; jealous disposition; craves coffee, and 
feels better after drinking it; ulcers on the legs, with a purplish circumfer- 
ence. 

Lauroc. Pain extending from sacrum to pubis; frontal headache, with 

45 



706 THERAPEUTIC HINTS TO DYSMENORRHEA. 

dizziness and dimness of vision; great melancholy; icy coldness of tongue, 
and coldness of extremities. (Osborn.) 

Magn. carb. During the pain no flow; flow more during night than 
during da3^; the blood is dark, acrid and thick; violent neuralgic pain in 
the face, right side, driving out of bed; or pain in the right shoulder or in 
the foot. 

Natr. mur. Menses scanty and dark; preceded by frontal headaches; 
often subject to fever-blisters on lips, and during summer to urticarious erup- 
tions. (R. E. Bilding.) 

Nux mosch. After suppression by bathing; fainting from pain; drowsi- 
ness, somnolence; changeable mood; does not know where she is; appears to 
herself as if changed to her surroundings; hands and feet icy-cold. 

Nux vom. Twisting pains moving about in the abdomen, with sickness 
of the stomach; crampy and stitching pains in the pelvic region; soreness 
across the pubis; cramps in the bladder; constant, unsuccessful urging to 
defecate; after all sorts of drugs and so-called pain-killers. 

Phosphor. Colicky pains; great fermentation in the bowels; a great deal 
of vertigo; chronic looseness of the bowels; or chronic constipation, with 
dry, narrow feces; slender-built women. 

Plati?ia. Great bearing down to the genitals, with profuse menstrua- 
tion; great fear of death; sadness and disposition to cry; or haughty disposi- 
tion; tetanous-like convulsions. 

Pulsat. Colicky pains, with tossing about; the blood flows by fits and 
starts; chilliness; thirstlessness; haemoptoe or hsematemesis; paleness of the 
face; mild, yielding, tearful disposition. 

Senecio. Cutting pains in the region of the sacrum, hypogastrium and 
groins, with too early or too profuse menses; she is pale, weak and nervous, 
and has a slight cough at night. 

Sepia. Colicky pains and scanty discharge; great bearing down, which 
obliges her to cross the limbs; morning sickness and great sensitiveness 
against any smell from cooking; toothache; half -sided headache; nausea; 
constipation. 

Sulphur. Scanty menses of a thick, acrid blood; crampy colic; terrible 
neuralgic pains in the face; much concerned about her salvation; congestion 
to the head and heat on the top of it; spotted redness of the face; cold feet; 
standing increases the pains; chronic eruptions here and there. 

Tarant. Before menses bearing-down pain; fidget}^ legs; must move 
about; better on riding horseback; during menses all worse with chorea-like 
restlessness, trembling and twitching of muscles. (P. Bender.) 

Viburn. op. Before menses pain in back, gradually extending to hypo- 
gastric region and down the thighs; headache with nausea and uneasiness; 
cramps and bearing down before discharge appears, lasting till after the flow 
has ceased. (J. C. King.) 

Xanthox. Neuralgic fever with pain along the course of the genito- 
crural nerve. (K. F. Blake. ) Abundant discharge. 



digest to amenorrhea. dysmenorrhea. 
Digest to Amenorrhcea, Dysmenorrhea. 



707 



Stupor and deep sleep: Hamam. 

Does not know where she is; appears to 
herself as if changed to her surround- 
ings: Nux mosch. 

Religious reveries : Sulphur. 

Delirium : Apis, Bellad. 

Frenzy: Arsen.-, Bellad. 

Hage, wants to bite; tries to escape: 
Bellad. 

Busy without accomplishing anything; 
let things drop out of their hands and 
laugh over it: Apis. 

Hasty and impatient: Natr. mur. 

Groaning" and moaning: Coccul. 

Cry out and weep for pain : Cact. grand. 

"Weeping*: Graphil. 

Crying", screaming: Chainom. 

Tossing" about, beside herself from pain: 
Aeon. 

Sad : Nat. mur., Blatina, Pulsat. 

Weeping" mood : Cimic, Platina. 

Melancholy: Lauroc, Nat. mur. 

Anxiety: Coccul., Graphit. 

about domestic affairs; Pulsat. 

about her salvation: Sulphur. 

Discouraged : Xanthox. 

Despair from pain: Arsen. 

Despairing grief : Graphit. 
Fear of being left alone: Arsen. 

of death: Platina. 

Changeable mood : Nux mosch. 

Yielding, mild disposition: Pulsat. 

Wavering, hesitating: Graphit. 

Irritable: Senec, Sulphur. 

Impatient irascibility: Bryon , Chamom. 

Jealous : Laches. 

Haughty : Platina. 

Nervous: Cimic, Pulsat., Secale, Senecio. 

Easily frightened : Kali carb. 

Vertigo : Phosphor. 

unto falling: Graphit. 

when turning head or lying down: 

Conium. 

and headache : Cyclam. 

unto fainting, worse in morn- 
ing: Graphit. 

■ and frontal headache with dimness 

of vison: Lauroc. 

Fullness of brain with headache, result- 
ing in stupor and deep sleep: Hamom. 

Congestion to head: Aeon., Apis, Bel- 
lad. 



and heat on top, and cold feet: 

Sulphur. 

and chest: Graphit. 

Flushes of heat to head and face: 

Laches., Sepia. 
Headache: Aeon, Cimic, Mercur. 

, throbbing, beating: Bellad., Laches. 

, , worse from external pressure: 

Bellad. 

, frontal: Natr. mur. 

, half-sided: Sepia. 

, awakens with: Natr. mur. 

, with nausea and jerking of head: 

Sepia. 
, and uneasiness: Viburn. op. 

Hot, sticky perspiration on forehead: 
Chamom. 



Distended veins on eyes, ears, lips and 

tongue: Digit. 
Paralytic sinking down of lids: Sepia. 
Chronic inflammation of lids, and other 

psoric eruptions: Sulphur. 
Enlarged pupils : Bellad. 
Weakness of sight: Mercur. 
Dimness of vision: Lauroc. 



Nosebleed: Digit. 

during puberty: Aeon. 

before menses: Laches. 

instead of menzes: Bryon., Laches. 

, vicarious, or hsematemesis : Hamam. 

Cold nose : Bellad. 

Face flushes frequently: Sepia. 

dark red: Graphit. 

, bluish: Digit. 

red on one side and pale on other: 

Chamom. 

spotted redness: Sulphur. 

pale, pallor: Amm. carb., Calc. carb., 

Pulsat. 

earthy color: Mercur. 

yellow : Pulsat. 

around mouth, across che.eks 

and nose: Sepia. 

bloated and pale: Pulsat. 

and red: Chamom. 

above eyes: Kali carb. 

- below eyes: Phosphor. 

, pimply eruptions about monthly 

period: Graphit. 

, fever blisters on lips: Natr. mur. 

, neuralgia, terrible: Sulphur. 



7o8 



DIGEST TO AMENORRHEA, DYSMENORRHEA. 



— , on right side, driving out of 

fled: Magn. carb. 



Tongue coated: Senec. 

white, with thirst: Bryon. 

covered with blisters: Natr. mur. 

, map-tongue: Natr. mur. 

, distended veins on: Digit. 

icy cold: Lauroc. 

Toothache : Arsen., Be/tad., Sepia. 
after menses: Calc carb. 



Thirst ; on swallowing audible clucking 

noise in throat: Cuprum. 
Thirstless : Pulsat. , Sepia. 
Craves coffee and feels better after drink- 
ing it: Laches. 

sweet things: Lycop. 

Loss of appetite: Senec. 

Loathing" of all food: Sepia. 

Nausea when smelling cooking: Sepia. 

when seeing food: Xauthox. 

when riding in a carriage: Sepia. 

, with twisting pains in bowels: Nux 

vom. 
Hsematemesis instead of menses: Bet lad, 

Hamam., Pulsat. 
Sour belching: Lycop. 
Dyspeptic feeling from eating pork or 

fat: Pulsat. 
Fullness in stomach and bowels: Lycop. 
Cramps in stomach, extending to chest, 

with nausea, belching and vomiting: 

Cuprum. 
Cardialgia instead of menses: Laches. 



Cannot bear anything tight around the 

waist: Calc. carb. 
Tenderness of hypogastric region: Cimic. 
Pains through hypogastric and lumbar 

region down the legs: Hamam. 
Fullness of bowels: Hamam. 
Colicky pains : Sulphur. 

and fermentation in bowels: Phos- 
phor. 

and scanty menses: Sepia. 

, must bend double: Aeon. 

, must draw lower limbs up to ab- 
domen: Coloc. 

, with tossing about: Pulsat. 

Cramp-pain, deep in abdomen, instead of 
menses: Coccul. 

in bowels and chest, and pressing 

down in small of back: Graphit. 



and bladder and rectum: Cau- 

loph. 

, extending to chest, with nausea, 

retching and vomiting: Cuprum. 

before and during menses: Viburn. 

Contractive spasms some hours after 
commencement of flow: Bromium. 

Cutting pains in hypogastrium, sacrum 
and groins: Senec. 

Tearing in abdomen: Laches. 

Lancinations from rectum to anus and 
pudendum: Arsen. 

Bloating of abdomen and extremities in 
young girls: Apoc. 

Pot-belliedness : Sepia. 

Constipation: Hamam., Senec, Sepia., 
Xanthox, 

, dry, narrow feces: Phosphor. 

, bowels move with difficulty: Natr. 

mur. 

, with piles and prolapsus: Collins. 

, or diarrhaea in the morning: Bryo?i. 

Diarrhoea: Phosphor., Pulsat. 

Diarrhoea with tenesmus: Merc. sol. 

after indignation: Coloc. 

after drinking milk: Sepia. 

Constant unsuccessful urging to defe- 
cate: Nux vam. 



Urine copious: Asclep. 

Frequent desire : Digit. 

Cutting in urethra after urination: Natr. 

mur. 
Urine scanty, dark: Apis. 
Soreness across pubis, and cramps in 

bladder: Nux vom. 



Bearing down: Aeon., Bellad., Cimic. 

, must cross her limb: Sepia. 

, intermitting: Asclep. 

in small of back: Graphit. 

, with discharge of dark, clotted 

blood: Chamom. 

and drawing in thighs: Conium. 

before menses: Tarant. 

and during menses: Vibicrn. 

, followed by discharge of scanty, 

dark, bloody mucus: Apis. 

with profuse menstruation: Platina. 

Painful contractions : Cauloph. 

Cramp-like pain in womb before the 
flow: Amm. carb. 

Crampy and stitching pain in pelvic re- 
gion: Nux vom. 



DIGEST TO AMENORRHEA, DYSMENORRHEA. 



709 



Stinging" pain in ovaries: Apis. 

Hard swelling" in ovarian region: Bryon. 

Neuralgia along the genito-crural nerve: 

Xanthox. 
Congestion and irritability of womb: 

Cauloph. 

of womb and head: Sulphur. 

During" pain no flow; more flow during 

night than during day: Magn. carb. 
Blood flows by fits and starts: Pulsat. 
Menses too late or not appearing: Phos- 
phor. 
Instead Of menses, itching of old tettery 

eruptions: Carb. veg. 

, cramp-pain deep in bowels: Coccul. 

, different complaints: Calc. carb. 

Menses scanty: Cauloph., Cimic., Co- 

nium, Graphit. 

, dark: Natr. mur. 

, , acrid and thick: Magn. 

carb., Sulphur. 
, , bloody mucus: Apis. 

, cease flowing when lying 

down: Cact. grand. 

profuse: Hatina, Xanthox. 

, coagulated blood: Cimic. 

• and too early: Senec. 

suppressed: Calc. carb., Mercur., 

Senec. 

by chagrin: China. 

by fright: Lycop. 

by mental emotions, a cold and 

febrile symptom: Cimic. 

from getting feet wet: Pulsat. 

from working in water:, Calc. 

carb. 

from bathing: Nux niosch. 

Between menses, debility, neuralgic 

pains, prolapsus: Cimic. 
Prolapsus uteri: Mercur. 
Leucorrhcea: Digit. 
Emissions of flatulence from vagina: 

Bromium. 
Suppressed sexual instinct: Conium. 



Cough, slight at night: Senec. 

dry, tight feeling in chest: Phos- 
phor. 

, with spitting of blood: Digit., Mil- 

lef., Pulsat. 

, , worse before midnight: Phos- 
phor. 

Congestion of chest and head: Graphit. 

Pressure on chest: Coccul. 



Constriction when lying, with anxiety: 

Graphit. 
Spasms of chest: Kali carb. 

and larynx: Cauloph. 

Dyspnoea: Coccul. 
Suffocating feeling in bed: Digit. 
Shortness of breath: Xanthox. 
Exhaustion from talking: Sulphur. 
Constant yawning: Digit. 

Heart, fluttering: Natr. mur. 

, palpitation: Aeon. 

, irregular action: Digit. 

constricted as if grasped by a band 

of iron: Cact. grand. 
Secretion of milk in the breasts: China. 
Liver-spots on chest: Lycop. 



Back-ache: Aeon., Calc. carb. 

, wandering back and shoulders: 

Senec. 

before menses, extending to hypo- 
gastric region and down the thighs: Vi- 
burn. 

down the thighs and through hips: 

Cimic. 
, towards front, with discharge of 

dark, clotted blood: Chamom. 
Pain in small of back, with stiffness: 

Kali carb. 

, with bruised feeling in hips: 

Laches. 

through lumbar and hypogastric re- 
gion down the legs: Hamam. 
from sacrum to pubis: Lauroc. 



Hands trembling: Mercur. 

, tetters and itching between fingers: 

Graphit. 

Nails thick and crooked: Graphit. 

Cold hands and feet: Calc. carb., Nux 
mosch., Sepia. 

Lower extremities, cedematous swelling 
of: Apis. 

, paralytic feeling of: Coccul. 

Legs, varicosed veins of: Hamam. 

, swollen: Xanthox. 

, ulcers on, with a purplish circum- 
ference: Laches. 

, fidgety of: Tarant. 

Feet cold: Sulphur. 

Limbs, aching, rheumatic pains: Cimic. 

, coldness: Lauroc. 

, tearing in, worse at night: Mercur. 

, , worse from motion; Brvou. 



710 



DIGEST TO AMENORRHEA, DYSMENORRHEA. 



swollen, with paralytic feeling: 

Digit. 

, bloating of abdomen and limbs: 

Apoc. 

, convulsive motions of, when she 

wants to use them : Coccul. 

, , with piercing shrieks: Cup- 
rum. 

upon which she lies go to sleep: 

Graphit. 

Pain in right shoulder or foot: Magn. 

card. 
Sleepy in daytime: Sulphur. 
Drowsiness, somnolence: Nux mosch. 
Stupor, deep sleep: Hamam. 
Drowsy, with inability to go to sleep: 

Bellad. 
Inability to sleep: Senec. 
Sleepless at night: Sulphur. 



Chilliness and thirstlessness: Pulsat. 

Neuralgic fever: Xanthox. 
Constant sweating: Mercur. 



Chlorotic state: Cyclam. 
Plethoric habit: Calc. card. 
Agitation of blood: Sulphur. 

in the evening: Lycop. 

Feeling 1 as though circulation had stop- 
ped: Lycop. 
Restlessness: Aeon., Arsen. 

, must move about: Tara?it. 

Disinclined to move about: Senec. 



Lassitude: Senec. 

Weakness, debility: Calc. card., Coccul. 

Fainting spells: Coccul. 

, from pain: Nux mosch. 



Chronic eruptions: Sulphur. 

Old tettery eruptions, itch when 

monthly should come on: Card. veg. 
Urticarious eruptions during summer: 

Natr. mur. 
Dryness of skin: Kalicarb. 
Wax-colored skin: Apis. 
(Edematous swelling all over: Calc 

card., Mercur. 



Spasmodic twitching: Bellad., Tarant. 

Cholrea-like restlessness during men- 
ses: Tar ant. 

Hysteric spasms: Cimic. 

Letanous-like convulsions: Platina. 

Epileptic fits during time of puberty: 
Caustic. ' 

Epileptiform spasms, with piercing 
shrieks: Cuprum. 



Scrofulous individuals: Calc. card. 

Chlorotic state: Cyclam. 

Age of puberty: Apoc. cann., Digit. , 

Kali card., Natr. mur., Platina, PuU 

sat. 
Blue-eyed persons: Bromium. 
Slender-built persons: Phosphor. 
Chagrin: Chamom. 
Fright and cold: Aeon. 
Getting feet wet: Xanthox. 
Suppression of menses: Mercur. % 

Senec. 

from working in water: Calc. card. 

from getting wet: Rhus tox. 

from getting feet wet: Pulsat. 

from bathing: Nux mosch. 

from cold, mental emotions, and 

fever: Cimic. 

from fright: Lycop. 

from chagrin: China. 

Worse from washing with cold water: 

Sulphur. 

from cold air: Calc. card. 

from staudiug: Sulphur. 

about midnight: Arsen. 

from warm room: Pulsat. 

Better from riding on horseback: 

Tarant. 

from external warmth: Arsen. 

from a full flow: Laches. 



Congestive type: Aeon., Apis, Bellad., 

Bryou. 
Neuralgic type: Asclep. syr., Bellad., 

Chamom. 



After Pulsat. follows Graphit. 
all sorts of drugs: Nux vom. 



VAGINA. 711 

VAGINA. 

Catarrh of the Vagina; Vaginitis. 

Like all other catarrhal affections of mucus membranes, it is character- 
ized by redness, swelling and increased secretion of mucus. There are here 
and there little protuberances, which consist of swollen papillae of the mucous 
membrane; it invests either a part of the vagina, or extends all over this 
organ. The secretion is at first scanty, but by degrees becomes more profuse 
and opaque. In chronic casss we find the vagina relaxed, its mucous lining 
bluish-red, and studded with swollen papillae. This relaxation not unfre- 
quently leads to prolapsus vaginae. The secretion is in such cases milky, 
more or less yellow, and sometimes of other appearances. It constitutes what 
is commonly called leucorrhoea, which is frequently the only sign of the exist- 
ing trouble. 

Its Causes are like those of the uterine catarrh, as recorded in their 
respective chapters: it is of quite rare occurrence during childhood, in which 
case it may be induced by the little thread- worms (oxyures) creeping from 
anus across the perineum into the vagina. 

Therapeutic Hints. 
Compare Uterine Catarrah. 

The virulent catarrh of the vagina is spoken of in the chapter of 
Gonorrhoea. 

Vaginismus 

Is defined by Schrceder as "an excessive sensitiveness of the orifice of the 
vagina, combined with spasmodic contraction of the constrictor cunni and 
the muscles of the floor of the pelvis." However, in some cases the introduc- 
tion of the finger for the purpose of examination has caused not only the 
most intense pain, but even hysterical convulsions, without contraction of the 
constrictor cunni. The anatomical changes are usually unimportant. In 
recent cases we find the affected parts usually swollen, with erosions, 
swellings of follicles and discharge from the mucous membrane; or papil- 
lary excrescences in the fossa navicularis, all of which may at a later period 
disappear again. These changes are most probably the consequence of 
mechanical irritation, brought about by unsuccessful attempts at coition; for 
the most usual source of vaginism is a small orifice and a want of moisture 
of the vagina, which, when associated with certain physical states, such as 
fear, apprehension, etc., and an existing oversensitiveness of the parts, may 
cause the whole series of distressing symptoms. Nettel mentions a case in 
which vaginismus seemed to be a symptom of lead poisoning, induced by the 
use of cosmetics. 

Therapeutic Hints. 

Coition ought not to be practiced until the hyperesthesia is in some 
measure overcome by hip-baths, injections of warm water, oiling the parts, 



712 PRURITUS VULV^. 

and the application either of one or the other of the following remedies, as 
indicated: 

Arnica. After forced attempts at coition. 

Bellad. Dryness of the vagina; contraction of the sphincter muscle, 

Cactus grand. Merely touching the parts causes constriction of the 
vagina, and prevents coition. 

Ferr. phosph. Painful coition. 

Ignat. When the mental symptoms correspond, with great proneness 
to spasmodic troubles. 

Kreos. Painful coition. 

Lycop. Dryness of vagina, with pain during and after coition. 

Natr. viur. Dryness of vagina, painful coition, and aversion to it. 

Platiiia. The slightest touch causes constriction of the vagina, and is 
so painful that spasms may ensue. 

Plumbum. Has caused this complaint. 

Sepia. Tenderness of parts; painful coition. 

Pruritus Vulvae 

Is frequently a mere symptom of other diseased conditions of the sexual 
organs. We find it in the beginning of pregnancy, and also before the men- 
strual flow; but its most intense forms occur during the climaxis, especially 
of unmarried women. The itching is so intolerable and distressing that it 
takes away all sleep and rest, and causes a number of nervous complaints. 
Physical examination generally reveals no particular change of the parts, 
except perhaps some dryness of the vagina or slight eruptions on the labia. 
Such persons are often subject to hcemorrhoidal complaints, and it is possible 
that this terrible itching is dependent upon a stagnation of blood in the 
vaginal veins. 

Therapeutic Hints. 

Ambra. During pregnancy, with soreness and swelling of the parts; 
numb feeling of the whole surface of the body in the morning; perspiration 
of the abdomen and thighs in the daytime when moving about; falling out 
of the hair, and great sensitiveness of the scalp to the touch. 

Bell. Of great clinical value as a cerate. 

Caladium. According to the experience of others and my own the most 
efficient remedy; the terrible itching sometimes causes the habit of onanism. 

Calc. carb. Itching and soreness; offensive discharge from the ears; 
cold in the head, with soreness inside of the nose; scrofulous taint. 

Canthar. Climacteric age; from rubbing and scratching, the skin swells 
into little tumors; urinary difficulties. 

Carb veg. Itching and burning of the pudendum and anus, especially 
before the menses; itching, tettery eruptions on the body; leucorrhcea, with 
burning and soreness; hcemorrhoids. 

Collin. Distressing itching, in connection with prolapsus and consti- 
pation. 



MAMM4. 7 r 3 

Conium. Violent itching of the pudendum and vagina, especially after 
the menses, followed by a pressing downwards of the uterus. 

Lycop. Itching, burning and gnawing, with chronic dryness of the 
vagina; varicose veins. 

Natr. mur. Falling out of the hair on the mons veneris; dryness or 
coolness and paleness of the vagina; aversion to an embrace; eruption on the 
boundaries of the hair on the neck. 

Nux. vom. Tingling and itching in the parts, which excites sexual de- 
sire and induces onanism. 

Plati?ia. When the sexual desire is greatly augmented, even to nympho- 
mania. 

Sepia. Swelling and itching eruption on the inner labia; leucorrhcea, 
with itching in the vagina and pudendum; ringworm- like eruptions on other 
parts of the body. 

Sulphur. Itching in the vagina and pudendum, with pimples all around; 
itching of the nose after menstruation; itching of the nipples; pimples here 
and there; haemorrhoids. 

Tab a cum. 

Tarant. Dryness and heat of the parts. 

Zincum. Excessive itching during the menses, inducing masturbation. 

MAMMAE. 
Mastitis, Inflammation of the Breasts. 

It develops itself chiefly during the period of nursing, and usually at 
the commencement; less frequently during weaning. Its cause is stagnation 
of milk within the gland or a tube of the gland, induced by sore or imper- 
fect nipples; or weakness of the child, in consequence of which the breasts 
are not thoroughly emptied of their contents; or undue pressure exercised 
upon the gland by misfitting dresses, producing obstructions in single tubes 
of the gland and final inflammatory symptoms. Here then we have an in- 
flammation of the milk-ducts of the mammae, which commences within and 
spreads outward. In other cases the inflammation begins in the subcutane- 
ous cellular tissue; a kind of erysipelatous inflammation, spreading inward, 
and caking a portion of the breast. This form may be caused by external in- 
juries, bruises, exposure to cold, and by fright; or it may be the result of the 
spreading of the above-named inflammation of the milk-ducts. 

It is a most painful affection in either case, and frequently results in the 
formation of abscesses. 

Thkrapkutic Hints. 

Apis. Burning, stinging pains in the breasts; considerable swelling and 
hardness; erysipelatous inflammation. 

Arnica. Soreness of the nipples; bruises of the breast. 

Bellad. During nursing and weaning, great hardness and swelling; 



714 THERAPEUTIC HINTS TO MAJDLE. 

bright redness in streaks along the milk-ducts; throbbing, stitching pain: 
headache; fever; worse in the afternoon; bowels constipated, and urine 
scanty. 

Bryon. Sets in mostly with a chill, followed by fever; great stitching 
pain in the breast, worse from slightest motion; tense swelling; little or no 
redness; bursting pain in the head when rising, with dizziness; great thirst; 
thick-coated tongue; constipation: feces as if burnt; pain in all the limbs 
when moving. 

Graphit. Inflamed, cracked nipples; tetter y eruptions on the scalp, 
hands and between the fingers; indurated Meibomian glands; old cicatrices 
from former inflammations. 

Hamam. Bleeding nipples, with great soreness. 

Hepar. Pain in the upper arms and thighs, as if in the bones; great 
hastiness in drinking and speaking; also in persons who have taken a great 
deal of mercury; when suppuration commences with frequent crawls, or 
when, after the breaking or opening of the abscesses the discharge is scanty, 
and there still remains great hardness of the inflamed parts. 

Laches. When the inflamed breast has a purplish appearance. 

Mercur. Especially when after Bellad., notwithstanding, suppuration 
sets in; chilliness and profuse sweat, which does not relieve; great nervous 
weakness and trembling; also in cases where suppuration takes place in 
different parts of the breast. 

Nux vom. Xipples painful during suckling, with little or no soreness 
or rawness. 

Phosphor. Phlegmonous inflammation; breast swollen; red in spots or 
streaks; hard knots in different places, with fistulous opening, discharging a 
watery, discolored, offensive ichor; dry, hacking cough, with hectic fever 
and colliquative sweats; slender built women, with a white and tender skin; 
weakened by disease or loss of fluids. 

Phytol. Sore and fissured nipples, with intense suffering when putting 
the child to the breast; the pain seems to start from the nipple and irradiate 
all over the body, going to the backbone, and streaking up and down, with 
excessive flow of milk, causing great exhaustion; a few days after confine- 
ment sudden chill, followed by some fever and a painful engorgement and 
swelling of the mammae; the drawing of milk is impossible. In ordinary 
caked breasts it is called specific. Badly-treated " gathered breast," with 
large, fistulous, gaping and angry ulcers, filled with unhealthy granulations 
and discharging a watery, fetid, ichorous pus; the gland is full of hard, 
painful nodosities. 

Rhus fox. Soreness and swelling of the breast from taking cold, 
especially getting wet; pain in all the limbs; worse when at rest; great rest- 
lessness; the lochial discharge turns red again. 

Silic. Chronic cases; when Phosphor, is not sufficient to heal the fistu- 



SCIRRHUS SEU CARCINOMA MAMM^. 7 15 

lous opening with callous edges, or to disperse the hard lumps in the breast' 
pale, earthy, color in the face; loss of smell; hectic fever. 

Sulphur. Sore and cracked nipples, with bleeding when nursing, the 
areolae are covered with yellowish scales, from underneath of which oozes an 
acrid fluid, with itching and burning in the night; hard lumps in the breast; 
ulcerating sore, with spongy excrescences and great itching; sleepless 
nights. 

Scirrhus seu Carcinoma Mammae, Scirrhus, or Cancer of the 

Breast. 

The scirrhous form is the most frequent; it appears either deep in the 
gland or nearer the surface, as a roundish tumor, which draws the region of 
nipple inward, causing a navel-like depression by its gradual contraction and 
its adhesion to the external skin. Its development is slow, but terminates 
finally in a deep ulcer, with callous, exuberant edges, and a foul, fungous 
opening. 

The medullary Cancer is of rare occarrence. It appears as one or sev- 
eral tumors, which destroy in a short time the surrounding parts of the 
gland, by ulcerating and producing fungous growths. 

The development of cancerous growths rest upon a constitutional con- 
tamination, the nature of which we do not know. Its development is, in 
most cases, slow, often intermitting, making halts for a long time. Finally, 
it perforates the skin, and appears as an open cancer, making rapid strides 
to final destruction. 

It is generally found in one breast at a time; sometimes in both, and 
often combined with scirrhous degeneration in other parts of the system. It 
causes the most intense, burning, stinging, lancinating pains, which deprive 
the patient of sleep and rest. The open ulcer discharges profusely an offen- 
sive ichor, or it bleeds easily and profusely when, by erosion, blood-vessels 
become destroyed. The nutritive action of the system is completely pros- 
trated, and we see the patient gradually lose strength and sink, with 
symptoms of marasmus, oedema of the lower extremities, colliquative 
diarrhoea or a sudden profuse haemmorrhage from the ulcer. 

Therapeutic Hints. 

Apis. When there is stinging, burning pain, whether in scirrhous 
tumors or in open cancers; pain in the ovarian region, with bearing down; 
scanty, dark urine; oedema of the lower extremities. 

Arsen. Nightly, burning pain like fire, with great restlessness; loss of 
strength and emaciation ; the pains grow better from the external application 
of warmth. 

Ars.jod. With swelling of gland in axilla. 

Asterias rub. Recommended by Petros for cancers of the left breast. 

Badiaga. Ought to be thought of, at least. 



7l6 THERAPEUTIC HINTS TO SCIRRHUS SEU CARCINOMA MAMM^. 

Bellad. Scirrhous tumors, with, erysipelatous inflammation and stitch- 
ing pain; frequent bearing down in the genital organs. 

Bromium. " After the extirpation of a hard tumor in the left breast, 
there appears a hard, uneven tumor in the right breast, which is grown tight 
to its surroundings; periodical lancinating pains, especially at night, worse 
from external pressure; grayish, earthy complexion of the face; suppression 
of menses; emaciation, and great depression of spirits." 

Calc. card. Indurations of the breast; too early and too profuse men- 
struation; soreness and swelling of breast before the menses. 

Calc. ox. Has, more than an) T other remedy, relieved the terrible pains 
in open cancers. 

Card. an. Scirrhous tumor, hard and uneven; the skin over it is loose, 
on places of a dirty, blue-red appearance; the pains are burning and drawing 
toward the axilla; oppression of the chest; nightly perspiration of the thighs 
only; desponding. 

Chim. umb. Tumor broke and left a small, irregular ulcer, with wasted 
edges, sloughing, discharging fetid pus; auxiliary glands enlarged. (E. S. 
Coburn.) 

Clemat. Scirrhus, left side, with stitches in the shoulder; or when the 
whole gland is very painful, worse in cold weather and during the night; 
worse during the growing moon; while perspiring, she cannot bear to be un- 
covered. 

Conium. Particularly, if the origin of the tumor can be traced to a 
bruise; starting, lancinating pains. 

Graphit. When the tumor grows out of old cicatrices, which have 
been formed by repeated gatherings of the breast. 

Hydrast. Scirrhous tumor; hard, heavy, and adherent to the skin, 
which is dark, mottled and very much puckered; the nipple being retracted; 
pains like knives thrust into the part; cachectic appearance of the face. 

Laches. Tumor in the left breast, with lancinating pain; inconsequence 
of pressure upon the tumor the pain extends into the left shoulder and down 
the arm; there is a constant painful feeling of weakness and lameness in the 
left shoulder and arm, which is aggravated by using the arm. In open can- 
cer, when it has a dark, bluish -red appearance, with blackish streaks of co- 
agulated and decomposed blood; chronic leucorrhcea; painful menstruation 
on the first day. 

Lapis alb. Recommended by v. Grauvogl. 

Lycop. Hard tumors, with stitching or cramping pain; circumscribed 
redness of the face; worse from 4 o'clock p. m.; during the paroxysms of 
pain she is obliged to walk about and to weep; she feels better in the open 
air. 

Nitr. ac. (Woodward.) 

Phosphor. When the ulcer bleeds easily. 

Sepia. Indurations in the breast and ovaries; yellow, spotted face; 
chronic leucorrhcea. 



THERAPEUTIC HINTS TO SCIRRHUS SEU CARCINOMA MAMM^. 717 

Silic. With great itching of the swollen gland. (J. B. Bell.) 
Compare besides, Aur. mur., Baryta, Card, veg., Chamom., Cistus, 

Hamam., Hepar, Natr. mur., Nitr. ac, Phytol., Rumex, Sulphur, Thuja, 

Zincum. 



SPINE. 



Anaemia, 

Is a diminution in the amount of blood contained in the cord, either in con- 
sequence of an insufficient supply of arterial blood, or in consequence of gen- 
eral anaemia. The insufficient supply may be due to weakness of the heart's 
impulse, to compression, thrombosis or embolism of the abdominal aorta, or of 
certain spinal arteries. General anaemia may be the consequence of great loss 
of blood, severe acute diseases, inanition, etc. 

Embolism of the aorta is usually followed by a rapid palsy of the legs, 
sphincters, reflex functions, etc. ; while in compression of the aorta the symp- 
toms of paralysis keep pace with the gradual development of the constriction. 
Anaemia caused by thrombosis and embolism of small arteries, gives rise 
probably to mere local and subordinate symptoms, of which nothing is known 
definitely. 

If general anaemia be the cause of spinal anaemia, the symptoms of the 
later will be so covered by the general complex of symptoms, that it will be 
hard to say what belongs to one or to the other, although motor weakness and 
slight tremor after exertion, later paresis and finally paralysis, first of the 
lower limbs and extending upwards to trunk and arms, may be attributed to 
spinal anaemia. The symptoms usually are relieved in a horizontal position. 

Therapeutic Hints. 

We will have to consider the various causes. There may be indicated: 
Arsen., Calc. carb., China, Cimicif., Ferrum, Gelsem., Ignat., Nux vom. y 
Phosphor., Phosph. ac, Secale, etc. 

Hyperaemia 

Is an increase in the amount of blood contained in the spinal cord and mem- 
branes, either in consequence of congestion (active or artificial fluxion) or 
stagnation (venous stasis). 

Congestion may be produced by overstimulation of the cord — from over- 
work, severe marching, sexual excesses, etc. ; by poisoning with strychnia, 
nitrite of amy], carbonic acid, alcohol, absinthe, etc.; by collateral fluxion 
in consequence of the suppression of menses, haemorrhoidal bleedings, foot- 
sweat, etc., or taking cold in general; by falls and bruises; and by febrile 
diseases. 

Venous stasis finds its causes in diseases of the heart and lungs, in ob- 



APOPLEXY. 719 

structions of the portal system, and accompanies severe spasmodic affections, 
such as tetanus, eclampsia, etc. 

The symptoms of spinal hyperemia are, without exception, bilateral, 
and usually limited to the lower limbs; they change their seat and degree of 
severity frequently and quickly, and are often relieved in a horizontal posi- 
tion. They consist at times of pain in the loins and along the spine, or of 
tingling, formication, or tearing pain in the lower extremities; of hyperes- 
thesia of the skin, girdle sensation and transitory jerking of the muscles, 
and trembling of the limbs. At other times we find symptoms of depression, 
such as numbness and heaviness of the lower limbs and slight anaesthesia. 

Therapeutic Hints. 

Congestion may require: Aeon., Arnica, Arsen., Bellad., Cuprum, 
Hype?., Nux vom., Rhus tox., Sulphur, etc. Venous stasis: Compare heart 
and lung diseases; abdominal disorders. 

Apoplexy, or Extravasation of Blood 

Within the spinal canal. This may take place between the vertebrae and 
the dura mater, or between the different spinal membranes, or within the 
spinal marrow itself. It is, compared with apoplexy of the brain, of very 
rare occurrence. This may have its reason partly in the peculiarity of the 
structure of the spine and its circulation, having numerous outlets and in- 
lets, thus giving less occasion for stagnation in the circulation; and partly in 
the greater security with which a long cord like the spinal marrow is held 
by its membranes, than a larger bulk, like the brain. 

1. Meningeal apoplexy, being an extravasation of blood between the 
spinal membranes, shows, when anatomically examined, a collection, usually 
of dark, coagulated, seldom fluid, blood, which extends over a smaller or 
larger surface within the spinal cord, sometimes filling the whole spinal 
column. 

Its Causes are manifold. The blood may, in consequence of apoplex}^ 
of the brain, or in consequence of the rupture of aneurismal swellings of 
blood-vessels in the brain, percolate into the spine. Its most frequent causes, 
however, are external injuries, either from excessive bodily exertions, or a 
fall, blow or wound, or diseases of the vertebrae. Trismus and tetanus seem 
to cause it secondarily. 

Symptoms. — If it sets in suddenly, the patient falls down, as in an apo- 
pletic fit, but without loss of conscioussness or sense. If it devolops slowly, it 
commences usually with headache and pain in the spine in the region of the 
exudation, which radiates in various directions, usually corresponding to 
the distribution of the nerve-roots first attacked; there is also formication, 
burning, tingling, etc., in the same regions, and characteristic jerkings of the 
muscles, occasionslly increasing to convulsions, trembling of the extremities, 
tonic tension and contracture of various groups of muscles, and tetanic stiff- 



720 THERAPEUTIC HINTS TO APOPLEXY. 

ness and painfulness of the back, making it difficult or impossible for the 
patient to move. After this, especially in large effusions, we observe numb- 
ness, pithiness, sensation of swelling and heaviness in the limbs and trunk, 
which may increase to paresis or even paralysis of the parts which are gov- 
erned from the spot affected. 

If the cervical region is affected the attack begins with pain in the occi- 
put, shoulders and arms, and stiff neck; anaesthesia and paralysis of upper 
extremities; oculo-pupillary symptoms; difficulty of breathing and swallow- 
ing; violent dyspncea; retarded and weak pulse. If in the dorsal region, we 
have pain in the back and abdomen, and pain in the form of a girdle; stiff- 
ness of the back; paralysis of the legs and abdominal muscles. If in the 
lumbar region, there is a pain in the loins, tearing in the lower limbs, peri- 
neum, bladder and genitals; stiffness of the loins; paralysis of the lower 
limbs, of bladder and rectum. 

2. Medullary apoplexy, an effusion of blood within the spinal marrow 
itself, is found chiefly in the gray substance of the marrow and is of various 
extent. It may be no larger than a pea, and it may reach the size of a hazel- 
nut or an almond. Such effusions have been found most frequently in the 
cervical, less frequently in the dorsal, and least frequently in the lower por- 
tion of the spine. 

Its Causes are chiefly inflammation, softening, or other lesions of the 
marrow which precede it. In some cases it seems to have been produced 
by external injuries (fall, concussion, with or wdthout fracture or luxation 
of the vertebrae, surgical operations), or by active congestion from taking 
cold, sexual excesses, overexertions of the body, etc. 

Symptoms. — As premonitory signs we find numbness in the fingers and 
in the feet; after exertion, great weakness and stiffness of the nape of the 
neck, extremities, or of the whole body. Its existence is characterized by a 
loss of voluntary motion, which maj^ come on suddenly or in the course of a 
short time more gradually. This paralysis affects all the parts which receive 
their nerves from that portion of the spine below the lesion, and it is always 
found on both sides. The paralyzed muscles are perfectly lax. 

Like motion, so is also sensation more or less impaired. The parts below 
the lesion become on both sides insensible to touch or partially so. If para- 
plegia lasts for some time it causes the limbs to shrink, and brings on gan- 
grenous bed-sores, sometimes quite rapidly. 

A lesion higher up affects the actions of respiration and deglutition, and 
the nearer to the medulla oblongata the more so, causing cessation of respira- 
tion and consequent death by asphyxia. 

Effusions in the dorsal and lumbar regions ma3 T exist for }^ears, and if 
not too extensive may allow even a partial recovery. 

Therapeutic Hints. 

The causes will hint to the appropriate remedies. Compare the fore- 
going chapters. 



SPINAL IRRITATION. 72 1 

Guaco is, according to Dr. Krb, a specific for paralysis of the tongue 
and extremities in consequence of blood}^ extravasation within the spine. 

Spinal Irritation. 

This complaint has by some been stricken out of the nomenclature of 
special diseases; Hammond considers it due to spinal anaemia, especially of 
the posterior columns, probably dependent upon some derangement of the 
sympathetic system; Ollivier and others consider it due to spinal hyperaemia, 
and still others look upon it as a dynamic disease, a functional disorder of 
the spinal cord, as there does not exist a pathological anatomy of spinal irri- 
tation. Neverthess a certain group of symptoms, frequently found in 
women, seems to demand a separate consideration of spinal irritation, even if 
it be but a dynamic disturbance of the spinal cord. 

Its most prominent Symptoms are: Pain and discomfort in the back, 
most frequently between the shoulder-blades, next in the back of the neck, 
less frequently in the loins, always increased from bodily exertions. The 
sore or sensitive spot or spots of the spine are easily detected by pressure, 
tapping, the passage of a hot sponge down the spine, and other irritations; 
at other times the pain is deep seated and is produced by pressure upon verte- 
brae which are not sensitive, also by movements of the spinal column, by stand- 
ing, etc. With these pains in the spine are frequently associated neuralgic 
pains in different parts of the body, sometimes fleeting, sometimes more sta- 
tionar3^. There is usually great weariness and exhaustion upon slight efforts, 
so that walking or manual occupations, such as sewing, writing, piano-play- 
ing, etc., soon become unbearable on account of the pains they excite in back 
and limbs. Spasmodic s3^mptoms, such as twitchings, choreoid movements, 
singultus, etc.,. are often observed, and disturbances in the vegetative organs — 
belching, nausea, vomiting; palpitation of the heart, dyspnoea, spasmodic 
cough, frequent desire to urinate, with abundant discharge of pale, clear 
urine — are frequently met with; numbness, tingling and paretic symptoms 
are of less frequent occurrence. The patients are irritable, depressed and 
often sleepless; they complain of dizziness, noise in ears and an inability to 
read for any length of time; their hands and feet are usually cold and they 
flush easily. 

Spinal irriiation, if located in the cervical region, causes head and chest 
symptoms, if in the dorsal region, intercostal neuralgia, gastralgia, nausea, 
etc., if in the lumbar region, symptoms of the pelvic organs and lower ex- 
tremities; and if diffused, symptoms of all kinds in peripherical organs. 

Spinal irritation is of no stated duration; it may last for years with 
many fluctuations. 

Therapeutic Hints, 

A great number of remedies may be indicated and the treatment must be 
wholly symptomatical. The following remedies have proved successful in 
actual cases: 
46 



722 THERAPEUTIC HINTS TO SPINAL IRRITATION. 

Act. iac. Constant nausea and retching on pressure upon the spine, be- 
tween the fourth and fifth vertebra; frequent fainting; palpitation on least 
movement; amenorrhcea. 

Asa/. Great painfulness of spine; belching; palpitation of heart in the 
night. 

Bcllad. On pressure upon the dorsal vertebrae she cries out, gets pale, 
nauseated and belches wind; in the spine continual burning pain; stomach 
sore to touch, with nausea and vomiting after eating. Or, sudden shriek on 
pressure upon the fourth dosal vertebra, followed by a dry, violent cough, 
red face, headache in forehead, photophobia and perspiration. 

Coccul. Stiffness of neck; pain in lower portion of spine; oppression of 
chest; palpitation of heart; trembling of limbs; numbness of right upper 
and lower limb. (Small.) Great hyperesthesia of all the senses, and an 
exalted susceptibility to impressions; dreadful headache, sleeplessness; when 
her mind is turned away from herself, her sufferings are forgotten. (C. W. 
Boyce.) 

Hype7\ Tenderness of entire spine; paroxysms of pain in different 
joints, accompanied by mania; frightful illusions; attempting to hide from 
wild beasts; screaming if approached; no recollection of the attack; appeared 
as if just aroused from sleep. (A. L. Dornberg.) 

Natr. mur. Headache on waking in the morning; sleeplessness; consti- 
pation; salty taste and repugnance to food; trembling sensation in region of 
heart. Vision becomes dim and indistinct after reading a while; eyes sore 
on pressure upon them; occasional neuralgia in forehead, with nausea and 
sensitiveness of eyes to gaslight; at times only one-half of an object is 
visible; black spots and streaks of light before eyes; easily fatigued; weak- 
ness from slight exertion; restlessness of the limbs; pain in back and sensi- 
tiveness of spine. (Burr.) 

Piper meth. Pain in the back of the head and spine, and relief from 
all sufferings temporarily by change (mental or physical); slight excitement, 
or diversion of the mind to some other topic. 

Rhus fox, Violent pain in head from back to front, and down the 
spine; lies on her back; head and back drawn backward, the slightest touch 
or move causes excruciating pain. Pulse slow; obstinate constipation; com- 
plete sleeplessness; pain in paroxysms. After getting wet. (Dittrich.) 

Secale. Tenderness of lower cervical and upper dorsal spinous processes 
with stiffness of neck. Pressure upon it produces pain there and all through 
the chest, with irritation to cough. 

Tarant. A slight touch along the spine provokes spasmodic pains in 
the chest and indescribable distress in the cardiac region; at times the heart 
feels as if twisted over; intense headache, as though thousands of needles 
were picking into the brain; sensation of burning all over the body. She 
trembled so she could hardly talk. Headache relieved by rubbing the head 
against the pillow. (Farrington.) 



HYDRORRHACHIS CONGENITA. 723 

Hydrorrhachis Congenita; Spina Bifida. 

This is an affection entirely analogous to congenital hydrocephalus. 
Being an imperfect development of the foetus, the latter is frequently ex- 
pelled before its full time. There are cases, however, in which children are 
born with this affection at full time. Its nature, like hydrocephalus congen- 
itus, is that of a dropsical effusion of serum, either between the dura mater 
and the vertebrae, or into the subarachnoidal space, or within the central 
canal of the spinal marrow. 

When such effusion takes place, before the vertebrae have perfectly 
closed, its pressure from within prevents their final closing; thus, from de- 
ficiency of the vertebral arches, the spinal column, posteriorly, appears cleft 
in two ; hence the name " spina bifida." This cleft may be of different de- 
grees. There may be only one of the vertebrae not closed. In the worst 
cases, this anomaly extends over the whole spinal column. In most cases, 
however, the split is confined to the lumbar or sacral region. Through this 
opening the fluid which collects inside presses out, and appears in the corre- 
sponding region as a smaller or larger tumor, according to the size of the 
opening and according to the quantity of fluid contained therein. In almost 
all cases this tumor grows rapidly after birth; it fluctuates; becomes denser 
and larger when the child cries, inhales, or presses at stool, or when it is held 
in an upright position; it sinks in, becomes smaller, when the child is quiet, 
lies in a horizontal position, or when it exhales. External pressure upon the 
tumor is painful to the child, often causes convulsions and, if combined with 
hydrocephalus, sopor and general paralytic symptoms. But these signs may 
all be wanting, when its communication with the spinal canal is very narrow. 
In some cases it is not fluid alone that protrudes through the opening of the 
vertebrae, but also portions of the spinal marrow itself, with its membranes 
and nerves. Such tumors are less fluctuating than those which consist of 
mere serum. 

In some cases the tumor or sac bursts during the birth of the child; in 
other cases, as alreadly stated, the tumor grows rapidly after birth; the in- 
teguments gradually inflame, become excoriated, and finally burst in a large 
circumference, which is followed by convulsions and death. In still others, 
only small openings form, and the fluid gradually oozes out of it; it may 
close and reopen again; most generally such cases terminate in death. Still 
there are cases on record in which individuals affected with spina bifida have 
lived to the age of puberty and longer. 

Therapeutic Hints. 

As the most important remedies, compare Arsen., Calc. card., Calc. 
phospk., Lycop., Silic, Sulphur. 

Case cured by Calc. phos. (Dr. H. P. Skiles). The Clinique, March 15, 
1887, p. 105. 



724 LEPTOMENINGITIS SPINALIS. 

Leptomeningitis Spinalis. 

We understand by this an inflammation of the soft membranes, the spinal 
pia mater and arachnoid ; inflammation of the dnra mater is rarely met with 
as a primary disease. 

Pathology. — The pia mater appears pale reddish, sometimes purple, 
swollen, and infiltrated with a jelly-like and frequently bloody exudation. 
After a while the redness disappears and the membrane looks dirty, yel- 
lowish and grayish, being covered with a coagulated, dirty-grayish and 
yellowish exudation, resembling inspissated pus. The inflammation some- 
times extends over the whole membrane; reaching -even into the cavity 
of the skull. In cases of recovery there are adhesions and thickening 
of the membrane, hyperemia, hydrorrhachis and atrophy of the spinal mar- 
row. The arachnoid is almost regularly involved in the inflammatory 
process. 

As Causes, we find mentioned, inflammatory processes of neighboring 
organs, either of the spinal marrow or of the vertebrae; external injuries; 
exposure to cold, etc. It is quite a regular attendant upon Tubercular 
basilar meningitis. 

Remarkable is its epidemic appearance when it is usually combined with 
cerebral meningitis, as in spotted fever, which compare. 

Symptoms. — A combination with cerebral affections of course tinctures 
the whole picture at once with brain symptoms, and may even disguise the 
spinal affection altogether. (See Brain Diseases. ) If the inflammation is 
confined to the spinal pia mater, we find: 

1. A pain in the back, at the place of inflammation, which even extends 
over the whole spine, and which is aggravated by the slightest motion, as 
turning in bed or rising, or pressing at stool, or voiding urine; it is better 
during rest; least in lying on the back; sometimes it is combined with a 
feeling of constriction around the body, as though a bandage were fastened 
around it. 

2. Pains in the limbs, aggravated by motion and touch. 

3. Painful stiffness of the muscles, which may amount to opisthotonus, 
especially in cases where the inflammation extends over the cervical portion 
of the pia mater. Even the masseter muscles may be affected, so that the 
whole resembles tetanus. Respiration is difficult, and the higher the inflam- 
mation extends the greater is the d3'spncea, which may end in suffocation. 
It is a characteristic feature that these tonic spasms are always excited by 
the least motion of the spine, but not by reflex irritation of the peripheric 
nerves. 

Acute spinal meningitis may pass over into the chronic form, with ex- 
udation and consequent paraplegia. Tuberculization of the exudate is fol- 
lowed by oedema of the lungs, catarrh of the bladder and decubitus. Its 
Prognosis is therefore rather a doubtful one. 



therapeutic hints to leptomeningitis spinalis. 725 

Therapeutic Hints. 

Aeon. After a sudden check of perspiration, or internal injury; high 
fever; crawling in the spine, as of beetles; cutting pain, extending in a circle 
from the spine to the abdomen; numbness of the small of the back, extend- 
ing into the lower limbs; the arms hang down powerless, as if paralyzed by 
blows; numbness, icy coldness and insensibility of hands and feet; all being 
accompanied b}^ despairing thoughts and dread of death. 

Atroph. sulph. Convulsions all over, if Bellad, did not prevent. 

Bellad. Drawing, burning and throbbing pain in the spine; drowsiness, 
with inability to sleep; frequent starting, as if electric shocks were running 
through the limbs. 

Bryon. Stitch-like pains from the slighest motion. 

Calc. card., and Phosph. When the inflammation proceeds from a 
disease of the bony structure of the spine. 

Cicitta. Frequent jerks in the upper portion of the body; through the 
dorsal vertebrae and arms; occasional jerkings of the head. 

Coccul. Unwieldiness of the lower exremities, the legs cannot be lifted 
in walking, but are dragged along; the hands feel pithy, lose their sensi- 
bility. 

Cuprum Clonic spasms, commencing in the fingers and toes and spread- 
ing further; before the spasms, painful jerkings in the hands and fingers and 
different parts of the body, commencing on the left side. 

Dulcam. Rheumatic persons who are always worse when the weather 
changes to cold; after taking cold; also during scarlatina and measles, when 
the eruption does not fully develop itself. 

Hyper. After a fall; slightest motion of the arms or of the neck ex- 
torts cries; the cervical vertebrae are very sensitive to touch; headache; desire 
for warm drinks; asthmatic spells, or spells of short, hacking cough. 

Kali hydr. After the abuse of mercury. 

Mercur. Paralysis of the lower extremities, of the bladder, or of the 
rectum, with occasional jerks in the paralyzed parts; violent pain in the 
spine, worse from motion; great restlessness and sleeplessness; aggravation 
at night in bed; insensibility of the skin. 

Nux vom. The seat of the pain is the lumbar region; the pain is worse 
when trying to move whilst lying on the back, also in the morning, stiffness 
of the lower limbs; great deal of belching; sensitiveness of the stomach and 
region of the liver to external pressure; stool seldom and hard. 

Plumbum. In chronic cases, where the paralyzed parts soon fall awa3 r 
in flesh, where the limbs become painfully contracted, and where there are 
frequent spells of colic with retraction of the abdomen; worse on right 
side. 

Rhus tpx. In combination with exanthematic processes; or in conse- 
quence of getting wet; high fever; great restlessness; tingling sensation in 
the limbs; paralysis of the extermities. 



726 MYELITIS. 

Myelitis, Inflammation of the Spinal Marrow. 

This affection is much less frequent than meningitis; and when it does 
occur, it almost always is associated with meningitis. 

Its pathological features in the stage of hyperaemia (red softening) con- 
sist of swelling, redness, and exudation; in the stage of fatty degeneration 
and of resorption (yellow and white softening) the affected substance as- 
sumes a creamy or milk}' appearance, becomes softer and softer, until at last 
nothing remains but the vascular network, and a portion of the hypertrophied 
septa, the softened nerve- substance having been gradually absorbed. This 
leads in the terminal stage to the formation of cicatrices or cysts, induration 
and sclerosis or hardening. The meninges are always more or less impli- 
cated in the inflammatory process. 

Its localization in the spinal cord varies greatly. When acute, it usually 
commences in the gra}^ substance and ma3 T extend more or less in a vertical 
direction — (Myelitis centralis); it may pervade the entire thickness of the 
cord for a longer or shorter distance — (Myelitis transversa); it may involve 
only a small portion of the cord — both vertically or transversely — (Myelitis 
circumscripta); it may be spread over a large area, but only in circumscribed 
and scattered spots — (Myelitis disseminata); it may attack only the peripheral 
layers of the cord — (Myelitis peripherica). 

As its Causes are mentioned, chiefly external injuries, and exposure to 
cold, or extension of inflammatory processes from neighboring parts. Some- 
times it has been observed during the course of typhus, of the acute ex- 
anthemata, acute rheumatism, variola, pleuro-pneumonia, and other severe 
illnesses. 

Its Symptoms embrace deviations in sensibility and motion. 

i. Sensibility. The patient experiences at first a sensation of cold- 
ness, numbness, pricking and pain in single toes and fingers, which sensa- 
tion extends from the periphery gradually further up towards the body; at 
first, perhaps, only in one, but soon in both sides. If there be a complication 
with meningitis, the patient cannot bear the slightest pressure or motion of 
the parts. 

There is a pain in the spine where the inflammation exists, which is ag- 
gravated more by external pressure than by motion; and a feeling of con- 
striction in those parts of the body which are supplied with those nerves, the 
roots of which originate in and near the affected part of the spinal marrow 
(girdle pain). In some cases these parts are very sensitive, whilst those be- 
low are quite dull and insensible. A complete anaesthesia or insensibility, 
however, takes place only in those cases in which the lesion is a degenera- 
tion of the marrow through its whole diameter. 

2. Motion. It shows itself at first as an unwieldiness of the peripheric 
muscles, which may end in complete paralysis. If the seat of the lesion be 
in the lumbar region, it causes paralytic symptoms of the lower extremities, 
which is of the most frequent occurrence; if it be in the dorsal region, it 



THERAPEUTIC HINTS TO MYELITIS. 727 

causes, in addition, paralysis of the sphincter ani and vesicae; and if still 
higher up, violent agitation of the heart. A lesion in the cervical region af- 
fects the upper extremities, the respiratory motion, deglutition and even 
speech. Respiration is most seriously interfered with when the lesion exists 
just above the origin of nerves of the diaphragm. When below it, it is a 
characteristic symptom that the patient is able to gape, but he cannot cough 
or sneeze. 

As long as the marrow is not disorganized in its whole diameter, so long 
is it possible that the parts below the lesion may still remain intact; so that, 
for example, in a cervical myelitis only the upper extremities are paralyzed 
and the lower not. When, however, the lesion extends through the entire 
diameter of the marrow, then all the parts below the lesion lose sensibility 
and motion; so that in such a case the patient consists of two halves; an 
upper one, which is normal and sound, and a lower one, which is dead, and 
deprived of feeling and voluntary motion. 

A peculiar and frequent symptom of myelitis is a persistent erection of 
the penis. The penis is painfully stiff, but shorter than normal, and may re- 
main so for days. It occurs chiefly in those cases in which the lesion has its 
seat in the dorsal or cervical region. 

Thus far we have seen that the symptoms of myelitis vary quite con- 
siderably according to the higher or lower location of the lesion. They vary, 
likewise, if the seat of the inflammation is confined only to the one or the 
other lateral cord. In such cases the paralytic symptoms may be only on 
one side — at least for a while — with more or less insensibility; or insensi- 
bility may exist in one, and paralysis in the other side, as in some taumatic 
cases. 

The lower the seat of the disease, the more slowly it works. Many 
have lived more than ten years with paraplegia. Cervical inflammation 
may terminate fatally in a very short time by its paralyzing effect upon 
respiration. 

Therapeutic Hints. 

As myelitis is almost always accompanied by meningitis, compare 
Leptomeningitis. 

Angustura vera. Twitching and jerking along the back like electric 
shocks; tension of facial muscles; lockjaw. 

A? sen. Dyspnoea and anxiety; constriction and tightness of chest, as 
if bound with a hoop; twitching, trembling, violent starting, weariness in all 
limbs; tetanic spasms. 

Gelsem. Early stage; spinal weakness from exhaustion; confusion of 
head, spreading from occiput to forehead; dim sight; looks heavy, dull, 
drowsy; paresis of tongue and glottis; incontinence of urine; muscles feel 
bruised and will not obey the will; loss of voluntary motion. 

Mercur. Probably the most important. Compare Meningitis. 



728 .MYELOMALACIA — MULTIPLE SCLEROSIS. 

Phosphor. After sexual excesses or getting wet; also when in connec- 
tion with an inflammatory process of the vertebrae; burning pain in the 
spine; some vertebrae sore to touch; dyspnoea and cough; weakness of sight; 
transient vertigo; constipation with narrow, dry stools; numbness and in- 
sensibility of the extremities. 

Physostigma. Tremors of young persons from emotional or physical 
disturbances; staggering gait, as if drunk; feeling of constriction around 
head and waist; feeling of weakness, as though paralyzed, passes downward 
from occiput through back to lower limbs, which feel as if asleep. 

Picric ac. Tonic and clonic spasms; keeps legs wide apart when stand- 
ing; looks steadily at objects as if unable to make them out; limbs too weak 
to support the body. 

Secale. Violent pain in the back, especially in the sacral region; anaes- 
thesia of the limbs; paralysis of the limbs; convulsive jerks and shocks in 
the paralyzed limbs; painful contraction of the flexor muscles; paralysis of 
the bladder and rectum. 

Silic. When the bony structure of the spine is affected. 

Sulphur. Burning and tensive aching between the scapulae; heat on 
the top of the head; palpitation of the heart; sleeplessness; often when 
other remedies do not seem to have any effect. 

Veratr. Painful paralytic weakness in the upper and lower limbs; he 
is scarcely able to drag them; tingling in the fingers, causing anxiety; pain- 
ful jerkings in limbs. 

Myelomalacia, Non-inflammatory Softening of the Spinal 

Marrow, 

Is a process of which we know scarcely anything. Its symptoms are quite 
obscure, sometimes covered by the symptoms of spinal apoplexy, or myelitis, 
or typhus, sometimes even wanting. Its pathological character is a non-in- 
flammatory degeneration of the marrow, by which it becomes converted into 
a soft, macerated mass of a whitish, 3^ellowish or reddish color. 
Inflammatory softening is the consequence of acute myelitis. 

Multiple Sclerosis 

"Is a form of chronic myelitis and encephalitis, which is characterized, 
anatomically, by the development of numerous insulated sclerotic nodules, 
varying in size and of a chronic inflammatory nature, which are scattered 
irregularly throughout the entire cord and usually also throughout the entire 
brain, but which seem to possess, nevertheless, certain spots of predilection. 
Sometimes a less intense, but more diffuse sclerosis unites the different nodules 
with one another." (Erb. ) It attacks women oftener than men, and most 
frequently makes its appearance during the second and third decades of life, 
scarcely ever after the forty-fifth year, and but few cases are known to have 
occurred in children under ten vears of asre. 



THERAPEUTIC HINTS TO MULTIPLE SCLEROSIS. 729 

As direct Causes are mentioned: catching cold, excessive mental and 
bodily exertions and intense emotions, traumatic influences, pregnancy, hys- 
teria and acute diseases. 

Its Symptoms are extremely variable and manifold, as a natural result 
of the development of nodules in so many different localities. 

Disturbances of sensibility are of not constant occurrence; disturbances 
of co-ordination (ataxia) are frequently observed, but a peculiar tremor, which 
accompanies voluntary movements and progressively increases, is almost reg- 
ularly present. By this tremor, which appears at every attempt at moving a 
part of the body, head or limb, voluntarily, multiple sclerosis differs entirely 
from paralysis agitans, where the trembling is predominantly observed dur- 
ing perfect rest, and may, at least in the earlier stages, be even controlled 
by the will of the patient. 

Besides these symptoms we observe: alteration of speech and voice. The 
speech is slow, hesitating, more or less indistinct and the voice becomes weak 
and monotonous; the acts of laughing and crying are accompanied by pecu- 
liar, noisy inspirations, and the movements of tongue and lips are frequently 
impaired, interfering with mastication and deglutition. There is a temporary 
or permanent diplopia, also nystagmus, amblyopia and at last blindness from 
atrophy of the optic nerve. We meet also head symptoms in the form of 
vertigo, sleeplessness, violent headaches and in some cases repeated apoplecti- 
form attacks, which are accompanied by high fever and followed by temporary 
hemiplegia. 

This complex of symptoms fits only to typical cases; variations are ex- 
ceedingly numerous, because the accidental distribution of the nodules varies 
in each individual case. 

Therapeutic Hints. 

Compare Myelitis. 

Arg. nitr. Vertigo and staggering gait; trembling and tremulous sen- 
sation; general debility, with trembling of the limbs; chorea-like movements 
of limbs; transient blindness; sunken, pale countenance; sleeplessness. 

Nnx vom. Especially in the beginning, with gastralgic attacks, ver- 
tigo, etc. 

P/wsfi/ior. Weakness of extremities and trembling at making an 
effort; legs weak, gait tottering as if he were not sure of himself; speech 
embarrassed; amaurosis with widely dilated pupils and deafness. 

Physostigma. The will is strong, but a difficulty lies in the way of 
carrying out its purpose; the palsy is commonly preceded b}^ twitching or 
trembling of the muscles. Attacks of partial blindness; nystagmus; trem- 
bling all over. 

Plumbum. Tremor of right arm during voluntary motion ;' the arms 
are " shaky " when he attempts to use them; tremor of arms, at times pre- 
ceded by weakness and numbness; the tongue trembles when being protruded, 
or when he tries to articulate; speech dragging and slow. Diplopia; dim- 



730 TABES DORSALIS. 

ness of sight; neuritis of optic nerve. There are man}' more symptoms which 
hint to multiple sclerosis. 

Tarant™ In water. Multiple scelerosis in consequence of fright and 
rheumatism. Trembling commenced in left hand, always aggravated by 
mental trouble. After a fright it affected all limbs. Intense pain during 
night prevents her rest and sleep, and an itching and crawling of left leg 
makes her rise and walk about. Bathing increases the pain, but fresh air 
ameliorates even at night. Intelligence and memory considerably dimin- 
ished; trembling and pricking prevents from doing any fine work. Motility 
and sensibility unaltered; neither paralysis, anaesthesia, nor hyperesthesia. 
The head trembles as much as the left hand and foot, and a slight tremor 
could be observed on the tongue, when opening the mouth. No appetite, 
chronic constipation. Since menopause, acne in face. The ophthalmoscope 
showed a slight hyperemia of the retina. (Cramoisy.) 

Tabes Dorsalis; Locomotor Ataxia; Sclerosis of the Posterior 
Columns; Leukomyelitis Posterior Chronica. 

All these different names have been given to " a disease of the spinal 
cord, which runs a slow course, which arises principally during youth and 
middle age, and which in all probability belongs to the group of Chronic 
myelitis." (Erb.) 

"It is anatomically characterized by ribbon-like sclerosis of the white 
posterior columns, leading to gray degeneration, and probably, also, by later 
participation on the part of the adjoining portions, of the white lateral col- 
umns and the gray posterior horns. " " The affection generally begins in 
the lumbar region, and may extend throughout the entire cord as far as the 
upper cervical portion, and even into the medulla oblongata." (Erb.) 

It attacks men much oftener than women, in the majority of cases be- 
tween the thirtieth and fiftieth year of life; before the twentieth and after 
the fiftieth year the disease is of rare occurrence. 

Its principal Causes are said to be: syphilis, sexual excesses and onanism, 
catching cold, bodily overexertions and hardships of all kinds, traumatic in- 
juries, emotional fits and passion; acute diseases, such as typhus, rheumatism, 
pneumonia, abortions, loss of blood, long-continued lactation, etc., diphtheria, 
etc. In many cases not any cause can be detected. 

Its Symptoms of the first stage consist of lancinating, neuralgic pains in 
the lower limbs, sometimes including the trunk, and more rarely in the arms, 
in paroxysms, frequently changing in severity and location, and often ex- 
tending over man}- months or even years; they at first appear at intervals, 
in the spring and fall, later the}^ are induced by every change of weather, or 
any overexertion or mental disturbance. With these pains become associ- 
ated, sooner or later, various kinds of parsesthesia, such as numbness, pithi- 
ness or formication in the feet, legs, thighs and on the trunk, and in the ulnar 
domain of one or the other hand — a characteristic symptom — in other cases, 
the sensation of a tight girdle at various heights on the trunk, or on the knee- 



TABES DORSAUS. 73 1 

joint or ankle-joint; further motor weakness and insecurity, which gradually 
increases to real motor disturbances, such as inability to walk and stand with 
former ease; unsteadiness when standing and walking; a swaying to and fro 
when on the feet, all of which manifestations are more pronounced in the 
dark or by closed e}-es. Often, not in all cases, to these disturbances are 
added diplopia in consequence of paresis or paralysis of various eye muscles, 
especially those supplied by the oculomotorius, and amblyopia, even amau- 
rosis, in consequence of degeneration of the optic nerve. The pupils are 
small, do not respond to light, but act during accommodation. (Argyll- 
Robertson symptom.) In many cases we meet with disturbances of the 
bladder, such as difficulty of micturition, dribbling of urine, etc., and with 
weakness and irritability of the sexual functions, such as various grades of 
impotence, insufficient erections, premature ejaculations, nocturnal or diurnal 
pollutions, excitability on coming in contact with women, etc. Gastralgia 
and head symptoms (dizziness, psychical irritabilty, etc.) are of rarer oc- 
currence. 

The second stage presents, besides the symptoms just detailed, a charac- 
teristic disturbance in the co-ordination of motion, which usually commences 
in the lower limbs. The gait becomes ataxic, that is, insecure, swaying, 
staggering; the legs are unsteadily swung about, the toes pointing outward 
and upward, and the heels coming down to the ground with a stamp; the 
whole operation, in most patients, is done under the close supervision of the 
eyes, and does not succeed at all with closed eyes or in the dark. With this 
faultily and imperfectly controlled movement of the limbs goes hand in hand 
a diminution of their powers of endurance, and, although in a lying position 
at first, the gross strength of the legs seems but little reduced — the patient is 
yet able to execute single movements of the limbs with tolerable certainty 
and strength, while in a tying position — yet by and by even in this position 
the voluntary motions become more and more uncertain, and especially so, 
if the patient closes his eyes, while at last walking and standing become 
quite impossible without help. 

As the disease advances, the ataxy extends also to the arms and hands, 
so that complicated movements, such as writing, piano-playing, sewing, etc., 
become difficult, awkward, and at last impossible; the muscles do not obey 
any more the command of the will, but make all sorts of jerking and irregu- 
lar movements when under its stimulation. The reflex action of the tendons 
is extinguished; a knock or blow, for instance, upon the patella- tendon 
above the knee is not followed by a jerk of the leg upward, etc.; this 
absence of the patella reflex is probably always an early and almost pa- 
thognomonic symptom, and is due, according to Westphal, to a lesion involv- 
ing a definite zone in the centre of the posterior columns of the lumbar part 
of the cord; the reflex action of the skin, however, may or ma}' not be affected. 
All other symptoms of the first stage grow more and more intense, until at 
the final stage actual paralysis (paraplegia), muscular atrophy, contractures, 



732 THERAPEUTIC HINTS TO TABES DORSAUS. 

troubles of the bladder and the digestive organs, bed-sores and general ma- 
rasmus finish the scene. 

The disease is of long duration, which is to be counted by years, and is 
characterized by considerable fluctuations for better or worse — sometimes 
gradually advancing to recovery; oftener, however, terminating in death. 

It differs from Chronic myelitis by its lancinating pains in the first stage 
and pronounced ataxy in its second stage, which myelitis has not. 

From Multiple sclerosis by the same, instead of which multiple scle- 
rosis presents a characteristic tremor on voluntary movement, attacking limbs 
as well as head and neek; 

From Progressive cerebral paralysis by the absence of disturbances of 
speech and physical changes, which are characteristic of cerebral paralsis; 

From Paralysis agitans by its disturbance in the co-ordination of motion, 
instead of which there is in paralysis agitans a tremor in perfect rest. 

Therapeutic Hints. 

Alcohol. Tremor worse in morning, cannot write; increasing muscular 
debility and paralysis; tingling, arthralgia, anaethesia, clonic and epilepti- 
form convulsions; locomotor ataxy. 

Alum met. Recommended by Von Bcenninghausen and verified by 
others. Soles of feet feel as if they were swollen and too soft; numbness of 
the heels; heaviness of limbs, can scarcely lift them; slow, staggering gait, 
as after a long sickness; inability to walk except with eyes open and in day- 
time; pain in the back as if bruised, or as if a hot iron were thrust through 
the lower vertebrae. 

Arg. nitr. Pains in the back, cannot walk with eyes closed, or in the 
dark; paralytic heaviness or weakness of the legs; staggering gait; legs feel 
as if made of wood, or padded, with insensibility to touch, diminished warmth, 
jerks in the toes, tottering, irresolute gait; emaciation of legs, with paralytic 
weakness; chorea-like convulsive motion of limbs; legs drawn up; arms 
jerked outward and upward. 

Arsen. Distressing pains; deadness in great toes, extending to foot 
and ankle-joint; feet feel large and heavy, and can be moved only by moving 
the whole limb; the gait is shuffling; feet are dragged along by lifting the 
legs; .slight numbness in hands. Paralysis with gressus gallinaceus, with 
atrophy of the muscles, especially of lower extremities. 

Bellad. Heaviness and lameness of legs and feet; he raises the feet 
slowly and puts them down with force; loss of co-ordination of muscles of 
both upper and lower limbs; trembling, twitching of limbs. Diplopia; 
amaurosis. 

Calc. card. Rheumatic pains in shoulders; loss of muscular power; 
atrophy of muscles of back, buttocks and lower limbs, with constant quiver- 
ing; dimness of vision, worse in right eye; cramps in feet and legs; exces- 
sively nervous; no appetite: constipation. (G. F. Butmau. ) 



THERAPEUTIC HINTS TO TABES DORSAUS. 733 

Cupr. ac. Numbness and lameness of left hand, especially of the fingers 
as far as they are supplied with the nervus ulnaris. Dragging of left foot in 
walking; numbness and lameness in sole of left foot gradually extending up 
to knee; walking and standing difficult; foot and leg atrophied; constant 
sense of coldness in left foot, little relieved by the application of hot bricks. 
Sometimes dull pain from hip to knee. (Heinigke.) 

Gelsem. Acute, sudden, darting pains; shooting, tearing along the 
tracks of the nerves, aggravated by changes of the weather; paralysis of 
motion; muscles will not obe} T the will, feel bruised; tingling, prickling, 
crawling. 

Nux vom. Partial paralysis of lower limbs from overexertion and 
being drenched in rain; drags limbs in walking, cannot lift them from the 
ground; sensation of lower limbs impaired, feels the sticking with a pin only 
when it penetrates deep enough to draw blood; legs always cold, bluish; 
constipation; burning at anus; occipital headache; no painful spot in the 
whole length of spine. (Bojanus. ) 

Phosphor. Burning heat in back; hands and feet numb, clumsy; limbs 
tremble from every exertion; when walking makes missteps, from weakness; 
swelling of hands and feet, w T ith stinging pains; paralysis, formication and 
tearing in the limbs; anaesthesia; increased heat; sexual irritation; nocturnal 
emissions; great irritability and nervousness. 

Physostigma. Unsteady from knees downward on walking, he must 
look to see where he puts his feet; needs a cane to steady himself. 

Piaic ac. Mental and physical prostration; cannot read a line with- 
out becoming exhausted; on attempting to walk he presses his hand upon 
his loin and slides his feet along the ground as in a paretic condition, soon 
becoming exhausted; dull headache deep in occiput; bodily exhaustion with 
mental clearness; sleeplessness at night from sheer exhaustion; when asleep 
priapism and seminal emissions, with or without sexual dreams; during coi- 
tion ejaculation too quickly; constipation. (S. Iyilienthal.) 

Secale. Difficult, staggering gait; complete inability to walk, not for 
want of power, but on account of a peculiar unfitness to perform light move- 
ments with the limbs and hands; contraction of the lower limbs, on account 
of which the patient staggers; trembling of the limbs, sometimes attended 
with pains; formication of hands and feet. Excessive sensation of heat, with 
aversion to heat or of being covered. (S. Lilienthal.) 

Stramo?i. Totters as if giddy, cannot make a few steps without help; 
trembling of limbs; muscles will not obey the will; difficult to bring hand to 
tumbler or carry the latter to mouth; obscuration of vision. 

Sulphur. Unsteady gait; great debilit}' and trembling; limbs go to 
sleep. After Nux vom. (Jahr.) 

Tar ant. Difficulty of moving the legs, they do not obey the will; 
weakness of legs, etc. 

Aside of these compare; sPLscul. hipp., Coccul., Caustic, Laches., Ntix 
mosch., Pinus sylv., Plumbum, Rhus tox., Silic, and many more. 



734 SPASMODIC SPINAL PARALYSIS. 

Spasmodic Spinal Paralysis. 

' ' This disease is clinically characterized by a gradually increasing 
paresis and paralysis, generally advancing slowly from below upwards, 
with muscular tension, reflex contractions and contractures, with strikingly 
increased reflex actions of tendons, while at the same time there is entire, or al- 
most entire, absence of all disturbances of sensibility, or trophic disturbances, 
of all vesical or sexual weakness, and of all cerebral disturbances." (Erb.) 

Its anatomical basis is probably, according to Charcot and Erb, a chronic 
inflammatory process, a sclerosis of the posterior divisions of the lateral 
columns. 

Its Etiology is unknown; it seems to develop most frequently between 
the ages of thirty and fifcy, and also at times in earliest childhood. 

Its Symptoms begin with motor weakness in one or both lowei limbs, 
increasing to paresis and ending in paralysis. These symptoms of weakness 
are early associated with motor irritations, commencing with twitchings, or 
jerkings of the legs when sitting or lying, increasing to spasmodic stiffness 
when making certain movements, or to regular tension of the muscles on 
active and still more on passive motion, and ending in permanent and severe 
contractures, wdrich fix the limbs in a position of extension. With all this 
there is a marked increase of the reflex actions of the tendons, so that on 
merely placing the point of the foot on the floor, while sitting, a tremor very 
generally sets in, evidently in no respect different from the clonic trembling 
on passive dorsal flexion of the foot. 

These combined paralytic and spasmodic manifestations result in a very 
peculiar, the so-called spastic gait, when the patient tries to walk, which is 
described by Erb as follows: " The legs are somewhat dragged, the feet seem 
to cleave to the ground, the tips of the feet find an obstacle in every inequality 
of the ground; every step is accompanied by a peculiar hopping elevation of 
the whole body, dependent on a reflex contraction of the calf; the patient 
immediately gets upon his toes, and slips forward on them, showing a ten- 
dency to fall forward. The legs are close together, held stiffly, the knees 
somewhat depressed forward, the upper part of the body slightly bent for- 
ward. There is no throwing about of the feet as in ataxy. This gait depends 
on muscular tension and reflex contractions in the various groups of muscles, 
which are set in activity during the process of walking. ' ' 

Sometimes the disease extends from one leg to the arm of the same side 
(hemiplegic form), and much later to the other leg and arm. In some cases 
the trouble begins in one or both arms and gradually descends to the legs. 

This whole group of symptoms becomes quite conspicuous by the 
absence of every disturbance of sensibility, of vesical and sexual weakness, 
of muscular atrophy and bed-sores; of disturbances of the brain and cranial 
nerves, and is thus easily distinguishable from other spinal and cerebral af- 
fections already detailed. 

Its course is slow and of long duration, and most generally terminates 
fatally by some other intercurrent disease. 



polyomyeutis anterior acuta. 735 

Therapeutic Hints. 

There is no case on record, as far as I am aware of, which has been 
diagnosed and treated as this particular form of disease. The special hints 
must be taken from special and peculiar symptoms of the individual case. 

Polyomyelitis Anterior Acuta, Acute Inflammation of the Gray- 
Anterior Columns (Anterior Horns). 

This affection has also been called: Spinal infantile paralysis, acute 
spinal paralysis of adults, acute atrophic spinal paralysis, paralysie atrophi- 
que de 1' Enfance, and is marked by the following group of characteristic 
symptoms: "It begins suddenly, usually with fever, with severe cerebral 
symptoms (deafness, coma, delirium, general convulsions); there is very 
rapidly developed and complete paralysis with entire relaxation of the 
muscles; this paralysis being of very variable distribution over the trunk and 
extremities, but generally in the form of paraplegia; there is an absence of 
any severe disturbances of sensation; no paralysis of the sphincters; nor bed- 
sores. 

A rapid improvement of the general condition soon follows; the pa- 
ralysis proves not to be of a progressive character; indeed, gradual improve- 
ment of the same begins, although the restitution of movement is not uni- 
form and remains in part lost forever. In some of the muscles there is ex- 
treme and rapidly progressing atrophy, with degeneration of tissue; the de- 
velopment of the bones is retarded; the extremities are cold and cyanotic. 
During the further course of the affection considerable deformities of the 
limbs and trunk arise (club-foot, curvatures of the spine, paralytic con- 
tractures, etc.). The general condition of the individual is admirable, in 
spite of the permanent defects in the motor apparatus, which almost invari- 
ably remain. 

The disease may occur at all periods of life, though it is by far the most 
frequent in children between the ages of one and four years. It is susceptible 
of an unusally large number of grades of severity. 

The anatomical lesion, although not yet quite certainly determined for 
all cases, may be regarded as most probably consisting in an acute myelitis 
of the gray anterior columns (anterior horns), which may extend more or 
less over the greater part of their entire length, but is disposed to be most 
heavily localized in the cervical and lumbar enlargements." (Erb.) 

Of its Etiology nothing is known with certanity. 

Therapeutic Hihts. 

The initial symptoms may require; Aeon., Bellad., Gelsem., ete. 
Compare Myelitis and Leptomeningitis. 



736 POLYOMYELITIS ANTERIOR J5UBACUTA et chronica. 

Polyomyelitis Anterior Subacuta et Chronica; Subacute and 

Chronic Inflammation of the Gray Anterior Horns; 

Chronic Atrophic Spinal Paralysis. 

" Clinically the disease presents itself as a motor paralysis, usually de- 
veloped without fever, with but slight general disturbance and insignificant 
disturbance of sensibility. The paralysis more or less rapidly seizes the 
entire lower extremities — generally in the course of a few days, or at the 
most a few weeks — and soon extends to the upper extremities also (much 
more rarely showing the opposite order of development and beginning in the 
upper extremities); it is associated with complete flaccidity of the muscles 
and loss of their reflex excitability, and is followed by rapidly progressive 
atrophy in the bulk of the paralyzed muscles, with the well-marked reaction 
of degeneration. 

The disease has certainly, as a rule, an ascending course, though it is by 
no means always progressive; its development generally comes to a stand- 
still sooner or later, this arrest introducing a gradual retrogression of the 
disturbances, which may lead to more or less complete recover y. 

The anatomical limits of the disease cannot, as yet, be declared with 
absolute certainty; but according to all that we know, there is every proba- 
bility of its being located in the gray anterior horns. The two post-mortem 
examinations thus far made virtually confirm this, and thus, for the present, 
we may designate the disease as a subacute or chronic inflammation or degen- 
eraiton of the gray anterior horns, with extensive disappearance and atrophy 
of the large multipolar ganglion- cells. " (Krb.) 

Etiology unknown. Duration long. 

Therapeutic Hints. 

Plumbum. The symptoms of chronic lead-poisoning correspond very 
closely with the symptoms of this complaint. 

Paralysis Ascendens Acuta, Acute Ascending Paralysis. 

' ' The disease is clinically characterized by a motor paralysis, which 
generally begins in the lower extremities, spreads pretty rapidly over the 
trunk to the upper extremities and usually also involves the medulla ob- 
longata, which sometimes runs its course without fever, sometimes with more 
or less active fever, which but slightly involves the general sensibility and 
the functions of the bladder and rectum, and which runs its course without 
any notable atroph} T of the muscles, and without any diminution or change 
of their electrical excitability. 

In the majority of instances the disease terminates fatally by asphyxia, 
paralysis of deglutition, and the like; but lighter cases may also end in re- 
covery. 

The anatomical characteristics of the disease are at present purely neg- 



COCCYODYNIA. 737 

ative. No pathologico-anatomical alterations are to be found anywhere, 
and especially not in the spinal cord, which might explain the picture of the 
disease. In particular there are no signs of hypersemia within the spinal 
cord, of myelitis, of acute destruction of the ganglion-cells or nerve-fibres. 

If the disease is therefore to be localized within the spinal cord at all, it 
is a question of finer, so-called impalpable disturbances of nutrition, not ac- 
cessible to our present means of examination." (Erb.) 

Of its Etiology nothing positive is known. Most cases occur between 
the ages of twenty and forty, some later; men are most frequently attacked. 

Therapeutic Hints. 

Consider all the remedies which show paralytic affections. Many cases 
may have been cured homceopathically without having been recognized as 
just this particular form of disease. 

Ooccyodynia 

Signifies pains in the coccyx and cocc}^geal region (muscular and tendinous 
fibres of the parts attached to the coccyx), of great variety of character and 
especially felt on sitting down or rising up, or standing to defecate, or at- 
tempting to exercise, but even during perfect rest. It may be of a neuralgic 
or rheumatic, or inflammatory nature. It has been observed to originate 
from " catching cold," especially in damp and cold weather; from falls and 
blows; from riding on horseback; after parturition and delivery by forceps; 
after suppression of eruptions. It attacks most frequently the female sex, 
is often of but short duration, but may be a source of great annoyance for 
years. 

Therapeutic Hints. 

In injuries with crepitation: Calc phosph. 

For periodical aching: Fluor, ac. (Hering), Rhus tox., Ruta g?av., 
Silic. 

After a fall on the ice; pain worse after sleep: Laches. 

After a fall resulting in periostitis of the coccyx: Mezer. (Oehme.) 

During the first appearance of catamenia after confinement: Cicuta. 
(Bruckner.) 

After confinement, burning and smarting and painful uneasiness in the 
coccyx, better when standing, worse from slightest motion or pressure. Ta- 
rant. (Gonzales.) 

W. S. Searle gives the following hints: 

Bellad. Ischia feels sore, as if no flesh were on them, yet she feels better 
when sitting upon something hard; intense crampy pain in small of back and 
coccyx; can sit only a short time; cannot lie down well; wakes often at 
night, and has to shift her position; unable to lie at all upon the back, and 
is most relieved by standing or walking slowly. 
47 



738 THERAPEUTIC HINTS TO COCCYODYNIA. 

Caustic. Dull, drawing pain in region of coccyx; darting and bruised 
feeling in coccyx; pain in small of back from any movement; pinching, 
crampy pain in lumbar region and buttocks. 

Card. an. Pain in cocc} r x, which becomes a burning pain when the 
parts are touched; pressing, bearing-down pain in coccyx, as if bruised; pain 
as from subcutaneous ulceration, worse on sitting or lying down; pressing, 
drawing, or stiffness in the lumbar region, as if the back were broken. 

Thuja. Painful drawing in sacrum and coccyx, and in the thighs when 
sitting; after having been seated a while, the drawing hinders standing 
erect; sudden cramp-like pain in lumbar region after long standing, and then 
attempting to walk; it seems as if he would fall. 

Cann. sat. Pressure as if with a sharp point, on the coccyx. 

Canthar. Lancinations and tearings in the coccyx, causing him to 
start. 

Cicuta. Tearing, jerking in coccyx. 

Cist. can. Burning, bruised pain in coccyx. 

Droscra. Itching stitch in coccyx when sitting. 

Graphit. Dull drawing in coccyx in the evening; violent itching of 
coccygeal region, the part being moist with scurfy eruption. 

Kali carb. Violent gnawing, at rest and in motion. 

Kali hydr. Pain in coccyx as from a fall. 

Kreos. Drawing pains along the coccyx down to the rectum and 
vagina, where a spasmodic, contractive pain is felt; better when rising from 
her seat; subsequent milky leucorrhcea. 

Laches. Continual pain in sacrum and coccyx; drawing pain, or as if 
sprained, in small of back, hindering motion. 

Mag?ics. Sudden, piercing pain in coccyx; sudden, violent, concussive, 
tearing, stitching pain in this region as if the spine were bent back. 

Mercur. Tearing pain in cocc3 r x relieved by pressing the hand against 
the abdomen; pain in sacrum, as if one had been lying on too hard a couch. 

Min\ ac. Drawing, burning along the back, beginning at the coccyx, 
as if under the skin; burning stitch in sacrum, causing one to start. 

Paris quad. Tearing in coccyx when sitting; pulsative stitches in 
coccyx. 

Petrol. Pain in cocc3 T x while sitting; great uneasiness and stiffness in 
small of back and coccyx in the evening. 

Phosphor. Ulcerative pain, hindering motion, and followed by painful 
stiffness of nape of neck. 

Phosph. ac. Itching stitch in coccyx; fine stitches in coccyx and 
sternum. 

Platina. Numb feeling in coccyx as from a blow. 

Ruta. Pain from coccyx to sacrum, as if caused by a bruise. 

Zinaim. Pushing, aching, or at times, pinching pain in coccyx; lan- 
cination in sacrum; pressure, tension and weakness in lumbar and sacral re- 
gion; cracking in back when walking. 



MOTORY APPARATUS. 



Rheumatism. 



We may, as chacteristic of rheumatism, establish the following three 
points: i. It attacks either the fibrous tissues, joints, aponeurosis, the sheaths 
of the tendons, the neurilemma, the periosteum; or the muscles and tendons. 
2. It is a peculiar, painful affection, caused no doubt by inflammation and 
nutritive disturbances; and, 3. It comes on independently of other acute or 
chronic diseases, or traumatic causes, etc. 

The principal Causes of its development are exposure to cold and at- 
mospheric influences, though they may not be the only causes; and thus it is 
agreed among the profession to call rheumatic all those affections which are 
of a very painful and inflammatory nature, which have become localized in 
any of the above stated tissues, and which are not of a secondary, or a sym- 
pathetic, or traumatic nature, but appear idiopathically; be they caused by 
exposure to cold and atmospheric influence or not. Its peculiar inclination 
to change localities is, although of frequent occurrence, not an invariable fea- 
ture of the disease. Rheumatism has been divided according to its location 
into — 

Rheumatismus Articulorum Acutus, Polyarthritis Rheumatica 
Acuta, Rheumatic Fever. 

Acute articular rheumatism is a constitutional disease, characterized by 
fever, inflammation of the joints and serous membranes in general. 

Regarding the etiology it is apparently becoming more and more recog- 
nized as a purely infectious disease, although exposure to cold and atmos- 
pheric influences have always been considered the chief exciting causes, and 
undoubtedly do play a most important role. 

The pathological changes are in the synovial membranes of one or several 
joints. They become inflamed, and yield a scanty exudation, which contains 
neither much fibrin nor a great many pus corpuscles. • The external visible 
swelling is the product of an inflamrnatoty oedema of the surrounding cellu- 
lar tissue. In severe cases, however, the inflammation may be very high, 
and the exudation quite rich in fibrin or pus globules. Accordingly, post- 
mortem examinations show either scarcely any inflammatory signs or a high 
state of hyperemia, and ecchymosed spots in the synovial capsule, which is 
filled with a quantity of purulent exudate; even the ends of the bones may 
foe injected and infiltrated by bloody extravasations. The heart and large 



74-0 RHEUM ATISMUS ARTICULORUM CHRONICUvS. 

vessels, in all recent cases, contain a large amount of fibrin; and besides, we 
find different structural changes of the heart, such as pericarditis, endocardi- 
tis and myocarditis, as complications of the acute form of articular rheuma- 
tism. 

Predisposition to this complaint seem to lie between the years of fifteen 
and forty. Early childhood and old age are generally exempt. Those ap- 
pear most prone to the disease who have once been attacked by it; men more 
than women, and robust persons more than weak and debilitated ones. It is 
found in all climates, though more in the middle than in the hot or polar 
zones; and oftener in winter and spring than in summer and fall. 

Symptoms. — An attack of articular rheumatismus is frequently, though 
not always, preceded by a feeling of general debility and malaise, with oc- 
casional chilly sensations. Then the fever commences, and with it the pain 
in one or several joints. Soon these joints begin to swell, and sometimes to 
redden; the swelling is not, in all cases, proportionate to the pain. The dis- 
ease either stays confined in the joint first attacked, or it spreads from joint 
to joint, attacking even the spine and the symphysis ossium pubis, rarely, 
however, the joints of the toes. The pain is generally excruciating, worse 
from the slightest motion or contact, and yet the patient is sometimes tor- 
tured by a restlessness which compels him to move, notwithstanding the 
greatest pain. 

The fever, in some cases, runs very high, and the temperature of the 
body ranges at times between 104 and 104. 9 F. ; this is, however, excep- 
tional, as in most cases the temperature is. not more than one or two degrees 
above the natural standard, and the pulse not higher than ninety to one 
hundred beats in a minute. In some cases we hear murmurs in the heart, 
even if not complicated with endo-carditis; and the respiration is often ac- 
celerated. The skin transpires profusely without amelioration and is often 
covered with a red or white miliary rash. The urine is generally scanty and 
saturated with urates and uric acid, which, on cooling, make a thick de- 
posit. 

Its complication with endocarditis amounts, according to Bamberger, to 
about twenty, and with pericarditis to about fourteen per cent. Complica- 
tions with myocarditis are much less frequent, and those of pleuritis and 
pneumonia, meningitis cerebralis or spinalis, occur still less often. 

Its course is not at all a regular one, confined to a certain cyclus. It 
may pass off in from eight to twelve days, and may torment many weeks. It 
very seldom terminates fatally, and then only in case of severe complications 
with affections of the heart, lungs or cerebral meninges. Its worst features 
are an increased liability to new attacks, and chronic derangement of the 
valves of the heart. 

Rheumatismus Articulorum Chronicus, Chronic Rheumatism, 

of the Joints. 

The form consists of a subacute inflammation of one or more joints. 
Post-mortem examination, therefore, reveals the synovial capsule and liga- 



RHEUMATISMUS MUSCULARIS. 74 1 

ments thickened, the cartilages of the bones spongiform, and the synovial 
fluid turbid. 

We may distinguish two forms. One in which single joints, often for 
months or even years, remain very painful to motion and contact, and show 
paroxysms of aggravation, chiefly in the night. On applying the hand to the 
diseased part, we often observe a sense of crackling or crepitation within on 
moving the limb. The swelling of the joint may be considerable, or it may 
be absent; or the joint may only appear swollen, because the adjacent mus- 
cles have become atrophied, not being used on account of the pain. This 
may lead to a false anchylosis of the joint, rarely to the development of a 
tumor albus or arthrocace. 

The second form or sub-acute, consists of frequently repeated attacks of 
acute articular rheumatism. Individuals subject to it are appropriately com- 
pared to barometers, as they feel, " in their bones," every little change in 
the weather immediately. It is often complicated with muscular rheumatism, 
and those forms of neuraglic and paralytic affections which are called rheu- 
matic. 

Rheumatismus Muscularis, Muscular Rheumatism. Myopathia; 

Myalgia Rheumatica. 

To this form are assigned all those rheumatic affections which are seated 
in the muscles, tendons, fasciae, periosteum, and other fibrous tissues, joints 
excepted. Post-mortem examination furnishes little positive information as 
to the nature of the complaint. In some cases the muscles have been found 
interspersed by hard fibrous callosities; in others, some of the peripheric 
nerves were found thickened and grown together; and in others, nothing at 
all could be detected. The pain is rather the most characteristic of all the 
symptoms; it is the so-called " rheumatic pain" — tearing, shooting, stitch- 
like, screwing, burning; sometimes aggravated, and sometimes relieved by 
motion, rest, cold or warm applications, etc. The swelling and redness is 
seldom prominent, often entirely wanting. Its seat is of course quite vari- 
able, as it may attack any set of muscles in the body. According to its 
location it has received different names, the principal of which are: 

Cephalalgia rheumatica, or that form which attacks the musculi fron- 
tales, occipitalis, temporales, the galea aponeurotica, or the periosteum of 
the skull. 

Torticollis rheumaticus, Myalgia cervicalis — "stiff neck" — has its seat in 
the cervical muscles, and interferes much with the free movements of the 
head; frequently draws the neck to one side, and may, if of long standing, 
cause a permanent contraction of the muscles of one side of the neck — "wry 
neck." 

Pleurodynia rheumatica, myalgia pectoralis et intercostalis, attacks 
principally the pectoralis major and intercostal muscles. In the first case, 
it hinders the motion of the arms; and in the second, it interferes with res- 
piration, and makes coughing and sneezing quite painful, simulating the 
pains of pleuritis. 



742 THERAPEUTIC HINTS LO RHEUMATISMUS MUSCULAR IS. 

Omodynia rheumatica, myalgia scapularis. is of frequent occurrence,, 
having its seat in the muscles of the shoulders and back; it causes not only 
great pain on moving the arms, but also when moving the trunk to stoop or 
to turn. 

Lumbago rheumatica, myalgia lumbalis, kink in the back, attacks the 
lumbar muscles and the fascia lumbo-dorsalis. It is a peculiar feature of 
this affection that it frequently sets in instantaneously; the individual having 
been moving about freely and without an} 7 pain, may in the next minute be 
unable to rise from his chair; it comes like a shock, and may remain un- 
abated for eight or ten days. 

Therapeutic Hints. 

I have preferred to annex the necessary hints to the end of the chapter 
on the different forms of rheumatism, because it is not the pathologic form 
that indicates the special remedy; any one remedy may be indicated in either 
form , but it is the peculiarity of the individual case which points out the cor- 
responding remedy. 

Aeon. When there is synochal fever and restlessness; great thirst, dry, 
hot skin, and scant} 7 , fiery urine; stitching pains in the chest, hindering free 
respiration, and great agitation of the heart, with anxiety. Articular rheu- 
matism, with hot, pale or red swelling of the joints, shifting sometimes from 
one to another; after exposure to cold, dry wind. " Kink in the back hin- 
dering deep inspiration." (Wm. J. Martin.) 

Amm. phosph. Recommended by Kurtz for arthritis modosa; the joints 
of the fingers, hands and back are swollen and bent; there is loss of appetite, 
emaciation, sleeplessness, nervous irritability, evening-fever. 

Ant. crud. Acute rheumatism, also gout, with gastric symptoms; nau- 
sea, vomiting, white tongne and great thirst at night. 

Apis. Stinging, burning pain with great soreness and lameness of the 
affected parts, commences on right side and goes to left; cedematous swelling; 
profuse sweat brings relief. 

Apocyn. andr. Rheumatism and gout; pain especially in the right 
shoulder and knee; pain in the joint of the big toe; bilious vomiting, with 
or without diarrhoea; fever; nervous excitement; sleeplessness; constipa- 
tion. 

Arnica. Tearing pain, great soreness, numbness and swelling of the 
affected parts; worse on slightest motion, and especially when lying and get- 
ting warm in bed; fears even the possibility of being touched; complains 
constantly that the bed or couch whereupon he lies is too hard. Podagra; 
pleurodynia; pressing pain in region of left side below heart, day and night. 

Arsen. Burning, stinging, tearing pain, with pale swelling of the 
joints; great debility into fainting; restlessness, anxiety, especially at night; 
profuse sweat, which relieves the pain but leaves the patient terribly weak; 
frequent chilliness alternates with heat; the affected limb has to be moved 



THERAPEUTIC HINTS TO RHEUMATISMUS MUSCUEARIS. 743 

constantly ; external application of heat relieves; metastasis to the heart; 
aggravation every other day. 

Aar. mur. Continued gnawing, boring pain deep in the joints after the 
inflammatory swelling has subsided. 

Bellad. Pressing, tearing, cutting pain deep in the bones, frequently 
running from the affected joint along the limbs like electric shocks; com- 
ing and going quickly; red, shining swelling of the joints; worse gener- 
ally at night, from touch and slightest motion, even talking; attended with 
high fever, hot, dry skin, thirst; throbbing headache and pulsation of the 
carotid arteries. Lumbago, intensely painful sensation of cramp in the 
lumbo-sacral region and coccyx; can sit only for a short time and while sit- 
ting becomes quite stiff and unable to rise again for pain ; crampy pains with 
stiffness in hip and ham, especially on left side. Torticollis, right sterno- 
cleido-mastoid contracted, no inflammation or pain. 

Benz. ac. Tearing pains as if in the bones, from left to right and from 
below upwards; irritable bladder, urine of ammoniacal smell; syphilitic and 
gonorrheal complications. Arthritis deformans. 

Berber. Lumbago, aching pain from above crests of ilia downward and 
inward to sacrum; aching pain in bladder before and after micturition; burn- 
ing micturition. (H. V. Miller.) 

Bryon. Stitching pain, tearing pain, worse from slightest motion; gener- 
ally the patient does not want to move, but sometimes he is compelled to move 
by an overwhelming restlessness, notwithstanding the pain. The swelling 
is not principally confined to the joints and chiefly of a faintish redness, 
streaking out in different directions. There is almost always loss of appe- 
tite, white tongue, feeling of dryness in the mouth without thirst, or else 
great thirst; nausea; pain in the liver or spleen; dry, hard stool, as if burnt; 
short breathing, with stitching pain in the sides of the chest; fever; sour 
sweats; easily irritated and angry. Pleurodynia, omodynia, lumbago, muscu- 
lar rheumatism in general; metastasis to the pericardium or pleura. 

Cact. gra?id. Metastasis to the heart, with a sensation of constriction 
in the region of the heart, as if the heart were grasped and compressed, as 
by a band of iron. 

Calc. carb. Chronic arthritis, with swelling of the joints, worse with 
every change of the weather; after working in water; also omodynia in right 
shoulder, or from the left shoulder down along the arm and towards the 
heart; lumbago, cold feeling in gluteal region and aching after Rhus fox., if 
it did not sufficiently relieve. Frequent sensation of coldness upon the top 
of the head; profuse sweat and coldness of the feet; great inclination to 
perspire; scrofulous diathesis. 

Calc. phosph. Rheumatic pains in various parts of the body, but 
especially in places where bones are joined by symphyses or sutures; worse in 
cold weather. 

Camphora. According to Kreussler, when the morbid process seems to 
yield under the influence of the proper remedies but for a short time and 



744 THERAPEUTIC HINTS TO RHEUM ATISMUS MUSCULARIS. 

then comes back again, attacking part after part of the body, even internal 
organs. 

Carbol. ac. Pains feel as if they would be increased by motion, but 
are not; pains come and go quickly, are worst in hip and shoulder- joints. 

Cauloph. Rheumatism of the wrists and finger-joints, with considerable 
swelling; also when shifting from the extremities to the back and nape of 
the neck, with spasmodic rigidity of the muscles of the back and neck; 
panting breathing; oppression of the chest; high fever; nervous excitement; 
delirium. 

Caustic. Tearing pain with stiffness and swelling of the joints; con- 
traction of the flexors; the pain is worse on exposure to cold air, better in 
the warmth of the bed; great weakness and lameness of the lower limbs 
and trembling of the hands. Chronic arthritis; old warts on the eyebrows 
and nose. 

Chamovi. Drawing pain in the muscles of the upper or lower extremi- 
ties, much aggravated during the night, with tossing about, as if beside him- 
self, and great irritability of temper; hot perspiration, especially about the 
head; redness of one cheek and paleness of the other. 

China. Pain in all the limbs, worse especially from external pressure, 
so that he is even afraid of anyone coming near him. lest he might be 
touched; bears hard pressure better than slight touch; intermittent charac- 
ter; great weakness; paleness of the face; bloated abdomen; after severe 
illness, loss of blood, etc. 

Cimicif. Pleurodynia of the right side of the chest; pain worse from 
motion, extorting screams; articular rheumatism of the lower extremities, 
with much swelling and heat of the affected parts. 

Coccul. When the upper arm or thigh cannot be moved in their joints 
on account of a lame pain. 

Colchic. Burning, tearing, or jerking pains; shifting; without swelling 
and redness, or with only a moderate, pale swelling; constant chilliness even 
near the hot stove, intermingled with short flushes of heat; dry skin or pro- 
fuse sweat; gastric symptoms before and during the attack; Colchic. is said 
to be indicated especially when the acute form merges into the chronic, or 
when, during chronic rheumatism, acute attacks set in; also in metastasis to 
the heart. 

Collin. Has been given in diseases of the heart following acute rheu- 
matism. 

Coloc. All sorts of pains, with sense of formication and numbness; 
frequent urination; skin cool; chilliness with inclination to perspire. 

Digit. Hurried, small pulse, easily affected by motion; strong pulsa- 
tions of the heart, with an indistinct and muffled sound of the heart; hurried 
respiration, hurried, abrupt speech; almost complete suspension of the 
urinary secretion; shining, white swelling of the joints, not very sensitive to 
pressure; a number of joints are attacked at once; the whole bod}' is pale. 
(Baehr. ) 



THERAPEUTIC HINTS TO RHEUMATISMUS MUSCUXAKIS. 745 

Dul cam. Chronic rheumatism, which gets worse from any little ex- 
posure to cold, or any change of temperature from warm to cold; also when 
rheumatic pains set in after acute cutaneous eruptions, or when the chronic 
form alternates with attacks of intestinal catarrh. 

Ferrum, omodynia. Either side; pain, especially in the deltoid muscles, 
of a constant, drawing, tearing laming nature, worse in bed; has to get up 
and to move slowly about; worse, also, from being too lightly covered for 
any length of time; face pale, flushing easily; no swelling. 

Ferr. phosph. Attacking one joint after the other without leaving the 
first; joints puffy but little red; high fever. Kink in the back. 

Gnaphal. Gouty pains in the great toes. 

Graphit. Arthritic nodosities on the fingers; swelling of the toes and 
balls of the toes; coldness of the dorsum of the feet. 

Guaiac. Arthritic lancinations and subsequent contractions of the 
limbs; the pain is excited by the slightest motion and accompanied by heat 
in the affected parts, especially when the patient has been injured by mer- 
cury. It also promotes the spontaneous breaking of gouty abscesses, reliev- 
ing greatly the sufferings of the patient. 

Hamam. Is recommended by Ludlam as " a local application to all 
kinds of articular rheumatism." The main characteristic of Hamam. is the 
great soreness of the affected parts; it may therefore, no doubt, act quite 
favorable in cases where this soreness is a prominent feature. 

Iodium. In chronic arthritic affections, when they are characterized by 
a violent, nightly pain in several joints, without swelling; previous abuse of 
mercury. 

Kali carb. Stitching, tearing pains in joints; shuddering; chilliness; 
nightly diarrhoea; fullness and pressure in stomach after eating; frequent 
waking and desire to urinate, with burning; cold feet; hearing impaired; 
noise in ears. (F. Schelling.) Lumbago, as if the small of the back were 
broken; pains shoot down back of thighs. 

Kali hydr. Large doses, in chronic arthritis with considerable spurious 
anchylosis. (Hirshel.) 

Kali sulph. Shifting from one joint to another, leaving the first with- 
out pain. (Schussler. ) 

Kahnia. The pains are shifting, changing location suddenly; deltoid 
rheumatism of both sides, but more particularly the right; tendency to affect. 
the heart; slow pulse. 

Kreosot. When the rheumatic pain in the joints, especially in the hip 
and knee-joints, is associated with a feeling of numbness, loss of sensation, 
and a feeling as though the whole limb were going asleep. 

Laches. Rheumatic swelling of the index-finger and wrist-joint; rheu- 
matic pains in the knees, stinging, tearing, and sense of swelling; swelling 
of the knees, with tension in the bend of the knees, difficulty in stretching 
the limbs, and pain of the thigh (posteriorly) as if swollen; bluish-red 
swellings. The pains are generally worse after sleeping; they do not im- 



746 THERAPEUTIC HINTS TO RHEUMATISMUS MUSCULARIS. 

prove after profuse sweats; the left side is generally the most affected; or the 
affection commences on the left and goes over to the right side. Arthritic 
contractions of the limbs after the abuse of mercury and quinine; irregular 
action of heart, and valvular affection. 

Lachnanth. Torticollis, the neck is drawn to one side. Stiff neck. 

Ledum. Rheumatic pains in the lower extremities, in the hip and knee- 
joints, especially when they commence below and go upwards; pains alter- 
nating with spitting of blood; arthritic nodosities with violent pains, which 
grow worse in the evening, when getting warm in bed, and last till midnight. 

Lith. Card. Gout}' disposition; rheumatic soreness or sudden shocks 
in region of heart; pains in heart before and during micturition, also before 
and during the menses; trembling and fluttering of the heart from mental 
agitation; valvular deficiencies. 

Lycop. The pain is mostly tearing, oftener on the right side, with and 
without swelling. In lumbago, if Bryon. has not sufficiently relieved, and 
the pain is worse from the slightest motion. In chronic forms, especially in 
old people, attended by forgetfulness, vanishing of thoughts, congestion of the 
head, vertigo, wretched countenance, sour belching, nausea early in the 
morning, flatulence in the stomach and bowels, causing great distress, con- 
stipation of the bowels, urine dark and turbid; or with sediment of red sand, 
oppression of the chest from flatulence, palpitation of the heart, frequent 
flushes of heat with nausea, dry skin. The pain is generally worse at night; 
cannot bear covering. 

Mangan. Arthritis vaga, shifting from one joint to another, or affect- 
ing cross- wise, with shining redness and swelling of the joints; burning 
spots about joints; pain worse from touch and motion, and at night causing 
the patient to moan and groan costantly. Gout; left big toe swollen, with 
excruciating pain radiating upwards; must constantly change position. 

Menyanth. Painful, spasmodic jerking of the lower extremities in 
gouty persons, with calcareous deposits in the joints. 

Mercur. Tearing pain not relieved by sweat, which is often very pro- 
fuse and of a musty swell; worse at night and in the warmth of the bed; 
worse also in cold and damp air; attacking joints and muscles, with and 
without swelling; or a mere puffiness of the affected parts, of a pale or 
slightly pinkish color; collection of saliva in the mouth of a copperish taste; 
slim}' tongue; bitter or sweetish taste; foul breath; violent pain in decayed 
teeth; swollen gums; swollen glands of the neck, painful when swallowing; 
griping in the bowels with diarrhoea, especially towards evening, with fre- 
quent urging; constant feverishness; internal heat, with chilliness and per- 
spiration; sleeplessness and restlessness at night; great debility. Complica- 
tion with cardiac, pulmonary, pleural and meningeal inflammation. ' ' Lame- 
ness, weakness and swelling of the leg in the region of the ankle-joint, in 
fleshy old ladies with rheumatic or gouty tendency." (A. C. Rickey.) 

Nux vom. Especially in rheumatism of the trunk, limbs not excepted; 
gout, in its incipient stage, in habitual drinkers; oversensitiveness to pain; 



THERAPEUTIC HINTS TO RHEUM ATISMUS MUSCUEARIS. 747 

constipation; during hard stool, violent pain in the affected part; scanty, 
dark urine; heat mixed with chilliness, especially when moving; perspiration 
relieves. Torticollis, head drawn to left side; after fright. 

Phosphor. Drawing, tensive pains, from slightest exposure to cold 
with vertigo, oppression and sense of lameness and weakness in the lower 
limbs. 

Phytol. Rheumatism of back and hip-joints. (A. E. Small.) Chronic 
form; obtuse, heavy, aching pain, generally worse in damp weather; with 
and without swelling; periosteal rheumatism with syphilitic taint; nightly 
aggravation; enlargement of the glands of the neck and axilla. 

Platina. Is recommended by Elb for the incipient state of endo- and 
peridarditis, in consequence of articular rheumatism, especially when there 
is intense anxiety and great palpitation of the heart. 

Pulsat. Drawing, tearing pain, frequently shifting from one part of the 
body to another, or attacking only one side; usually attended by swelling 
and redness; pale face; slimy mouth; bitter taste; loss, .of appetite; no 
thirst; constant chilliness, with heat in the affected part; chilliness of left 
side; mild, quiet, tearful disposition; worse towards evening and at night in 
the warm room; better from changing position and moderately moving 
about in the fresh air; from drinking cold water and from uncovering the 
affected part. 

Rhodod. Nightly drawing pains in the periosteum from wet, cold and 
stormy weather; worse during rest, disappearing when moving. 

Rhus tox. Drawing, tearing pains in fibrous tissues, joints, and sheaths 
of the nerves, attended with a sense of lameness and formication in the 
affected parts, with or without swelling and redness, caused by exposure to 
wet, damp weather, to rain, by bathing or straining; worse during rest and 
when commencing to move; better from continued motion and dry, warm, 
external applications; great restlessness. Lumbago. 

Ruta. Wrists and feet; puffy swelling about the insteps; sour sweat. 

Sabina. Chronic arthritis and gout; the patient cannot bear a heated 
room; he feels decidedly better in the cool air and in a cool room; better 
from sitting erect, from moving and stretching; feeling of deep-seated inward 
trouble; melancholy and sad. 

Salic ac. Inflammatory rheumatism of the joints, with great swelling 
and redness; high fever and excessive sensitiveness to the least jar; motion 
impossible. 

Salicylate of soda. Rheumatism especially of the upper extermities, 
with tinnitus aurium. H. I. Giragosian. Hahnemannian Monthly. Oc- 
tober, 1 89 1. 

Sanguin. Right arm swollen, can't be raised, but moved laterally; 
sensation of coldness in arm, which no amount of clothing can remove; stiff 
neck, pain in shoulder; trapezius sore to pressure and painful on movement. 

Secale. Kink in back. (Schiissler. ) 

Silic. In chronic gouty nodosities. 



74-3 DIGEST TO RHEUM ATISMUS. 

Spigel. When complicated with endocarditis or pericarditis. 

Spongia. With heart affection, wakening after midnight with sense of 
suffocation. 

Sticta pulm. Inflammatory, articular rheumatism, especially of small 
joints, with circumscribed redness; subsequent synovitis, with exudation. 
(Price.) 

Sulphur. Chronic rheumatism; podagra; tearing, stitching pain; or 
when, after Bryon. y the stitch-pain leaves, and a dull, aching, pressive pain 
remains; sleeplessness; hot head and cold feet. 

Tarant. Articular rheumatism, attacking almost all the joints from 
below upwards to neck, attended with nervous symptoms, such as: spasmodic 
jerking of the head backwards or sideways; jerking, sighing breathing; 
palpitation of heart with pain in region of heart. 

Tart. emet. Lumbago; slightest effort to move causes retching, cold, 
clammy perspiration and excruciating pain. 

Tilia Eur. When during a rheumatic fever a warm profuse perspiration 
does not alleviate but aggravates the pain, and the swelling of the joints in- 
creases, with great thirst and a decided decrease of the urinary secretion. 
(A. Lippe.) 

Thuja. Rheumatic and arthritic pains, especiall}' of a sycotic or gonor- 
rhceal nature; sweating of the parts not covered; those which are covered 
keep dry; sensation as if the whole body were very thin and delicate, and 
could not resist the least attack, as if the continuity of the body would 
be destroyed. 

Ver. alb. Electric jerks in the affected limbs; worse in bed; necessity 
to sit up and let legs hang out of bed, or must walk about. 

Ver. vir. Rheumatism, especially in left shoulder, hip and knee; also 
recommended in endocarditis and pericarditis. High fever; red streak 
through centre of tongue, with coating upon either side. 

Zincum. General, articular rheumatism, especially of the smaller joints, 
with tearing pain, lameness, and trembling or crampy pain; or twisting in 
the affected limbs, and frequent jerking of the whole body during sleep; 
fidgety feet. 

Digest to Rheum atismus. 



ITS DIFFERENT FORMS AND LO- 
CATIONS. 

Acute articular rheumatism: Aeon., 
Ant. erud., Apoc. andr., Bryon., 
Cimie., Perr. phosph., Hamam., 
Platina, Put 'sat., Rhus tox., Salic, ac, 



Dulcam., I odium, Lycop., Phytol., 

Sabina, Sulphur. 

, with acute attacks: Colchic. 

Muscular, in general: Bryon. 
Torticollis, right sternocleidomastoid 

contracted, no inflammation or pain: 



Sticta pulm., Tarant., Tilia Eur op., Bel lad. 

Ver. vir., Zincum. > muscles of back and neck rigid: 

When the acute form merges into the Cauloph. 

chronic: Colchic. > head drawn to left: Nux vom . 

Chronic form: Calc. carb., Caustic, Stiff neck: Lachnanth., Sanguin. 



DIGEST TO RHEUM ATISMUS. 



749 



Pleurodynia : Arnica, Bryon, Nuxvom. 

, right side: Cimic 

Omodyilia: Bryon., Sanguin. 

, right side : Calc card. 

, either side : Ferrum. 

Lumbago, kink in back : Aeon., Bellad., 
Berber., Bryon., Calc. card., China, 
Ferr. phosph . , Kali card. , Lycop. , Rh us 
tox., Secale, Tart. emet. 

Kink in back, hindering deep inspira- 
tion : Aeon. 

Gout : Aeon., Amm. phosph., Ant. crud., 
Apoc. andr., Arnica, Arsen., Bryon., 
Calc. carb., Caustic, Coloc, Graphit., 
Guajac, Iodium, Lithium carb., Lycop. , 
Natr. mur., Sabina, Silic, Sulphur. 

, left big toe, with radiating pain up- 
ward : Man g an. 

, habitual drinkers : Nux vom. 

Arthritis nodosa : Amm. phosph., Benz. 
ac , Calc. phosph., Graphit., Kali hydr., 
Ledum, Menyanih., Silic. 

, promotes breaking of gouty ab- 
scesses : Guaiae. 

Trapezius, shoulder : Sanguin. 

Trunk and limbs : Nux vom. 
Back and hip : Phytol. 
Shoulder and hip : Carbol ac. 

and knee, left side : Ver. vir. 

and knee, right side : Apoc. andr. 

and knee : Kreos. 

Right arm swollen, can't be raised, but 

moved laterally : Sanguin. 
Deltoid muscles : Ferrum. 

, more the right side : Kalmia. 

Wrist and index finger : Laches. 

and finger- joints : Cauloph. 

and feet : Ruta. 

Back of hands and fingers swollen and 

bent : Amm. phosph. 
Lower extremities : Cimic, Ledum. 
Hip and knee-joints : Ledum. 

and ham, worse left side : Bellad. 

Ankle-joints : Memoir. 

Small-joints : Digit., Sticta pulm., Zin- 

cum. 
Where there are symphyses or sutures : 

Calc. phosph. 



Shifting, moving : Aeon., Colchic, Man- 

gan, Mercur., Pulsat. 

, suddenly : Kalmia. 

from one joint to another, without 

leaving the first : Ferr. phosph. 



, leaving the first without pain : 

Kali sulph. 

— from left shoulder down arm and 
towards heart : Calc carb. 

— from below upwards : Benz. ac, 
Ledum. 

— from extremities to back and nape 
of neck : Cauloph. , Tarant. 

— from right to left : Apis. 

— from left to right : Benz. ac. , Laches. 



One side only : Pulsat. 
Right side oftener : Lycop. 
Left side mostly : Laches. 
Crosswise : Mangan. 



Aching : Berber. , Phytol. 

Burning : Apis., Arsen., Colchic 

Crampy : Bellad, Zincum. 

Drawing : Chamom., Phosphor., Pulsat., 
Rhus tox. 

Formication and numbness : Arnica, 
Coloc, Kreos., Rhus tox. 

Heat : Aeon., Guajac, Pulsat. 

Jerking: Golchic. 

Lameness: Apis., Ferrum, Rhus tox., 
Zincum. 

Lancinating : Guajac 

Soreness : Apis, Hamam. 

Stinging: Apis, Arsen., Laches. 

Stitching : Bryon., Kali carb., Sulphur. 

Swelling : sense of : Laches. 

Tearing : Arnica, Arsen., Bellad., Benz. 
ac, Bryon., Caustic, Chamom., Col- 
chic, Ferrum, Kali carb., Laches., 
Lycop., Mercur., Pulsat., Rhus tox., 
Sulphur, Zincum. 

Twisting : Zincum. 

Quickly coming and going : Bellad., 
Carbol. ac. 



Aching from above crests of ilia down 

and inward to sacrum : Berber. 

in gluteal region : Calc carb. 

Boring, gnawing deep in the joints after 

the swelling has subsided : Aur. mur. 
Burning in spots about the joints. 
Coldness in arm, which no covering can 

remove : Sanguin. 

in gluteal region : Calc. carb. 

Cramp in lumbro-sacral region and 

coccyx : Bellad. 
Cutting, pressing, tearing deep in bones, 

running from affected joint along limbs 

like electric shocks : Bellad. 



75° 



DIGEST TO RHEUMATISMUS. 



Drawing in periosteum, nightly : Rhodod, 
and tearing in muscles in upper and 

lower extremities : Chamom. 
, shifting from one part to an- 
other : Pulsat. 
in fibrous tissues, joints and 

nerve-sheaths : Rhus tox. 
Lame pain in upper arm and thigh : 

Coccul. 
Lameness and weakness in lower limbs : 

Caustic, Phosphor. 

of ankle-joints : Merc. sol. 

Pain in all the limbs : China. 

in thigh, posteriorly, as if swollen : 

Laches. 
Shooting" down back of thighs : Kali 

card. 
Stitching, tearing in joints: Kali card. 
Tension in bend of knees : Laches. 



Swelling : Apis, Arnica, Cauloph. 
Swelling and heat: Cimic. 

of joints; Calc. carb., Tilia Europ. 

and stiffness: Caustic. 

of index-finger, wrist-joint, and 

knees: Laches. 

about ankle-joints: Merc, sol, 

of toes and balls of toes: Graphit. 

or no swelling: Lycop. Phytol. 

of joints or muscles: Merc. sol. 

No swelling: Ferritin. 
Swelling and redness: Aeon., Pulsat., 
Rhus tox., Salic, ac. 

circumscribed: Sticta pitlvi. 

bluish: Laches. 

faintish, pale: Aeon., Arsen., 

Bryon., Colchic. 

, shining: Bell ad. 

, shining white: Digit. 

Puffiness about instep: Ruta. 

, but little red: Ferr phosph. 

, of a pale or slightly pinkish color: 

Mercur. 

Breathing, jerking, sighing: Tarant. 

, hurried, and abrupt speech: Digit. 

, panting: Cauloph. 

, short, with stitch-pain in sides of 

chest: Bryon. 
, hindered, from stitching pains in 

chest: Aeon. 
Oppression: Cauloph., Rhus tox. 
from flatulency: Lycop. 



Suffocation, sense of, after midnight: 
Spongia. 

Spitting of blood alternates with rheu- 
matic pain: Ledum. 

Inflammation pulmonary, pleural, men- 
ingeal: Bryon., Merc. sol. 

Metastasis to heart: Arsen, Bryon., 
Cact. grand., Colchic, Kalmia lat. 

Heart affection: Collins. , Mercur., 
Spongia. 

Endo- and pericarditis: Platina, Spi- 
gel., Ver. vir 

Valvular deficiencies : Laches., Lith- 
ium carb. 

Slow pulse : Kalmia. 

Hurried, small pulse, easily affected by 
motion: Digit. 

Palpitation : Colchic, Lycop., Platina, 
Tarant. 

Agitation with anxiety : Aeon. 

Strong pulsations, with muffled sound 
of heart: Digit. 

Trembling and fluttering of heart from 
mental agitation: Lithium carb. 

Irregular action : Laches. 

Pains in heart before and during mic- 
turition and menses: Lithium carb. 

Region Of heart, pain: Tarant. 

, constriction, as if heart were grasped 

by an iron hand: Cact. grand. 

, soreness and shocks: Lithium Carb. 

, pressing below heart, day and night: 

Arnica. 

ACCOMPANYING SYMPTOMS: 

Forgetfulness, old people; vanishing 

of thoughts: Lycop. 
Delirium: Cauloph. 

Sad, melancholy: Sab in a. 
Anxiety: Aeon., Arsen., Platina. 
Irritable: Amm. phosph. 

, beside himself: Chamom. 

. angry: Bryon. 

Mild, quiet, tearful: Pulsat. 

Nervous excitement: Apoc. andr., 

Cauloph. 
Restlessness : Arsen., Rhus tox. 



Vertigo : Lycop. , Phosphor. 
Congestion : Lycop. 
Throbbing headache : Bellad. 
Meningeal inflammation : Mercur. 

Hearing impaired, noise in ears: Kali 
Carb. 



DIGEST TO RHEUM ATISMUS. 



751 



Face pale : China, Pulsatt. 
, easily flushing: Ferrum. 

on one check, the other red: 

Chamom. 

Whole body pale: Digit. 

Wretched countenance : Lycop. 

Old warts on eyebrows and nose: 

Caustic. 
Carotid arteries pulsate: Bellad. 
Swollen glands of neck, painful on 

swallowing: Mercur. 

and axilla: Phytol '. 

Tongue white : Ant. crud. Bryon. 

coated on both sides, with red streak 

in middle: Ver. vir. 

slimy: Mercur., Pulsat. 

Teeth decayed, painful, swollen gums; 

foul breath: Mercur. 
Taste bitter: Mercur^, Pulsat. 

copperish or sweetish collection of 

saliva: Mercur. 

Thirst: Aco?i., Bellad., Bryon., Tilia., 
Eur op. 

at night: Ant. Crud. 

, none: Pulsat. 

, , with feeling of dryness in 

mouth: Bryon. 

Loss of appetite : Amm. phosph., 
Bryon., Pulsat. 

Nausea, vomiting: Ant. crud. 

, sour belching early in the morning: 

Lycop. 

Gastric symptoms : Colchic. 

Bilious vomiting, with or without diar- 
rhoea: Apoc. andr. 

Pain in liver or spleen : Bryon . 

Fullness and pressure in stomach after 
eating: Kali carb. 

Flatulence in stomach and bowels: 
Lycop. 

Bloated abdomen : Chamom. 

Constipation: Apoc. andr., Bryon., 
Lycop., Nux vom. 

Diarrhoea nightly: Kali carb. 

, with griping in bowels, worse to- 
wards evening: Mercur. 

alternares with rheumatic attacks: 

Dulcam. 



Aching in bladder before and after mic- 
turition: Berber. 

Irritable bladder : Benz. ac. 

Frequent waking and desire to urinate, 
with burning: Kali carb. 



urination: Coloc. 

Burning micturition : Berber. 

Urine scanty, dark: Nux vom. 

, fiery: Aeon. 

dark, turbid, red sediment: Lycop. 

decreasing: Tilia Europ. 

suppressed: Digit. 

Contraction of flexors: Caustic. 

Contraction of limbs: Guajac. Laches. 

Synovitis, with exudation: Sticta pulm. 

Jerking of head backwards and side- 
ways: Tarant. 

lower extremities: Menyanth. 

affected limbs: Ver. alb. 

whole body during sleep: Zincum. 

Trembling: Zincum. 

of hands: Cimic. 

Fidgety of feet: Zincum. 

Sensitive to pain: Nux vom. 

, as if body were thin and delicate 

and could not resist the least attack 
without being destroyed: Thuja. 

Weakness : China. 

Debility : Mercur. 

unto fainting: Arseu. 

Emaciation : Amm., phosph. 



Restlessness: Aeon., Arsen., Bryon., 
Mercur., IZhus tox. 

Tossing about : Chamom. 

Sleeplessness: Amm. phosph., Apoc. 
andr., Mercur., Sulphur. 

Must constantly change position: Man- 
gan. 

Affected limb has to be moved con- 
stantly: Arsen. 

Has to get up and move slowly about: 
Ferrum. 

Difficult to stretch the limb: Laches. 

Does not want to move: Bryon. 

Bed feels too hard: Arnica. 

Hard pressure feels better than slight 
touch: China. 

Coldness upon top of head: Calc. carb. 

in gluteal region : Calc. carb. 

of feet: Kali carb. 

and hot head: Sulphur. 

and profuse sweat: Calc. carb. 

of dorsum of feet: Graph it. 

Skin cool : Color. 

Chilliness, shuddering: Kali carb. 

of left side: Pulsat. 

alternating with heat: Arsen. 



752 



DIGEST TO RHEUMATISMUS. 



when moving during heat: Nux 

vom. 

even near stove, intermingled with 

flushes of heat: Colchic. 

Chilliness, with internal heat and per- 
spiration : Mercu r. 

, with perspiration: Coloc. 

Fever: Apoc. andr., Bellad., Bryon., 
Cauloph., Fer. phosph., Mercur., Salic, 
ac, Ver. vir. 

and restlessness: Aeon. 

in evening: Amm. phosph. 

Heat mixed with chilliness: Arsen., 
Merc, sol., Nux vom. 

Flushes of heat, with chilliness: Col- 
chic. 

- , with nausea: Lycop. 

Hot head and cold feet: Sulphur. 

Dry skin: Aeon., Bellad., Colchic, 
Lycop. 

Perspiration, hot about the head: Cha- 
mom. 

and cold feet: Calc. card. 

, with chilliness and internal heat: 

Mercur. 

and chilliness: Coloc. 

of parts not covered: Thuja. 

sour: Bryon., Ruta. 

brings relief: Apis, Nux vom. 

: , but leaves the patient very 

weak: Arsen. 

without relief: Laches., Mercur. 

, worse after: Tilia Europ. 

, inclined to: Calc. card., Mercur. 

breaks out suddenly and disappears 

again: Colchic. 



Worse in evening: Ledum. 

and night: Pulsat. 

at night: Bellad., Chamom., Lodium, 

Ledum, Lycop., Mangan., Mercur., 

Phytol., Rhodod. 

every other day: Arsen. 

intermittent: China. 

in bed: Ferrum., Ver. alb. 

from being covered: Ferrum, Lycop. 

lying and getting warm in bed: 

Arnica. 

in warm room: Pulsal., Sabina. 

from sweat: Laches., Mercur., Tilia 

Europ. 
after sleep: Laches. 

from cold air: Caustic, Dulcam., 

Phosphor. 



Worse from cold and damp weather: 
Calc carb. and phosph., Mercur., 
Phytol. 

from change of temperature from 

warm to cold: Dulcam. 

from slightest motion: Arnica, Bel- 
lad., Bryon., Cimic.,Guajac, Mangan., 
Salic, ac, Sanguin. 

from least jar: Salic ac 

when commencing to move: Rhus 

tox. 

from effort to move, causing retch- 
ing and cold perspiration: Tart. emet. 

, as if the pains would be worse from 

motion, but are not: Calc. phosph. 

from talking: Bellad. 

during hard stool: Nux vom. 

from sitting, can't rise after: Bellad. 

during rest: Rhodod., Rhus tox. 

from touch: Bellad., Mangan. 

, fears the possibility of being 

touched: Arnica, China. 

Better from warm external applications: 
Arsen., Rhus tox. 

the warmth of bed: Caustic 

uncovering: Lycop., Pulsat. 

cool air and in a cool room: Sabina, 

Pulsat. 

drinking cold water: Pulsat. 

sitting up and letting legs hang out 

of bed: Ver. alb. 

changing position: Pulsat. 

walking about: Ferrum, Ver. alb. 

moving about : Rhodod. , Pulsat. 

continued motion: Rhus tox. 

perspiration: Nux vom. 

CAUSES. 

Severe illness, loss of blood: China. 
Exposure to cold, dry wind: Aeon. 
Wet, cold, stormy weather: Rhodod. 
, , , bathing or straining: 

Rhus tox: 
Working" in water: Calc carb. 
After cutaneous eruptions: Dulcam. 
Scrofulous diathesis : Calc carb. 
After gonorrhceal or sycotic affections: 

Benz. ac, Thuja. • 

Syphilis : Phytol. 
Abuse of mercury: Guajac, Lodium, 

Laches. 
C amphora, when proper remedies seem 

ineffectual. 



GOUT, PODAGRA, ARTHRITIS. 753 



Calc. Carb., when Rhus tox. did not suffi- 
ciently relieve. 
Lycop., when Bryon., was insufficient 



and pain is worse from motion. 
Sulphur, when Bryon., leaves a dull, ach- 
ing, pressive pain. 



Gout, Podagra, Arthritis. 

Gout differs entirely from rheumatism in the form of its attacks, 
by the presence in the blood of uric acid, by its never attacking children, 
and only grown persons after thirty years of age, and men oftener than 
women, especially such as are accustomed to a rich table and the habitual 
use of beer or wine, and who take very little bodily exercise. It is, there- 
fore, a very rare occurrence to find a poor man suffering with podagra. 
According to statistics its main cause is a hereditary disposition, which 
is general^ aroused into activity by overcharging the blood with ni- 
trogenized substances, and a want of exercise to consume the too-liberal 
supply. 

The repetition of diverse acute attacks of gout and its chronic form 
causes peculiar changes in the joints which it attacks. We find in and around 
them, besides the ordinary sign of inflammation, a chalky deposit, consisting 
principally of urate of soda, and less frequently of compounds of uric acid 
with lime, magnesia and ammonia. This deposit either lines the internal 
surface of the synovial capsule like a soft mush, or incrustates the cartilages 
of the bones as a hard mass, or even fills the whole joint as though it had 
been injected with plaster of Paris, growing hard and causing anchylosis. 
At the same time gouty deposits may take place on the external surfaces of 
synovial capsule, on the tendons and in the surrounding cellular tissue, and 
give rise to hard nodosities, tophi. In some persons similar deposits have 
been observed on other and different parts of the body, especially in the skin. 
The course of an acute attack of gout is as follows: The gentlemen 
in question generally does not dream of what may happen to him over 
night. He feels fine; he has enjoyed a good dinner and supper as usual, the 
proof of which we can read in his face; his cheeks are full, round and of a 
florid complexion, only his nose looks a little suspicious. There we observe 
a fine network of enlarged capillary blood-vessels, tinging it rather redder 
than would be necessarily required for a good-looking nose. He is fat, and 
his stomach and belly are in quite a prosperous condition, looking very well 
cared for. It may be, though, that in the last few days he did not feel al- 
together right; his appetite may not have been quite as sharp, his sleep not 
quite as refreshing; he may have had some palpitation of the heart and his 
urine may have been concentrated and turbid. All this, however, is gener- 
ally overlooked or attributed to some imprudence in diet. Then, all at 
once in the night, generally after midnight, the gentleman is aroused by a 
burning, screwing pain in one of his big toes, which gets worse from hour to 
hour. If the toe were screwed in a vise, the pain could not be worse, and the 
poor sufferer, unaccustomed to such severe handling, moans and groans and 
tosses about without avail. The toe soon commences to swell and redden; 
48 



y54 THERAPEUTIC HINTS TO GOUT, &C. 

there is great thirst, high fever, dry skin, concentrated urine and great mental 
irritability. Finally, towards morning, a remission of the violent pain takes 
place; the day passes along comparatively easy, until next night the same 
violent paroxysm recurs. In this way it goes on for about a week, when 
finally, the pain, redness and swelling gradually disappear, and, at last, the 
skin of the affected toe peels off. This is a first attack of Podagra. Gout 
almost always commences in this way. In later attacks, however, other 
joints may become involved. If, then, it attacks the finger-joints, it is called 
Chiragra; if the knee-joint, Gonagra; if the shoulder-joint, Omagra. These 
acute attacks are at first far apart. Years ma)' intervene between them, but 
finally the intervals grow shorter and the acute regular attacks become 
chronic and irregular. 

Such chronic, irregular attacks often last for weeks and months, and al- 
ways cause the above-stated deposits in and around the affected joints. They 
are generally not quite so painful, nor attended with as high a fever as an 
acute, regular podagra: they are always preceded by digestive derangements 
and they attack several joints at the same time. After the attack subsides, 
the swelling does not, but remains at first soft and doughy, until at last it 
changes into a hard tophus, which grows with each subsequent attack. Such 
hardened, chalky deposits within the joints frequently give rise to the forma- 
tion of abscesses, which break and discharge masses of pus mixed w T ith cal- 
careous substances. 

At still other times this morbid process attacks internal organs such as 
the stomach, brain or heart; then is called anomalous gout. 

Gout of the stomach manifests itself as a very severe cardialgia, with 
violent vomiting, frequently even of blood; Gout of the brain, as a kind of 
apoplexy, or violent headache, vertigo, furibund delirium, and subsequent 
stupidity and sopor; and Gout of the heart, as irregular palpitation of the 
heart, disturbed circulation, dyspnoea and syncope. 

It might be quite difficult to diagnosticate these spells as gout, if it were 
not that they are almost always preceded or succeeded by gout}' manifesta- 
tions of the peripheric organs. This settles the question. Gout is a stub- 
born disease, but is not fatal unless complicated with other diseases, or in 
consequence of the organic mischief which it produces in the course of time, 
in the form of a lingering cachexia, or apoplexia, or angina pectoris. 

Therapeutic Hints. 

As the principal exciting cause of its first development is high and lazy 
living, this, of course, ought to be stopped, as a first step. 

In acute attacks, the following are principally indicated: Aeon., Arnica, 
Arsen., Bryon., Calc. card., Sabina, Sulphur. 

In chronic gout the main remedies are: Amm. phosph., Calc. card., 
Caustic, Coloc, Guajac, /odium, Lycop., Mangan., Natr. ?nu?., Sabina, 
Silic, Sulphur. 

For special hints compare Rheumatism. 



ARTHRITIS DEFORMANS. 755 

Arthritis Deformans. 

11 This disease, also described under the names of Arthritis sicca, spuria, 
nodosa, pauperum, rheumatoides, arthroxerosis, Malum senile, articulorum, 
Rheumatismus nodosus, Polypanarthritis, Rheumatic gout, Nodular gout, is 
applied to an inflammatory process of the joint, which produces chronic 
changes but never suppuration of the joints. It affects the nutrition of all 
the constituent parts of the joint, causing, on one hand, abnormal prolifera- 
tion, on the other absorption; and so the whole shape of the joint becomes 
deformed. ' ' (Senator. ) 

There are two varieties of arthritis deformans, one beginning in the 
smaller joints of the extremities, and the other in the large joints of the 
trunk (vertebral column, hip), subsequently extending towards the peri- 
phery, and by preference called the " senile" form. 

The peripheric variety is much more common in women than in men, 
and is essentially a disease of the poorer classes. Developing towards the 
thirtieth year of life, it increases in frequency among women about the cli- 
macteric period, and is caused chiefly by prolonged exposure to cold and 
damp, by inadequate food, debilitating haemorrhages, unduly protracted lac- 
tation, grief and anxiety, by manual labor (sewing, knitting, laundry- work, 
in women; watch-making, in men). 

The senile variety is more common in men than in women; it begins at 
the age when senile changes (atheromatous degeneration of the arteries, cal- 
cifications, etc. ) commence to develop, and it attacks the rich no less than 
the poor. Thin people appear to be specially predisposed to it. 

The Symptoms consist of neuralgic pains in the parts affected, which 
lose by slow degrees their mobility; the articular ends of the bones become 
thickened, and gradually displaced, and when moved produce a peculiar 
grating, which can be distinctly felt through the soft parts. There are also 
not seldom excrescenses and nodular masses around the joints, while the 
muscles and soft parts in the neighborhood of the joint, or even of the en- 
tire limb, begin to waste. In the smaller, peripheral joints the, disease 
spreads invariably symmetrical, which appears not quite so obvious in the 
senile form. The fingers from the index to the ring fingers, more rarely the 
little finger also, are flexed and dislocated at the metacarpal end of the first 
phalanges, usually towards the ulnar side, less frequently towards the radial 
side. The thumbs generally remain free, while the great toes are more fre- 
quently and more severely attacked than their neighbors. An attack of the 
hip and knee, shoulder or elbow-joints shortens the respective limb; an at- 
tack of the vertebral column (spondylitis deformans) produces stiffness and 
rigidity of the spine, with pains radiating from the back; an attack of the 
cervical vertebrae prevents bending or rotating the head; an attack of the 
dorsal and lumbar spine shortens and twists the body. Cases occur where 
even the lower jaw, the clavicles, in fact all the joints of the body become 
implicated. 



756 RACHITIS. 

The process of the disease is very slow, but steadily progressing in parox- 
ysms, which are usually attended with severe pain and slight febrile disturb- 
ances. The urine shows a diminution in the amount of phosphoric acid. 

Therapeutic Hints. 
Calc. phosph., Phosph. ac. Compare the hints under Rheumatism. 

Rachitis, Rickets. 

Other names by which this disease is known are: Rachitismus, Morbus 
anglicus, Articuli duplicati, Zweiwuchs, Doppelte Glieder. Its character con- 
sists essentially of an irritation of the osteo-plastic tissue in consequence of 
which there is an overgrowth of the same, with less earthy salts than are 
required for the formation of healthy bone. Heitzmann asserts that this ir- 
ritation of the osteo-plastic tissue can be brought about by the influence of 
lactic acid (phosphorus exerts a similar influence), and that, when combined 
with a deficiency of lime in the food, it is capable of producing true rickets. 
This supposition agrees with the frequency of its development during the first 
two or three years of life, and with the fact that an excess of lactic acid has 
been detected in the urine of rickety children. After the third year the dis- 
ease develops much more rarely, and between the age of five and puberty it 
is quite an exceptional phenomenon; sometimes it develops in utero. 

As Causes have been mentioned: hereditary influences, chronic tuber- 
culosis in the father, constitutional syphilis in the parents; cold, damp, ill- 
ventilated dwellings. 

Its Premonitory Symptoms are: intestinal and bronchial catarrh, 
feverishness and restlessness towards evening and through the night, perspi- 
ration about the head, slow, irregular teething. After a while changes in ' 
the bony structure become apparent. The articular ends of the long bones 
swell. 

The prominence of the contiguous epiphyses, for instance of the upper 
and lower arms, is so marked, that the joint between them forms a depression 
which gives the appearance of two elbows, hence the name Articuli dupli- 
cati, or Zweiwuchs (double growth). The fontanelles and sutures of the 
skull delay inclosure, and the occipital bone becomes soft and flexible, and may 
often be depressed by the finger as though it were of parchment. This soft- 
ness extends over the entire bony structure, and is the cause of the deformi- 
ties which the bones undergo in consequence of the force of the muscles at- 
tached to them and of the weight of the body. The legs usually exhibit an 
outward curve and become bow-shaped, while the thorax appears laterally 
compressed, causing the breast-bone to project like the keel of a boat 
(chicken breast). The junctions of the ribs with their cartilages become 
thickened and nodular, and appear like the beads of a rosary. The spine 
often becomes curved, the pelvis flattened in its antero-posterior diameter, or 
otherwise deformed, and the growth of the child in length delayed. The 
hairy part of the head is unchecked in its growth, and the head seems un- 



THERAPEUTIC HINTS TO RACHITIS. 757 

duly big and often sinks down between the shoulders; the abdomen is very 
prominent , and in advanced cases the child looks like a dwarf. 

In mild cases, or such as come early under judicious treatment, the de- 
formities do not reach this grade; by a renewed activity of growth the mor- 
bid process may be checked without leaving any marked thickening of the 
bones behind. 

There have been observed some cases of an acute nature in which 
within a few weeks the epiphyses of all or of most of the long bones became 
swollen; there were swellings on the cranial bones, and a simultaneous 
swelling of the gums and palate, with digestive derangements and fever, 
the whole process running its course within a period of a few weeks, termi- 
nating either in recovery, or in death by complications, such as pneumonia, 



Therapeutic Hints. 

It ought to be ascertained, whether the milk which the child receives is 
of a proper condition. When the child has been fed on paps and other mere 
farinaceous food, its diet should be changed to nitrogenous substances, such 
as rare beefsteak, mutton chops, etc. 

When, notwithstanding, the most proper kind of nourishment, the dis- 
ease still develops itself, the child needs medicinal aid. 

For the preceding chronic diarrhoea compare the corresponding chapter. 

For the swelling of the bones compare — 

Alumina. Abnormal cravings, liquid stools, with much straining; 
absence of sweat, dry, lustreless hair; persistent strabismus; slow in walking, 
speaking, cutting teeth; large head; open fontanelles; bathed in cold sweat; 
voracious appetite; distended abdomen; progressive wasting; persistent watery 
diarrhoea. (Dr. Edward Fornias, in Horn. Physician, May 1887, p. 170.) 

Aselli jecoris oleum. This is best used in the form of a trituration 
with sugar. It is not at all necessary to give the oil by the spoonful. 

Bellad. Curvature of the lumbar vertebrae; squinting; enlarged pupils; 
pain in the throat when swallowing; thick, protruding belly. 

Calc. carb. Slow, difficult teething; profuse sweating about the head; 
fontanelles open; abdomen enlarged; whitish, frothy diarrhoea; curvature of 
the spine and deformities of the extremities. 

Calc. phosph. Not less important than carbonica; its principal in- 
dications are the fontanelles, which remain widely open, the diarrhoea and the 
emaciation of the child. Both the Calc. carb. and phosph. have been ad- 
minstered in large, crude doses with far less good results than in a homoeo- 
pathic preparation. 

Natr. mur. ' ' Particularly useful when the thighs are notably emaci- 
ated, and the disease in its early stages, with slight pliability of the bones. ' ' 
(Gilchrist.) 

Phosphor. Has been used even by the old school with great success. 

Previous abuse of mercury may call for Asaf., Aurum, Hepa>\ /odium, 



75S MALACOSTEON. 

Sulphur; and still other peculiarities of the case may point to August., 
Flour, ac, Lad. ac, Lycop., Mercur., Mezer., Phosph. ac., Sepia, SiliC, 
Staph is., Symphytum, Theridion (Baruch) and others. 

Malacosteon; Mollities Ossium: Osteomalacia, Softening of the 

Bones. 

Rachitis consists of a deficient calcification of the growing bone; mala- 
costeon, on the contrary, of a gradual withdrawal of earthy. salts from the 
already formed bony structure. It is a chronic disease peculiar to adult life, 
and especially to women who have passed through one or more pregnancies. 
It usually begins during pregnane)-, with an active congestion and prolifera- 
tion of corpuscular elements, which is followed by the removal of earthy 
salts. The real cause of this decalcification of the bones is still a matter of 
conjecture. Damp dwellings, however, seem prominent among the exciting 
causes. 

Malacosteon is a very rare disease. In some cases the morbid process 
is confined to the pelvis and spine, in others it spreads over all the bones of 
the skeleton. The calcareous constituents being extracted, it is obvious that 
the whole frame loses its form. In this way originate curvatures of the spine; 
the pelvis, from the pressure of the legs, flattens in on both sides and projects 
in front with its pubic region; the extremities become flexible, yielding to 
any pressure in any direction, and in some cases it has been observed that 
women of a stately size gradually shrunk down to a dwarf's figure. 

The disease commences with severe boring and tearing pains in the 
affected bones, worse on motion and better at rest, and usually attended with 
more or less fever; the saliva and secretions of the skin are said to contain 
appreciable quantities of phosphate of lime; the general condition ma}% in 
some cases, for a long time be not essentially affected, while in others the 
system shows early signs of a deep-seated cachexia. 

Therapeutic Hints. 

I do not find a single case mentioned in our literature. However, 
Ar?iica, Rhus tox., or Symphytum, after difficult confinement; and Calc. 
carb. and phosph., Flour, ac, Phosphor., Silk., and others, as constitutional 
remedies, might be suggested. 

Progressive Muscular Atrophy. 

The character of this disease consists in a gradual atrophy and fatty 
degeneration of certain muscles, which in the course of time spread further, 
involving progressively more and more of th£ muscular tissue. 

On post-mortem examination, we find, therefore, (i ) the muscles dimin- 
ished in size; (2) the muscular fibres changed from red to a pale and 
yellowish color. On applying the microscope it appears that this process 
commences with a change of color of the muscular fibres, which are growing 



PROGRESSIVE MUSCUEAR ATROPHY. 759 

paler, and a disappearance of their transverse striae. Later we observe fat- 
globules in the centre of the ultimate fibrils, and at last a disappearance of 
the fibrils themselves, so that the sarcolemma or sheath, which envelopes the 
ultimate fibrils, shrinks together, containing only single fat-globules. 

This degenerating process does not take place simultaneously in all the 
fibres of a muscle; we find on the contrary in the same muscle fibres thus 
degenerated and others perfectly healthy, until by degrees all are involved 
in the same morbid process. 

Some authors have thought, that this morbid process within the muscles 
is the consequence of a disease of the nerves at their roots, because in some 
cases there have been found on post-mortem examination quite conspicuous 
structural changes in the anterior roots of the spinal nerves. Yet in other 
cases nothing of the kind could be detected. And as the muscle retains its 
susceptibility to the electric currents as long as there are any muscular fibres 
left, whilst in the case of degeneration of the peripheric nerves this suscepti- 
bility to the electric current leaves at quiet an early stage: it seems to follow, 
that those authors are right, who have considered the progressive muscular 
atrophy as a primary affection of the trophic centres of the muscles themselves. 
It is found in all classes of people; seems, however, to attack women 
oftener than men; appears to be in some cases hereditary and in others 
brought on by overexertion of the muscles, qr by taking cold; whilst in still 
others it could not be traced to any special cause. 

This disorder creeps on very slyly, mostly without any pain or any other 
apparent disturbance of the body. Commencing generally in the muscles of 
one hand or one shoulder, or in the muscles of the neck, rarely in the muscles 
of the face; the first apparent symptom is a weakness in the parts involved, 
a loss of muscular power, which is associated by a diminution of their volume. 
The attacked parts grow flat and shrink away. We find therefore in such 
cases the prominent muscle of the thumb gone, and the spinal processes 
sticking out, when the muscles of the neck have become atrophied. If these 
atrophied muscles are exposed to a cold draught of air (if we, for example, 
blow upon them), we observe at once a vibratory motion of the muscular 
fibres, a jerking of single fasciculi. This is quite a constant symptom of 
the disease. Its pathognomonic sign, however, is the susceptibility of these 
muscles to the electric current, which causes a contraction in them, as long 
as there are any fibres left, distinguishing it thus from any paralysis which 
has its cause in a morbid condition of the nerves. 

The atrophy and fatty degeneration and consequent paralysis may stay 
confined to the parts first attacked, but in other cases it creeps on, involving 
progressively all the muscles supplied by the cerebro-spinal nerves, with the 
exception of the muscles of the heart and the intestinal canal. Thus gradu- 
ally, in these terrible cases, the patient becomes incapable of moving himself, 
of feeding himself, of expressing any mental emotion by his face; of talking, 
and lastly, even of swallowing. It takes years before death releases him 
out of this terrible bondage, if not intercurrent disease shortens his suffering. 



760 osteitis. 

Therapeutic Hints. 

The electric current, by induction or faradization, persistently used, has 
improved cases where the disease remained confined to single parts of the 
body. 

Arg. nitr. y Arsen., Caustic, Cuprum, Laches., Plumbum, Sulphur. 

Osteitis, Caries, Necrosis, Exostosis. 

Osteitis is an inflammation either of the periosteum, or of the bone 
itself, or of its diploe or its medullary membrane, or of all these different 
structures together. It may be caused by external injuries, such as frac- 
tures, bruises, etc., or by chemical influences; or it may be the consequence 
of certain constitutional contaminations, like scrofulosis, arthritis, scurvy, 
syphilis, mercurial poisoning, or suppressed acute or chronic skin diseases. 

Its symptoms generally consist of a deep-seated, heavy, boring pain 
which assumes a tearing character when the periosteum is affected at the 
same time. This pain is usually worse at night (especially if of syphilitic 
origin) and worse also from pressure and motion. There is generally a 
feeling of heat in the bone, and if the inflamed bone is superficial, its in- 
teguments soon participate in the inflammatory process. Febrile actions are 
mostly wanting, except in acute cases. Such an inflammation may ter- 
minate in 

Caries, by which we understand an ulceration of the bony structure; or 
even in 

Necrosis, which means a dying off of a portion of the bony structure, 
which, in favorable cases, is gradually thrown off and replaced by a new for- 
mation. 

In other cases the inflammation causes an exudate upon the bone, 
which hardens and grows fast to the bone, thus augmenting its natural size 
more or less considerably; this is called Exostosis. 

Therapeutic Hints. 

Angus, t. Caries, especially of the long bones; great longing for coffee, 
the use of which must be entirely prohibited; great sensitiveness of mind, 
very touchy, easily irritated from the least provocation. 

Arse?i. " Excruciating pain in bones of legs and arms, like the gnaw- 
ing of rats, or boring with a gimlet into the bones; sudden and rapid pros- 
tration, with restlessness and emaciation." (Gilchrist.) 

Asa/. Osteitis, caries in scrofulous individuals, and after the abuse of 
mercury; bluish redness and swelling of the external parts; ulcer with 
bluish hard edges, which are very painful to the slightest touch ; discharge 
of thin, very offensive pus. Pulsations in the pit of the stomach, per- 
ceptible to the eye and hand; ill-humor and irritated mood. 

Aselli jecor. ol. In different affections of the bones, in scrofulous sub- 



THERAPEUTIC HINTS TO OSTEITIS. 76 1 

jects, especially when the extremities of the bones are affected; fistulous 
ulcers, with raised edges, easiry bleeding, and discharging a flocculeut pus 
and ichor of a nauseating smell. 

An rum. Caries of the nasal bones in consequence of ozaena, diffusing 
a most horrrid odor; caries of the cheek-bones and exostosis of the skull and 
other bones; with boring pain, after the abuse of mercury. 

A ur. mur. Caries of the left external malleolus, after allopathic 
drugging. (Linsley.) 

Bell ad. Scrofulous individuals with glandular swellings, crusts on the 
corners of the mouth and sore, swollen and bent vertebrae; exostosis on the 
forehead, and caries of the palatine bones. 

Calc. card. Osteitis, with swelling; caries and necrosis of scrofulous 
individuals; diarrhoea, hard, bloated abdomen; chronic symptoms on the 
scalp; emaciation. 

Calc. phosph. For similar affections; and especially after fractures, 
when the callus does not ossify. 

Chi?ia. Caries, especially where there is profuse suppuration. 

Fluor ac. Caries in consequence of syphilis or abuse of mercury; caries 
of the temporal bone. 

I odium. 

Lycop. » 

Mercur. Osteitis, caries; pain, as if the part were broken. 

Mezer. Periostitis and swelling of the bones, especially on the tibia, 
with the most violent nightly pains in the bones. 

Nitr. ac. Especially in syphilitic affections and after the abuse of 
mercury. 

Phosphor. Exostosis on the skull, with violent tearing and boring pains, 
worse at night; swelling of the glands of the neck; sour belching and vomit- 
ing; burning in the mouth, oesophagus and stomach; constipation; emacia- 
tion; fainting when raising the head; lame weakness of the extremities. 

Phosph. ac. Osteitis, and also when after an external injury of the 
periosteum there remains a feeling as though the bone were scraped by a 
knife. 

Ruta. Periostitis and pains in consequence of external injury, with 
erysipelatous inflammation of the external parts. 

Silic. One of the most important remedies in the different affections of 
the bones, with fistulous openings and discharge of thin pus and bony frag- 
ments. 

Staphis. Is recommended, especially in osteitis of the phalanges of the 
fingers. 

Sulphur. After suppressed itch and mercurial poisoning. 

Theridion . ( Bar uch . ) 



762 TUBERCULOSIS OF THE JOINTS. 

Tuberculosis of the Joints, White Swelling. 

Tuberculosis being a constitutional infectious disease, inay localize itself 
in various parts of the body. When localizing in the joints, it attacks by 
preference the hip-, knee-, ankle-, elbow-, or wrist-joints, and was called by 
older writers, on account of the peculiar glossy, shining appearance of the 
affected joint, "white swelling." "In its incipiency we find the synovial 
membrane injected, somewhat opaque, and here and there softened or thick- 
ened by fibrous exudation. There is effusion of lymph, which assumes a 
pulpy consistency of a pale yellowish or greenish color. The articular car- 
tilage is of a dull whitish or slightly grayish aspect, and somewhat thickened, 
softened and partially separated from its osseous connections. The cancel- 
lated structure of the bones is abnormally vascular, light, porous, humid, and 
at the same time easily broken and cut. Not unfrequently its cells are dis- 
tended, with yellowish tubercular matter, of a semi-solid, osseous consistency; 
or, this substance presents itself in the form of distinct masses, free or en- 
c)^sted, and, perhaps, not larger than a millet-seed. The ligaments appear 
abnormally red, tumefied and softened. The synovial fluid is generally 
increased in quantity, but rarely to any considerable extent. In its further 
progress, the lymph gradually increases in quantity and is often intermixed 
with a little sero-purulent matter, or thick, greenish-looking pus. The 
synovial membrane is partially destroyed, and what remains is of an opaque, 
muddy and ragged appearance. The cartilage is ulcerated, pulpified, dis- 
colored, perforated and almost completely detached. The boii3 T structure is 
very red, soft, carious, rough and easily crumbled. The ligaments exhibit 
well-marked signs of inflammation, being loose and spongy at one joint, 
attenuated at another, and perhaps thickened or hypertrophied at a third. 
In this way the structures of the joint are completely subverted, with hardly 
any trace of their original appearances. Pus is more usually seen, often, 
indeed, in large quantites, sometimes thick, pultaceous, caseous, ichorous or 
sero-sanguinolent. In some instances it is very thin and almost black, evi- 
dently from the effects of the necrosed condition of the bones. 

"In case of recovery, the joint will be found to be filled by a white, 
fibrous, organized substance; the extremities of the bones being anchylosed, 
or firmly attached by new matter to the surrounding structures. It is very 
rare that a new socket is formed; and yet this is not impossible. In time, 
the artificial joint may admit of considerable motion, but, in general, this is 
extreme^ restricted. Occasionally an imperfect ligament is formed round 
the bony remnants, and the surface of these bony remnants may even become 
slightly tipped with cartilage. Finally, osseous growths — short, irregular and 
friable — sometimes make their appearance upon the bones, in the vicinity of 
the former disease. ' ' ( Gross. ) 

This is the general character of the pathological changes which tubercu- 
losis causes, when located in the joints. I shall now speak of the several 
joints which it attacks in preference, causing affections which are not unfre- 
quently met with in practice. 



COXARTHROCACE. 763 

Coxarthrocace, Coxalgia, Hip Disease. 

This affection is most frequently found from the third to the seventh 
year. Growing out of a constitutional diathesis, it may be excited by exter- 
nal injuries, exposure to cold, or different wasting diseases; sometimes it 
comes on stealthily without any appreciable cause. It seldom, or never, 
attacks both hip-joints, but is frequently complicated with psoas abscess, 
ophthalmia, pulmonary phthisis and degeneration of the lymphatic glands. 

In its first stage, we observe that the child is easily tired, and complains 
of a pain in the knee, on the inner side, which is worse from motion, so that 
the child limps when walking; this pain is likewise worse in the night, and 
frequently attended with spasmodic jerking of the extremity, disturbing 
sleep. The knee itself shows neither swelling nor discoloration. Gradually 
the pain extends to the thigh and leg, and in some cases it is felt most keenly 
in the tendo Achillis, or over the instep; or it shifts from one place to 
another; or may disappear for a short time entirely. Finally, after weeks 
and even months, the pain is also felt in the hip and its neighborhood; and 
then most intense and persistent directly over the articulation, deep-seated 
and of a dull, gnawing character. Up to this time there is no perceptible 
impairment of the general state of the system. By and by, however, during 
the second stage, when the pain in hip and knee increases still more in vio- 
lence, when the buttock flattens, the gluteo-femoral crease disappears and the 
limb apparently grow T s longer, with nightly spasmodic twitchings and wasting 
of its muscles: then we also find the sleep habitually disturbed by unpleasant 
dreams, and frequent starting of the patient out of sleep with crying and 
screaming; the appetite becomes impaired, the bowels often constipated, and 
there is more or less fever, especially at night, followed frequently by copious 
sweats. Now the patient begins to show a careworn countenance; he grows 
peevish and irritable, and loses flesh and strength. 

In the third stage matter forms within the diseased joint. "This is in- 
dicated by an increase of pain on the slightest motion; by a sense of throb- 
bing and tension, deep and persistent; by severe swelling of the gluteal 
region, generally most prominent at the centre of the articulation; by oedema 
of the subcutaneous cellular tissue; by a remarkably turgid and enlarged 
condition of the subcutaneous veins; by violent rigors, followed by high 
fever and copious sweats. As the matter increases in quantity, it gradualh- 
works its way towards the nearer surface; its approach being denoted by the 
appearance of a circumscribed, erysipelatous blush. Here there is generally 
distinct fluctuation, and the parts, feeling soft and baggy, soon j-ield at one 
or more points, followed by the escape of the contents of the sac. ' ' (Gross. ) 

These openings may in different cases form in different places: in the 
gluteal region, either directly above the joint, or in its immediate vicinit3~; 
on the upper and back part of the thigh, below the great trochanter; on the 
upper and inner .surface of the thigh; on the superior and external part or 
the groin; on the sacro-sciatic notch; or on several points, either simultaue- 



764 THERAPEUTIC HINTS TO COXARTHROCACE. 

ously or successively. Or the matter may partially escape internally, when 
the bottom of the acetabulum is perforated, into the rectum, bladder or 
vagina; or it ma}' collect in a sort of pouch, between the inner surface of the 
iliac bone and the soft parts of the pelvis. 

By this time the limb has actually grown shorter from one inch and a 
quarter to several inches, and the foot points either directly forwards and 
outwards, but oftener inwards. The thigh is generally flexed upon the pelvis, 
and turned either towards the sound limb or is bent off from it. The great 
trochanter generally lies directly over the acetabulum, or in its immediate 
vicinity; whilst the head and neck of the femur are usually so much wasted 
as to exist only in a rudimentary form. Dislocations of the femur are ex- 
ceedingly rare; and are possible only in such cases where there is an exten- 
sive destruction of the soft parts; allowing the superior extremity of the bone 
to move about, and to insert itself into a new position. 

Therapeutic Hints. 

Arsen. Third stage; the child is emaciated, exhausted; very restless; 
has diarrhoea, worse in the middle of the night; wants to drink constantly, 
but little at a time. It is indeed going fast if Arse?i. should not soon change 
the scene for the better. 

Bel lad. Burning, stinging in the articulation; nightly aggravation, with 
starting in sleep, fever, and congestion of the head; or drowsiness, with in- 
ability to go to sleep. Cramps in glutei muscles; outer hamstring feels as if 
contracted; inability to walk. 

Calc. ca?'b. Second stage; sweat on the head during sleep; scratching 
the head impatiently when getting awake; frequent desire for boiled eggs; 
abdomen hard and bloated; inclined to diarrhoea, especially towards evening; 
glandular swellings on the neck. 

Calc. phosph. Third stage; it puts an end to the further destruction 
of the bone, stops suppuration and promotes new organization. 

Carb. veg. Third stage; ichorous, offensive, blackish discharge; deeply- 
sunken state of the whole organism. 

Chijia. Profuse suppuration, sweat and diarrhoea. 

Coloc. Second and third stage; difficult urination of dark urine; green 
diarrhoea; lies upon the affected side with bent-up knee; the pain is of a 
cramp}* nature, as though the parts were screwed in a vise. 

Hepar. Suppurating stage, with fever and sweat, where the patient 
wants to be tightly covered. 

Iodium. Intermittent, sharp, tearing pain between the left hip and the 
head of the femur, increased by moving the joint; glandular swellings; abuse 
of mercury. 

Kali carb. Third stage; crampy tearing in the hip joint and knee; 
bruised pain in the hip- joint when moving and sneezing; twitchings of the 
muscles of the thigh; dull pain in the side of the knee when walking, and 
especially when extending the limb; starting when asleep; twitching of the 



GONARTHROCACE. 765 

limbs during sleep; all the symptoms worse towards three o'clock a. m. ; 
great tendency to start, especially when being touched. 

Laches. In any stage, if there be a regular aggravation of febrile motion 
in the afternoon about three o'clock, an aggravation of general malaise after 
sleep, a notable offensiveness of the alvine discharges, even if of a natural 
consistence, and previous abuse of mercurial preparations; before or after 
Laches, is frequently indicated. 

Lycop. When there is an aggravation of fever and suffering, especially 
from four to eight o'clock p. m. ; great fear of being left alone; violent jerking 
of the limbs and body, awake and asleep, and great crossness on awaking 
out of sleep. 

Mercur. First and second stage, with prominent aggravation in the 
night, restlessness and inclination to sweat; is frequently indicated before or 
after Bellad. , and when suppuration seems inevitable. 

Phosphor. Hectic fever; dry, hacking cough; chronic diarrhoea; urine 
turbid on voiding, precipitating a white sediment on cooling; thin watery 
pus oozing from the diseased joint. 

Rhus tox. First and second stage; on pressure upon the trochanter, 
pain in the hip-joint; pain in the knee predominant; swelling of the glands 
of the neck; crusty eruptions on face and head; after exposure to rain; worse 
in damp, cold weather; when keeping quiet, and on first moving. 

Silic. In suppuration and caries of the bones anywhere, one of the most 
important remedies; pale, earthy complexion; loss of smell and taste; stop- 
page of the nose or acrid coryza; the parts upon which one lies easily go to 
sleep; any little sores or wounds are apt to fester; glandular swellings. 

Stramon. According to Dr. Jeanes, always indicated when the left hip 
is affected. I have given Stramon. with great success wherever abscesses 
form, if attended with violent pain, driving one mad. 

Sulphur. Psoric individuals; frequent redness and inflammation of the 
eyelids; heat of the head, and cold hands and feet; frequent red spots in the 
face; is averse to being washed; morning diarrhoea, or constipation; sleepy 
in the daytime and wakeful at night; easily perspiring. 

Gonarthrocace, Tumor Albus Genu, White Swelling of the Knee. 

Gonarthrocace, growing upon the same constitutional contamination as 
hip- joint disease, runs through nearly the same phases as that disease, and is 
most frequently excited by an extenal injury, such as a fall, twist, or blow 
upon the knee. 

At first there is a severe, dull, heavy, gnawing pain at the inner condyle 
of the femur, at the lower part of the patella, or at the inside of the head of 
the tibia; seldom at the outer part of the joint; it may be intermitting, and 
it may be continuous in its character, extending up and down the limb, and 
depriving the patient of all sleep and rest. 

After a while the parts commence swelling, owing partly to interstitial 
deposits, and partly to an increase of synoval fluid. This swelling is at first 



766 THERAPEUTIC HINTS TO GONARTHROCACE. 

most conspicuous in front and at the sides of the patella, effacing the normal 
depressions in that region, and replacing them by soft, fluctuating bags. " A 
similar prominence, often of great size, exists just above the joint, over the 
lower part of the femur, bounded inferiorly by the patella, and on each side 
by the lateral ligament, its anterior wall being formed by the tendon of the 
exterior muscles Yen- little tumefaction ever occurs in the popliteal region, 
even in the more advanced stages of the disease. The skin is tense and glossy; 
they subcutaneons veins are abnormally large; the knee is stiff, if not immov- 
able; and the leg, more or less flexed, is swollen and cedematous, while the 
thigh is remarkably atrophied. In proportion as the ligaments yield, the 
deformity of the joints increases, owing chief! y to the displacement of the head 
of the tibia, which allows the muscles to draw the leg outwards, so as to give 
it a twisted and contorted appearance. Occasionally, though rarely, there is 
an actual enlargement of the diseased bones. The fluctuation, which consti- 
tutes so prominent a symptom in the earlier periods of this complaint, often, 
in a great measure, if not entirely, disappears during its progress, owing to 
the adventitious deposits upon the synovial membrane, and the absorption of 
the redundant synovial fluid. Whenever this is the case, the swelling, instead 
of being soft and yielding, well be comparatively firm and resisting; but it 
still possesses some degree of elasticity, often so deceptive as to lead to the 
idea that the joint contains a good deal of fluid, and which nothing but the 
most careful examination can dispel." (Gross.) 

Lastly, though not always, the involved structure commences to suppu- 
rate, and the matter may either be absorbed, or may escape at different places 
about the knee — very rarely , though, in the ham — forming numerous fistulous 
openings, and leading to caries and necrosis of large portions of the diseased 
bones. 

Therapeutic Hints. 

Aeon. After exposure to severe cold. 

Arnica. After a fall or blow, and Rhus to. x., after a twist, sprain or 
strain, may severally be entirely sufficient to ward off all serious consequences. 

Arsen. Third stage; discharge of fetid pus; oedema of the legs; hectic 
fever; sleeplessness; emaciation; exhaustion. 

Bellad. Red, shining swelling, w T ith throbbing pain and enlarged blood- 
vessels along the limbs. 

Bryon. Pale swelling, with stitching pain from slightest motion. 

Calc. Carb. Scrofulous individuals; too early and too profuse menstru- 
ation; pot-belliedness; looseness of the bowels; glandular swellings. • 

Iodium. Second and third stage; fistulous openings, discharging a thin, 
watery ichor, and being surrounded by pale, spongy edges, which bleed easily: 
feverishness; emaciation. After the abuse of mercury. 

Kali hy dr. Doughy, spongy swelling of the knee, without fluctuation; 
skin tense at times, red in spots and hot. Inside a feeling of heat; gnawing, 
boring pain at night, necessitating a constant change of position. After a fall. 

Laches., Lycop. Compare the preceding chapter. 



BURSITIS. 767 

Mercur. After suppressed itch; nightly pains, etc. 

Pulsat. Fever, dryness of tongue, without thirst; diarrhoea, scanty and 
delaying menses. 

Silic. Violent, lancinating pains; caries; fistulous openings; cachectic 
condition. 

Sulphur. Psoric individuals. Besides, compare Coxa?throcace. 

Bursitis. 

The bursse mucosae are closed sacs, analogous in structure to synovial 
membranes, and secreting a similar synovial fluid. Those concerning us 
now are situated over the patella and the inner side of the head of the tibia. 
Being greatly exposed to external pressure and irritation, they are subject to 
inflammations like the synovial membrane, constituting an affection known 
under the name of Bursitis, or House-maid's knee, the latter on account of its 
frequent occurrence among female servants, who induce it while working in 
a kneeling position. It is distinguished from synovitis by its superficial 
nature and the regularity of its tumefaction. In acute cases it is attended 
with severe pain, swelling and fever; it may terminate in suppuration, or, 
when becoming chronic, in the formation of a solid tumor. 

Therapeutic Hints. 

Ant. crud. " The integument is hard and horny, smooth and slightly 
discolored, with a sensation as if being pricked with needles, or of being 
destitute of feeling." (Gilchrist.) 

Apis mel. " Inflamed, fluctuating; biting, stinging in the part." (Gil- 
christ.) 

Arnica. And the remedies mentioned in the foregoing chapters may 
likewise need consideration in special cases. 

Arsen. " Dark color, bluish generally, with much effusion, and in- 
tense burning relieved by external warmth." (Gilchrist.) 

Fragraria vesca. " Burning-smarting, worse when warm and in warm 
weather." (Gilchrist.) 

Pulsat. " Smarting itching, relieved by cold." (Gilchrist.) 

Silic. In chronic bursitis; pain as if sticking or itching. 

Sticta puh?i. Has been found, by Dr. B. C. Price, of great efficacy. 

Sulphur. " Inflamed, with a feeling of formication." (Gilchrist.) 

Podarthrocace, Abscess of the Ankle-joint. 

Commencing with pain, this affection soon shows signs of a swelling- 
just in front of each malleolus, filling up the hollow which naturally exists 
there. So also gradually disappear the grooves at the side of the tendo 
Achillis, and the whole joint swells considerably. By and by, if suppura- 
tion takes place, the pus may escape at different places, forming, like in the 
knee-joint disease, fistulous openings, and may lead to considerable destruc- 
tion of the affected bones. 



768 malum pottii. 

Therapeutic Hints. 

Compare the preceding chapters. Only one remedy, not mentioned 
there, I must add here, namely: 

August. In a case where none of the very carefully selected remedies 
seemed to have any effect, this remedy at once arrested the morbid process 
and brought it to a perfect cure. In this case, the condyles of the tibia 
were quite seriously involved, and it was on account of a remark of Aegidi, 
1 ' Angustura acts especially upon the long bones, ' ' that this remedy was 
given with so happy a result. 

Malum Pottii, Kyphosis, Angular Curvature of the Spine; 

Spondy larthr ocace . 

When the disease has already developed to a visible backward curvature 
of the spine (hunchback), its diagnosis is easy enough, only that it comes too 
late. Of much greater importance are the symptoms of the initial stage: 
the child cries whenever it is taken hold of below the ribs, with spasmodic 
drawing up of the legs, and shortness of breath. Besides this there are: 
periodical pains in the epigastric region; listlessness and disinclination to 
move; disposition to lie flat on the stomach or side, only rarely on the back. 
Finally as the disease progresses, one or more spinal processes project back- 
ward in an acute angle, the head sinks backward between the shoulders, 
and when walking the child props the arms on the thighs or knees, instinct- 
ively supporting the spine, and avoiding all motions which would necessi- 
tate a bending of the spine. All this is produced by a tubercular affection, 
or according to other writers, by an inflammatory process of the vertebrae, 
causing the bones to become carious and to crumble away, or to form 
abscesses. Probably both views are correct. The tuberculous form seems 
hardly ever to induce congestive abscesses, which are more apt to occur in 
endosteitis. Both forms no doubt grow out of a general contamination of 
the system, scrofulosis, and where this condition exists, an unlucky fall or 
wrench may be sufficient to induce the development of the disease. So also 
it has been observed to often follow after measles, and especially whooping- 
cough. The disease is always of a slow and tedious nature. 

Therapeutic Hints. 

As the spinal column gradually loses its fitness to sustain the 
body in an erect position, the horizontal position will make itself 
in many cases necessary; but too long a confinement in bed has other 
quite serious objections, and it has, therefore, been an object of many 
physicians to invent means by which the strain of the spinal column may be 
relieved. The most simple and effectual of these means seem to be Sayre's 
starched bandage, by which chest and abdomen are enveloped in fold after 
fold, until a compact casing of the material surrounds the trunk, capable of 
retaining the bony column in a fixed position. This is done while the patient 



PANARITUM. 769 

is suspended by the arm-pits, and the head held in an erect position; the 
weight of the body straightens the spine. As soon as the starch is well dried 
and stiffened, the patient is liberated and left to his freedom. 

Cede, card., or phosph. after Sulphur, when the known scrofulous symp- 
toms call for its use. 

Natr. mur. Has been recommended by Kafka a^s a constitutional ad- 
juvant to Phosphor. 

Phosphor. Main remedy of Kafka. Its symptoms will indicate its use 
in special cases. 

Psorin. Proposed by Iyilienthal as being fairly indicated by its symp- 
toms. 

Silk. Indicated by its characteristic action upon inflammatory processes 
of boiw structures, and also by the peculiar symptom: " sweating of the 
head only." 

Sulphur. Is according to Jahr, the remedy to commence with, if indi- 
cated by the general condition of the patient. 

If excited by external injury: Aeon., Arnica, Hyper., Rhus tox. 

Other remedies recommended: August., Arsen., Asa/., Aurum., Bellad., 
Calc. jod., Hepar., Lycop., Mercur., Mezer., Phosph. ac, Plumbum, Pulsat. 

Compare also Rachitis and the foregoing chapters. 

Panaritum, Paronychia, Whitlow, Felon. 

This is an inflammation of the thumb or of one of the fingers, which 
terminates in suppuration. There are two varieties, a superficial and deep. 

The superficial form, Whitlow or Run-around, is generally seated im- 
mediately around and beneath the nail, commencing either at the side of the 
finger, upon its dorsal surface, or its extremity. Without much if any swell- 
ing the part has a dusky, i^d aspect, tender on pressure and exquisitely 
painful, throbbing violently and incessantly, and causing more or less consti- 
tutional disorder. Two or three days after these phenomena present them- 
selves pus will be observed beneath the epidermis, involving the superficial 
structures. The inflammation generally extends some distance up the finger, 
and occasionally even over a considerable portion of the hand, which may 
be considerably swollen, stiff and painful. Not unfrequently a reddish line, 
indicating the course of an absorbent vessel, is seen running along the arm 
as high up, perhaps, as the axilla. 

In the deep-seated variety, Felon, the inflammation involves all, or nearly 
all of the structures of the finger, and is frequently followed by the destruc- 
tion of one or more of the phalanges. The pain is of extraordinary severity, 
depriving the patient of sleep for days and nights together, throbbing, ten- 
sive and diffused, often extending as high as the elbow, and even to the 
shoulder, steady and persistent, but greatly aggravated by a depending posi- 
tion, and only subsiding with evacuation of the inflammatory deposits, or 
the death of the parts. The swelling also is great, sometimes enormous, 
involving both finger, hand and wrist; the skin is red andcedematous, puffy, 
49 



770 THERAPEUTIC HINTS TO PANARITUM. 

erysipelatous in aspect, and the whole limb is often stiff and useless. In 
consequence of the inflammatory action, pus forms deep among the tissues, 
in the connecting cellular substance, within the sheaths of the tendons, and 
beneath the periosteum, and spreading in all directions, causes extensive 
destruction, burrowing along the finger and hand. In neglected cases even 
gangrene may occur, ^followed by sloughing of the tendons, and exfoliation 
of the phalanges. This grave form is always attended with well-marked 
constitutional disturbance. The patient, tortured with pain, is feverish and 
unable to sleep; his appetite is lost; his head, back and limbs ache; the face 
is flushed, and the pulse is strong, hard and frequent. In some cases 
delirium is present. (Gross.) Causes unknown; no doubt of an infec- 
tious nature. 

Therapeutic Hints. 

Amm. ca?-b. I have seen the nightly pain which had deprived the 
patient of sleep for several nights, relieved in a few hours, and the morbid 
process stayed at the same time by one or two doses of Amm. card. 500 

Anthrac. Where there is sloughing, with terrible burning, and when 
Arsen. gives no relief. 

Apis. According to Wolf, specific especially after the abuse of Sulphur; 
the characteristic pain is burning-stinging. 

Arsen. When the sore assumes a gangrenous aspect; burning like fire, 
with anxious restlessness; worse about midnight. 

Bryon. In the commencement, where there is a gastric-rheumatic dis- 
position; white or yellowish-coated tongue; dry feeling in the mouth, with- 
out thirst, or great thirst; bitter taste in the mouth; dry, hard stool, as if 
burnt. 

Caustic. Recommended by Goullon, to t^e used externally and inter- 
nally . 

Graphit. According to Kreussler, superficial inflammation about the 
root of the nail, with burning and throbbing pain, and subsequent inflamma- 
tion and proud flesh. 

Hepar. Violent throbbing, "gathering" pain; it accelerates suppura- 
tion. The hand is kept wrapped up, because it ameliorates the pain. 

Iris vers. " An early application either in tincture, or the whole fresh 
plant bruised and bound on the part, will, in many cases, completely abort 
the felon . " ( Gilchrist . ) 

Juncus eff. Recommended by Minnichreiter, who applied the pith of 
this plant upon the panaritium with the greatest success. 

Laches. According to Hering, in severe cases, where the inflamed por- 
tion assumes a purplish hue, or becomes gangrenous. 

Ledum. When the whitlow is the consequence of the prick of a needle, 
a splinter, etc. 

Lycop. When there are the following constitutional disturbances: fre- 
quent belching, bloatedness of the region of the stomach and belly; pressure 



BUNION. 771 

and heaviness, and sometimes throbbing in the precordial region, burning 
in the stomach and oesophagus; nausea; sensation of twisting, crawling and 
emptiness in the stomach, accompanied by frequent yawning; congestion to 
the head; cold feet; dry stool; red, burning urine; mental irritability. 

Maland. Suppuration of all the finger and toe-nails. (Straube. ) 

Mercur. When the inflammation extends to the sheaths of the tendons 
and ligaments of the joints, and in superficial whitlows. " The pain is re- 
lieved when the finger is exposed to the air." (Gilchrist.) 

Natr. siriph. Suppuration at the root of the nail, with deep red swell- 
ing of the whole phalanx, and great painfulness; the patient looks sickly 
and pale; feels weary and dull in the head, especially in the morning; has 
no appetite, and is chilly and feverish in the evening; the pain is easier out- 
of-doors than in-doors. Prominent causes: damp region, damp walls, damp 
cellars. 

Nitr. ac. "The hand is carried wrapped up, but the finger exposed, 
from a sensation as if a splinter or a piece of glass were in the part, which 
the friction of the wrappings aggravates." (Gilchrist.) 

Rhus tox. Where there are rheumatic pains in the limbs; worse during 
rest and on beginning to move; sensation in the limbs as of going to sleep, 
and formication; tired feeling and sweating from any little exertion; erysipe- 
latous redness of the inflamed part. 

Sa?iguin. Suppuration of the roots of all the finger-nails. 

St lie. Deep-seated inflammation; affection of the bone; proud flesh; 
terrible pain ; worse in bed; very important after Hepar. 

Stramon. Is most important when the pain is almost unbearable, driv- 
ing to despair. It ameliorates it at once, and hastens benign suppuration. 

Sulphur. According to Wolf, when Apis is not sufficient on account of 
latent psora. 

Bunion. 

What bursitis is to the knee, bunion is to the metatarsal joint of the 
great toe, an inflammation of the bursae situated in this joint, inconsequence 
<_>f undue pressure of shoes or boots. 

Arnica. Often relieves the acute symptoms, and Calc. carb. frequently 
cures chronic cases. 

Ingrowing Toe-nails. 

Compare Colchic. , Graphit. , Kali carb. , Magnet, austr. , Mar. ver. , Natr. 
mur., Phosphor., Silic. 

Perchloride of Iron has been used externally to dry the inflamed parts. 
(Wahle.) 



NERVES. 

The anatomical diseases of the peripheral nerves comprise: 

Neuritis, Inflammation of the Nerves. 

This may be acute or chronic. The acute form, usually brought on by. 
external injuries, or neighboring destructive processes (sloughing cancer), 
begins with chilliness, or an actual rigor, being followed by fever, tieadache 
and sleeplessness, and is attended by severe pain, starting and extending 
from the injured spot over the region to which the nerve is distributed. In 
some cases a red line in the skin indicates the course of the inflamed nerve, 
and the skin surface of its distribution exhibits a marked degree of hyperaes- 
thesia with the subjective sensation of numbness and formication. 

The chronic form is characterized by pain and paraesthesia in the area 
of distribution of a certain nerve, by motor and sensory irritation with sub- 
sequent paralysis, by painful swelling of the nerve. 

The most important * remedy for neuritis in consequence of external in- 
jury is Hyper, perf. (Hering.) 

Atrophy of the Nerves 

Is most frequently the consequence of inflammation, compression or central 
disease, and can only be reached so far as the original disease is amenable to 
treatment. 

Hypertrophy and Neoplastic Formations in the Nerves. 

Hypertrophy of peripheral nerves, that is an increase of the nerve- 
fibres in number, great thickness of the medullary sheath and even of the 
axis cylinder, or oftener an interstitial hypertrophy of the connective tissue, 
is of a mere anatomico-pathological, but of no clinical interest. 

Neoplastic formations in the nerves, also called neuromata, are made 
up either of true nerve-tissue (Neuromata vera), or are composed of any 
other tissue, giving rise to Fibromata, Myxomata, Sarcomata, Carcinomata, 
Syphilitic gummata, Lepra nervorum, all known under the general name 
Neuromata spuria. 

Their Etiology is obscure, and "an exact anatomical diagnosis can be 
accomplished with certanty only by means of the microscope. When no 
tumors can be demonstrated by external examination, their presence can be 



HYPERESTHESIA. 773 

concluded only with some probability from the existing nervous disturb- 
ance." (Krb.") 

The functional diseases of the peripheral nerves comprise: 

Hyperesthesia, Anaesthesia. 

By means of the sensory nerves we receive external impressions. Light 
affects the optic, sound the auditory, perfume the olfactory, sapid substances 
the gustatory nerves, palpable things the nerves of touch, and heat, cold, 
etc. , the nerves of general feeling. 

These nerves are so constituted that they bear external influences to a 
certain extent with perfect ease, although we find in even healthy individuals 
a great difference in this respect. Some perceive the slightest, others only 
more powerful influences; but, as a general rule, the ordinary influences of 
the outer world are borne by all with equal ease. 

In this disease, however, it is often different. We observe that ordinary 
light, the slightest noise, the least touch, etc., are unbearable. This con- 
dition is called morbid sensitiveness. It is frequently in combination with a 
state of fidgetiness and restlessness, and then it is called nervousness. 

Post-mortem examinations do not reveal the least alterations of the 
nerves, and its seat ma}^ just as well be referred to the primitive forces of 
the mind, of which the corresponding nerves are merely the bodily organs, 
by which the mind lies open to external influences. 

Anaesthesia of the sensory nerves is the opposite to morbid sensitiveness 
— a want of natural sensibility; to which we might add numbness, pithiness, 
either in consequence of pressure upon a nerve, or in consequence of central 
disturbances, by which its normal action is interfered with. 

Therapeutic Hints. 

Compare Boenninghausen's Repertory. 

Sensitiveness to light: (principally) Aeon., Arsen., Bellad., Enphras., 
Me? r cur., Rhus tox., Sulphur. 

Sensitiveness to noise: Aurum, Coffea, Lycop., Sepia, Spigel. 

Sensitiveness to smell: Aurum, Bellad., Lycop., Mercur., Phosphor., 
Sepia. 

Sensitiveness to taste: Bellad., China, Coffea. 

Sensitiveness to touch: Arnica, Bellad., Coffea, Hepar, Lycop., Nux 
vom., Pulsat., Sepia, Spigel. 

Nervous debility: China, Coccul., Nux vom., Phosphor., Pulsat., Silic. 

Fidgety disposition: Anac, Bellad., Hyosc, Mercur., Rhus tox., Sepia, 
Staphis., Stramon., Zincum. 

Pithy, numb feeling: Coccul., Hyosc, Lycop., Oleand., Opium, Phosph. 
ac, Stramon. 



74 NEURALGIA. 



Neuralgia. 



Neuralgia literally means a pain of the nerves. In this sense of the 
word, any and every pain would be a neuralgia; because there is no pain 
possible without sensitive nerves. 

This is not the sense in which the term neuralgia is used. 

Hasse defines it in the following language: " Neuralgia characterizes it- 
self physiologically as an irritation in the course of one or several sensory 
nerves, which irritation may exist on any part of the nerve, from its origin 
down to its termination, and which irritation is felt as pain; not, however, 
only in the place where the irritation exists, but also in different other places 
of the same nerve; sometimes even through its whole length." Such irrita- 
tion and consequent pain may be occasioned by the most different causes, so 
that neuralgia may be a symptom of very different conditions. Structural 
changes of the nerves themselves, however, are very rarely found, and then 
only in paralytic conditions. Those coarser structural changes which we 
have called tumors of the nerves, or neuroma, ma}^ exist without any neu- 
ralgia; and the most violent neuralgia may not show a trace of structural 
change on post-mortem examination. We cannot, therefore, so clearly define 
neuralgia pathologically as other forms of disease; as, indeed, it is only a 
symptom of the most different conditions. 

Such conditions are either peripheral or central. 

i. Peripheral Causes are either organic changes of the nerves them- 
selves — most frequently in consequence of external injuries — or organic 
changes in the neighboring parts of the nerves, as inflammation, caries, and 
exostoses of the bones, especially in the neighborhood of the foramina, 
through which the nerves make their exit, also tumors — especially carcinoma 
and aneurisma — and affections of the liver, uterus, ovaries, kidneys, etc. 

2. Central Causes are structural changes in the brain and spinal cord, 
and their membranes, consisting of tumors, softening, sclerosis and deposits 
of morbid products. Besides these causes we may also mention exposure to 
cold, metallic poisoning — especially by mercury and lead — and miasmatic 
influences, which latter cause a periodical type, like intermittents. 

Symptoms. — i. Pain. It is of various kinds: boring, cutting, tearing, 
burning, like lightning, but always described as excruciating. It generally 
comes in paroxysms, and is felt in many cases distinctly running along the 
course of a certain nerve. It is often provoked or aggravated by softly 
touching or stroking the parts, whilst hard pressure frequently relieves it. 

2. Concomitant symptoms. They consist of affections of the motory 
nerves, causing spasmodic motions in those parts in which the affected sen- 
sory nerve branches out, prosopalgia and almost always distortions of the 
face; of affections of the vasomotory nerves, which manifest themselves in 
paleness of the skin and chilly sensations, followed by heat and turgor, 
sometimes by profuse perspiration or profuse secretion or scantiness of urine; 
of affections of the trophic nerves, causing change of color in the hair, fall- 



CEPHALALGIA. 775 

ing off of the hair, or thickening or atrophy of various tissues, or a dis- 
position of the skin of various inflammatory processes, such as erythema, 
erysipelas, pemphigus, urticaria and zona. 

The most important special forms of neuralgia are: 

Cephalalgia; Hemicrania or Migreena, or Nervous Sick 

Headache. 

Cephalalgia or headache, or pain in the nerves of the head, may be at- 
tended upon the most various morbid conditions of the body, to which some 
persons are more liable than others. We have headache from anaemia and 
from active hyperemia, also toxic, hysterical, rheumatic and sympathetic 
headache. 

Hemicrania or Migraena or nervous sick headache on the other hand is 
a peculiar form of half -sided headache, which, by some, has been considered 
as a neuralgia of the temporal, frontal and occipital nerves, or as a hyper- 
esthesia of the brain, or a cerebral neuralgia, or as a hysterical manifesta- 
tion of some derangement of the menstrual function, while Du Bois Ray- 
mond took it for a neurosis of the vasomotor nerves, consisting of spasms of 
the vascular muscles of the affected side, causing paleness and contraction of 
the features and dilatation of the pupils, and Moellendorff considered it as a 
paresis of the vascular muscles, which manifests itself in dilatation of the 
central retinal and choroidal vessels of the affected side, in a slower pulsa- 
tion of the heart, in a soft and large pulsation of the carotids and temporals, 
and in cold hands and feet. Both agree in this, that hemicrania is due to 
alterations in the cerebral circulation, in the one case produced by spasm 
and in the other by relaxation of the vascular muscles, both induced by a 
disturbance of the sympathetic nerve either in its cranial or cervical portion. 
Dr. G. C. Savage, of Jackson, Tenn. , says — that sick headache is often due 
to hypermetropia and astigmatism, either alone or combined, and offers as a 
cure properly fitted glasses. This view I can confirm. 

This complaint, which is so frequently met with, returns periodically. 
It generally commences in the morning, increases during the course of the 
day as the sun ascends, and reaches its culmination in the evening; very 
often it attacks only one side of the head, or passes from one side to the 
other, or is confined to the top of the head, or to the forehead or occiput. 
If often reaches an almost unbearable pitch, is associated with nausea, and 
generally ends with gagging and vomiting of bitter, greenish, or slimy 
masses. In some cases one thorough vomiting is sufficient to relieve the pain, 
while in others both retching and pain continue for several hours, until 
finally, a sound sleep relieves it all. During the paroxysms the patient is 
very sensitive to light, noise, strong smells and touch; he seeks a dark, quiet 
place where he can lie undisturbed. 

Migraena is most frequently met with in women of a hysteric, chlorotic, 
or ansemic tendency, and a weak and nervous constitution, also in married 
women who have no children, and in young widows. Men of weak con- 



776 THERAPEUTIC HINTS TO CEPHALALGIA. 

stitution , who read and stud}- much in the night, or who lead a loose life, 
are likewise subject to migraena. In all, it seems that the habitual use of 
coffee and tea has a great deal to do with its periodical recurrence. 

Therapeutic Hints. 

In all obstinate cases the eyes should be examined, and if there is any 
hypermetropia or astigmatism, proper eyeglasses should be provided. 

Aeon. In full-blooded individuals; rush of blood to the head; the pain 
is centered in glabella, excruciating, driving to despair. " Crampy pain at 
root of nose, making her feel as if going crazy." ( Gilchrist.) 

Aithusa cyn. Pressing pain in the forehead, as though it would split; 
or as if there were a tight hoop around the head ; eyes appear protruded and the 
face is pale; great anxiety and restlessness drives into the open air, which 
relieves. At its height, vomiting, belching; hiccoughing; finally diarrhceic 
stool; some hours sleep and pain in the stomach for several days. 

Agar. Pressing pain in right temple, as if a nail were thrust in, worse 
sitting, better moving about slowly; dull, drawing headache, worse in morn- 
ing, extending into root of nose, with nosebleed or thick mccous discharge; 
headache from overwork at desk. 

Amm. carb. " Feeling as if the head would burst; anxiety and inclina- 
tion to weep; discharge of sharp, burning water from the nose; pale, bloated 
face; much thirst; debility, compelling to lie down; during the day and in 
the morning, perspiration, principally about the joints. Worse in the even- 
ing, and from wet poultices and pressing the teeth together; better from 
pressure and w 7 armth. ' ' (Gilchrist. ) 

Amy I, ?iit?-. Hemicrania, w T orse on left side; the affected side looks pale 
in comparison with the sound one. 

Anacard. "Loss of memory; fluent coryza; loss of taste; diminished 
sensibility, parti cularly of smell, sight and hearing; sensation as of a hoop 
around the parts; coldness internally, with external heat; clammy perspira- 
tion of palms of hands, worse in morning, periodically; also from rubbing; 
better during dinner. Leftside." (Gilchrist.) 

Ant. crud. Headache after bathing in the river, from deranged stomach 
by alcoholic drinks; thick, white coating on tongue. 

Aranea diad. When the spells come at regular hours; flimmering be- 
fore the eyes; dizziness in the head, which obliges the patient to lie down; on 
rising a feeling as though the head and hands were bloated and swollen. 

Arg. nitr. Pressive pain in the forehead on getting awake in the morn- 
ing, gradually extending from the supraorbital ridge upwards to the coronal 
suture, with heaviness in head and vertigo, which does not turn in a circle, 
but inclines the patient to reel to one or the other side; dimness before the 
eyes; ringing in the ears; sense of relaxation in the stomach, as though it 
were hanging down loosel)*; all the symptoms better after eating a good 
dinner and drinking a glass of wine; w r orse after drinking coffee; or the pain 
is half-sided in one of the frontal protuberances, or close to the side of the 



THERAPEUTIC HINTS TO CEPHALALGIA. 777 

glabella near the supraorbital ridge, or in one of the temples, sometimes ex- 
tending down into the bones of the face; the pain is of a pressive, screwing, 
throbbing nature, and is always preceded by general indisposition; chilliness, 
loss of appetite; growing dim before the eyes, and nausea. At its height it 
is attended with trembling of the whole body and a deadly nausea, which 
ends with vomiting. 

Arnica. Periodical spells, commencing slightly in the morning in the 
forehead, with flickering before the eyes, which is aggravated by reading or 
writing, gradually extending through the temples into the occiput, and 
reaching its acme in the afternoon. A warm room is unbearable, but the 
open air does not ameliorate; must lie perfectly quiet, stretched out upon his 
back; worse from any motion, quick walking, bending, going up stairs, 
talking, thinking and after eating. Sour perspiration. 

Arsen. Hemicrania in persons with affections of the liver; alternating 
bilious colic and migrsena; great sensitiveness of the head to the open air; 
during the spells the patient is very restless, constantly moves the head and 
limbs to and fro, and imagines that he gets some relief from so doing; better 
from external warmth; from wrapping the head up in warm cloths; he feels 
extremely prostrated; thinks he must die; feels chilly and hovers near the 
stove. 

Aur. met. " Melancholy mood, dejected, inclined to weep, and longing 
to die, almost driven to suicide; fiery sparks before eyes; roaring in ears; 
very sensitive smell; bloated, shining face; hysterical spasms with laughing 
and crying alternately." (Gilchrist.) Swelling of cranial bones with bor- 
ing; syphilitic and mercurial origin. 

Bellad. One-sided pain, especially on the right side; throbbing, beating, 
attended with vertigo, congestion of the head and eyes, and throbbing of the 
carotid arteries; or great paleness of the face; pain worse on lying down, 
better on bending head backward, and external pressure. 

Bryon. Headache on first waking in the morning, gradually increasing 
until evening; pain as though the forehead would burst; worse from any 
motion, coughing or sneezing, Tongue thickly coated; violent thirst or only 
dry feeling in the mouth; gastric derangement; constipation or diarrhoea in 
the morning; the patient is very irritable and cross; gets angry easily. 

Cact. grand. Pain in right temple by spell, brought on often by a glass 
of wine, by attending the opera, getting his dinner at too late an hour; it 
commences in the morning and increases as the da}^ advances to an awful 
height, with vomiting. He must lie perfectly quiet; any attempt to keep 
up, any noise, light or exertion, increases the suffering terribly; constant dry 
nose. 

Calc. carb. Chronic cases; some da3'S before or after the menses, which 
are profuse, pain centering in top, as if she should go crazy; after suppressed 
eruptions; strange feeling of coldness in some part of the head, or in the 
whole head; pain worse from early in the morning after getting awake until 
afternoon; cold, sweaty hands and teet. 



/ /' 



THERAPEUTIC HINTS TO CEPHALAGIA. 



Calc. phosph. Headache of. children from going to school; from change 
of weather with other rheumatic pains, especially along sutures and 
symphyses. (Hering.) 

Camphora. Throbbing pain like a hammer in the cerebellum, syn- 
chronous with the beats of the heart; after sunstroke. Icy coldness of the 
whole body; cold perspiration. 

Chamom. Commences with nickering and fiery zigzags before the eyes, 
so that one cannot see or read, followed by terrible headache. 

China. The pain is increased from slight touch, from opening the eyes, 
or from keeping them shut; sometimes the pain is relieved by lying down, 
at other times the patient cannot lie down; better while moving about gently, 
or sitting up erect. Nursing females after loss of vital fluids. 

Chin, sulph. Intermittent neuralgia at regular hours. 

Chionanthus. Sick headache, worse in left eye; pain in abdomen; nausea, 
and vomiting of dark green bile. The tincture and lower dilutions have 
been mainly used. 

Coccnl. The pain is worse after eating, drinking or smoking and at- 
tended with a sense of emptiness and hollowness of the head. 

Coffea. When the pain drives to despair and the patient runs wildly 
about the room. 

Coloc. Pain, tearing, and screwing together; great restlessness and 
anxiety, with sweat, which smells like urine; urine scanty and fetid; after 
chagrin and indignation. 

Ferrum. Congestion of the brain; throbbing; crimson face, which, at 
other times, is quite pale and earthy-looking. The pain drives one out of 
bed. 

Gelsem. Commences with dimness of sight and double vision; vertigo; 
heaviness or lightness of head; wild feeling, alternating with uterine pains; 
worse about 10 a. m., and when lying down; better from shaking head, from 
sitting and reclining the head on high pillow, from profuse emission of urine. 

G/onoiti. Congestion of the brain; throbbing, pulsating pain from below 
upwards, with fullness and feeling of enlargement of the head; it feels like 
the motion of waves in the brain; congestion of the eyes; ringing in the ears; 
palpitation of the heart. During pregnancy, before the menses, or when 
the menses do not appear; from heat of sun. 

He par. Headache over the eyes pressing down upon the eyes; covers 
tightly even when hot and perspiring; extremely vehement from slightest 
cause; could murder any one without hesitation. 

Ignat. Throbbing pain in the occiput, worse from pressing at stool; 
from smoking, from the smell of tobacco-smoke; for nervous subjects who 
get frightened easily, feel hurt easily, etc.; intermittent from 9 a. m. to 2 p. 
m., worse from washing hands in cold water, bending head forward, stepping 
heavily; better from soft pressure, lying on back, and heat. 

Iris vers. Beginning with a blur before the eyes; of hepatic or gastric 
origin, with nausea and vomiting; mostly on right side, or changing sides in 
different attacks. 



THERAPEUTIC HINTS TO CEPHALALGIA. 779 

Laches. Temporal nerves of one side painful, with throbbing in the 
temples; heat in the head; vertigo with paleness of the face; pain in the left 
ovarian region; bloatedness of the stomach; frontal headache after suppressed 
coryza. 

Li I. tigr. Terrible, tearing, crazy pain running from back up into top 
of head, with a feeling as if she would lose her reason, or would lose her 
sole when dying. Squeezing feeling about the heart. 

Melilot. Congestive headache, better from bleeding of nose. 

Menyan. Pressing pain in forehead and temples from above downwards, 
relieved by firm pressue with the hand. 

Natr. micr. Commencing in the morning when getting awake; it gets 
worse from reading, writing and talking; and is frequently indicated when 
school-girls, who apply themselves closely to their lessons, get a severe head- 
ache. 

Nux vom. Pressive boring, dull pain, mostly over left eye, commenc- 
ing in the morning, increasing through the day, growing milder in the even- 
ing, attended with dimness of sight, stoppage of the nose, sour and bitter 
vomiting, constipation; palpitation of the heart; worse from mental exertion, 
light and noise, in the open air, after eating; brought on by masturbation, 
hysteria, with profuse menses, sedentary life, close mental application, abuse 
of coffee, with haemorrhoidal disposition, constipation, disturbances in the 
ganglionic system. 

Phosphor. Intense pain in eyes and whole head, worse in left eye, in 
forenoon, or from stooping, better while eating, lying down, and after sleep- 
ing. Bloated face; puffiness under eyes; blue rings around the eyes; pale, 
hippocratic countenance. 

Phosph. ac. Dreadful pain on the top of the head, as though the brain 
were crushed, after long-continued grief. For youths who grow very fast 
and slender. 

Platina. Cramping pain, as though the part were in a vise; especially 
above the root of the nose, with heat and redness of the face, tearful disposi- 
tion, and too early and profuse menstruation. 

Pulsat. Tearing, pressing, stitching pain, mostly on right side of head, 
worse in the evening and at night, in the w T arm room, better from external 
pressure and in the open air, with aversion to eating and drinking; water 
tastes bitter; nausea; vomiting; oppression of the chest, and chilliness; mild, 
yielding disposition; scanty, delayed menses; disposition to looseness of the 
bowels. 

Rhus rad. Commencing in the back of the neck, the muscles are sore 
to touch, it spreads up and over entire head; worse in rest and cold, better 
on moving and warmth; brought on by cold draught on back and neck, and 
cold, damp and rainy weather. 

Sanguin. The pain commences in the back part of the head, rises and 
spreads over the head, and settles especially above the right eye, with nausea, 
vomiting and chilliness; the patient is obliged to seek a dark room and to lie 



780 digest to cephalalgia. 

perfectly still; flushes of heat; burning of the soles of the feet; scanty urine 
at first, later profuse flow of clear urine. 

Sepia. The pain is jerking upwards, like an electric shock, or boring; 
worse from motion, better from holding the eyes shut; pale, yellowish, dirty 
color of the face; white tongue; aversion to food; sour taste after eating; 
constipation; obstruction of the portal system; leucorrhcea between menses; 
irregular menses; bearing down of the womb. 

Silk. Pressing, throbbing pain in the occiput upwards, also from 
occiput to eyeballs, especially the right one, worse from every quick exertion, 
pressing to stool, etc., better from getting warm, and after sleep; the pain is 
attended with a peculiar exaggeration of the mind; when crossed, he has to 
restrain himself from doing violence; appetite good; while eating the pain 
is much milder, but grows so much the worse again afterwards; brought on 
by exposure of the back to any slight draught; better from wrapping the 
head up warmly. 

Spigcl. Different sorts of pains, frequently extending into the eye and 
side of the face, always worse from stooping, slightest motion, concussion, 
noise and during stool; they are apt to appear at regular hours, either in 
the forenoon or in the night, and are mostly attended with paleness of the 
face, palpitation of the heart and oppression of chest. 

Sulphur. Pain in the forehead and top of the head; heat in the head 
and coldness of the feet; flying heat in the face; nightly sleeplessness; itch- 
ing of the skin; suppressed eruptions; looseness of the bowels early in the 
morning, driving out of bed; haemorrhoids, etc. 

Thuja. Hemicrania of sycotic origin, mostly worse soon after midnight. 
" Intermittent from 9 p. m. to 4 or 5 A. M., commencing slightly on crown of 
head, gradually expanding over whole head, and increasing to an excruciat- 
ing height, with restlessness, must get out of bed. After the attack paralytic 
weakness of the legs. Has had thirty years ago an intermittent fever, which 
was suppressed . " ( Kbck . ) 

Veratr. Pain very violent, driving one to despair; or prostrating, 
causing fainting; cold sweat and great thirst; great nausea, vomiting and 
diarrhoea, or obstinate constipation. 

Zincum. In chronic cases of cerebral affections; great weakness of 
sight; stitching pain in the right eye; paleness of face; now and then vomit- 
ing; fidgetiness of the legs. 

Digest to Cephalalgia. 

Beating, throbbing: Arg. nit., Bel lad., Pressive : Arg. nit., Nux vom., Pulsat. 

Ferrum, Glonoin. Like a hoop around: JEthusa, Anac. 
, , like waves, from below up- Screwing" together : Arg. nitr., Coloc. 

wards: (Hanoi n. , as though in a vise: Platina. 

Boring, <lull: Nux vom. Tearing: Coloc. 

Bursting: Amm. card., Bryon. and stitching: Pulsat. 

Congestive: .Iron.. Bellad., Ferrum, 

Melilot. Forehead, pain as if it would burst or 
Dull, drawing: Agar. split: ASstAusa, Bryon. 



DIGEST TO CEPHALALGIA. 



7 8l 



, down to bones in face: Pulsat. 

and top of head: Sulphur. 

and temples, from above downward: 

Menyanth. 

, pressive 011 awakening in the morn- 
ing: Arg. nitr. 

Forehead, pain in one of the frontal pro- 
tuberances: Arg. nitr. 

, from supraorbital ridge up to coro- 
nal suture: Arg. nitr. 

, over eyes, pressing down: Hepar. 

, over left eye: Nux vom. 

, jerking upwards, like an electric 

shock, or boring: Sepia. 

, in glabella: Aeon., Arg. nitr. 

, root of nose: Aeon., Agar., Platina. 

Temples, with throbbing: Laches. 

, in one of the, extending down into 

the bones of the face: Arg. nitr. 

, through into occiput: Arnica. 

, right side: Bellad., Cact. grand., 

Iris, Pulsat. 

, , as if a nail were thrust in: 

Agar. 

, leftside: Anae., Amyl?iitr. 

, changing sides in different attacks: 

Iris. 

Eyes, affecting: Hepar. 

, , and side of face: Spigel. 

, , and whole head: Phosphor. 

Eyes, affecting left eye : Phosphor. 

Top, crown of head, as if brain were 
crushed: Phos. ac. 

, , extending over whole head: 

Thuja. 

Occiput, throbbing: Ignat. 

, , synchronous with the beats of 

the heart: Camphor. 

, upwards: Silic. 

, spreading all over head; muscles of 

neck are sore to touch : Rhus rad. 

, and settling in right eye: San- 

guin., Silic. 

, terrible, tearing, crazy pain up to 

top of head: Lil. tigr. 

Commencing on waking in the morning: 
Natr. mur. 

, increasing till evening: 

Bryon., Cact. grand. 

, afternoon: Arnica, 

Calc. carb. 

, growing milder in even- 
ing: Nux vom. 

slightly, growing gradually to severe 



height, and decreasing again slowly: 

St annum. 
Intermittent, at regular hours: Aranea 

diad., Chin, sulph., Spigel. 

, from 9 a. m. to 2 p. m. : Ignat. 

, from 9 p. m. to 4 or 5 a. m. : Thuja. 

, either in forenoon or in night: 

Spigel. 
Periodical: Anac, Arnica, Thuja. 
Alternating with bilious colic: Ars. alb. 
Preceded by dimness before eyes and 

nausea: Arg. nitr. 
dimness of sight and double vision: 

Gelsem. 

blue before eyes: Iris vers. 

flickering and fiery zig-zags before 

eyes: Chamom. 

general indisposition, chilliness: 

Arg. nitr. 

BETTER. 

Lying down: China, Phosphor. 

on back: Arnica, Ignat. 

perfectly still : Sanguin. 

Reclining head on a high pillow: Gel- 
sem. 

Bending head backwards: Bellad. 

Holding eyes shut: Sepia. 

In a dark room : Sanguin. 

Sitting erect : China. 

Moving about gently: Agar., China, 
Rhus rad. 

Shaking the head: Gelsem. 

External pressure : Amm. carb., Bel- 
lad., Menyanth., Pulsat. 

, soft: Ignat. 

warmth: Amm. carb., Arsen., 

Ignat., Rhus rad. 

Wrapping head up warmly: Arnica, 
Silic. 

Open air : JEthusa, Pulsat. 

While eating : Anac. , Phosphor. , Silic. 

After eating a good dinner and drinking 
a glass of wine: Arg. nitr. 

After sleep: Agar., Phosphor., Silic. 

Bleeding of nose: Mellot. 

After profuse emission of urine: Gel- 
sem., Ignat., Sanguin. 

WORSE. 

Mental exertion : Arnica, Nux vom. 
Reading, writing, talking: Arnica, 

Natr. mur. 
Light and noise: Cact grand., Nux 

vom., Spigel. 



7 82 



DIGEST TO CEPHALALGIA. 



Motion: Arnica, Bryan., Sepia, Silic., 
Spigel. 

, must lie perfectly still: Cact. grand. 

Stooping", concussion: Arnica, Bryon., 

Fgnat., Spigel., Phosphor. 
Sitting" : Agar. 
Coughing, sneezing: Bryon. 
Pressing at stool: Ignat., Silic, Spigel. 
Opening or shutting the eyes: China. 
In rest : Rhus rad. 
When lying : Bellad., Gelsem. 
Must out of bed: Ferrum, Thuja. 
Touch, slight: China. 
Rubbing: Anac. 
Pressing teeth together: Amm. card. 



In cold : Nux vom., Rhus rad. 
Washing hands in cold water: Ignat. 
Wet poultices : Amm. carb. 
In warm room : Pulsat. 
In a warm room, but open air does not 
relieve: Arnica. 



After eating: Arnica, Coccul., Nux 
z>om., Silic. 

drinking: Coccul. 

coffee: Arg. nitr. 

smoking: Coccul., Ignat. 



Morning: Agar., Anac. 
Forenoon: Phosphor. 

, 10 o'clock: Gelsem., Natr. mur., 

St an num. 
Evening : Amm. carb. 

and night: Pulsat. 

After midnight : Thuja. 

CAUSES. 

Close mental application: Nux vom. 

, at school: Calc. phosph. 

, , girls: Natr. mur. 

Overwork at desk: Agar. 
Opera: Cact. grand. 
Grief: Phos. ac. 
Chagrin, indignation: Coloc. 
Cerebral affections : Zincum. 
Suppressed coryza : Laches. 

Gastric derangement : Bryon., Iris. 

, from alcoholic drinks: Ant. crud,, 

Nux vjm. 

Hepatic derangement: Arsen., Iris. 

Masturbation : Nux vom. 

Before menses, and if they do not ap- 
pear: Glonoin. 



, which are profuse: Calc. carb. 

During pregnancy : Glonoin. 
Nursing and after loss of fluids: China. 



Heat of sun: Camphora, Glonoin. 

Bathing: Ant. crud. 

Draft on back and neck: Rhus rad. 

Silic. 
Change of weather: Calc. phosph. 
Damp, rainy weather: Rhus rad. 



Sycosis : Thuja. 

Syphilis: Aur. met. 

Suppressed intermittent fever: Thuja. 

eruptions: Calc. carb., Sulphur. 

Mercurial poisoning : Aur. met. 



Full-blooded persons: Aeon. 
Youths, growing very fast: Phosph. ac. 
Nervous persons who get easily fright- 
ened, or feel easily hurt: Ignat. 

ATTENDING SYMPTOMS. 

Loss of memory : Anac. 

Wild feeling, alternating with uterine 
pains: Gelsem. 

Feeling as if going crazv, Aeon., Calc. 
carb. 

she would lose her reason: Lit. tigr. 

she must die: Arsen. 

Inclination to weep: Amm. carb., Aur. 
met., Plalina. 

Longing to die : Aur. met. 

Laughing and crying alternately: Aur. 
met. 

Runs wildly about the room: Coffea. 

Melancholy, dejected: Aur. met. 

, would lose her soul when dying: 

Li I. tigr. 

Anxiety: Amm. carb., Coloc. 

and restlessness: sEthusa. 

Despair: Aeon., Coffea, Veratr. 

, almost driven to suicide: Aur. met. 

Mild, yielding disposition: Pulsat. 

Irritable, cross, angry: Bryon. 

Has to restrain himself from doing vio- 
lence: Silic. 

Could murder anyone without hesita- 
tion: Hepar. 



Vertigo: Arg. nitr., Bellad., Gelsem. 

, inclines the patient to reel to the 

one or the other side: Arg. nitr. 
, obliges to lie down: Aran. diad. 



DIGEST TO CEPHALALGIA. 



783 



, and paleness of face: Laches. 

Congestion: Aeon., Bel/ad., Glonoin. 
Heat: Laches. 

and cold feet: Sulphur. 

Cold feeling in some part of head, or in 

whole head: Calc. card. 
Feeling of enlargement: Glonoin. 
as if head were bloated and swollen: 

Aran. diad. 
Feeling of emptiness and hollowness of 

head: Goccul. 
Heaviness or lightness of head: Gelsem. 
Swelling of cranial bones, with boring: 

Aur. met. 
Sensitiveness of head to open air: 

Arsen. 



Sensitive smell : Aur. 7net. 



Eyes appear protruded: sEthusa. 

congested: Glonoin. 

Blue rings around the eyes: Phosphor. 
Stitching pain in right eye: Zincum. 
Weakness of sight: Zincum. 
Dimness before eyes: Arg. ?iilr. 
Objects appear smaller than the'y are: 

Platina. 
Fiery sparks before eyes: Aur. met. 
Flimmering, flickering before eyes: 

Aran., Arnica. 
Ringing in ears: Arg. nitr., Glonoin. 
Roaring: Aur. met. 



Pllfnness under the eyes: Phosphor. 

Face bloated: Phosphor. 

and shining: Aur. met. 

and pale: Amm. carb. 

pale: A^thusa, Bellad., Sepia, 

Spigel., Zincum. 

, yellowish-dirty: Sepia. 

, hippocratic countenance: Phos- 
phor. 

on affected side: Amy I nitr. 

crimson during pain, at other times 

pale and earthy: Ferrum. 

, heat and redness: Platina. 

, flying in: Sulphur. 

Nose dry: Cact. grand. 

stopped up: Nux vom. 

bleeding: Agar. 

, fluent coryza: Anac. 

, sharp, burning water from: Amm. 

carb. 

, thick, mucous discharge 

Agar. 



from ; 



Loss of taste : Anac. 

Taste sour after eating: Sepia. 

, bitter, of water: Pulsat. 

Aversion to eating and drinking: Pulsat. , 

Sepia. 
Appetite good: Silk. 
Thirst: Amm. carb., Bryon. 

, great, and cold sweat: Veratr. 

Dry feeling in mouth, without thirst: 

Bryon., Pulsat. 
Tongue coated, thick white: Ant. crud., 

Bryon. 

white: Sepia. 

Nausea, vomiting: Arg. nitr . Lpec, 

Pulsat., Sanguin., Veratr. 
Vomiting now and then: Zincum. 

at its height: ASthusa, Arg. nitr. 

bitter, sour: Nux vom. 

Belching, hiccoughing: A^thusa. 
Stomach, pain for several days: AEthusa. 

bloated: Laches. 

relaxed, as though hanging down 

loosely: Arg. nitr. 
Diarrhoea: AS thusa, Pulsat., Veratr. 
early in morning, driving out of bed: 

Sulphur. 

early in morning: Bryon. 

Constipation : Bryon., Nux vom., Sepia 

Veratr. 
Obstruction of portal system: Sepia. 
Haemorrhoids : Sulphur. 
Urine scanty and fetid: Coloc. 
at first, later profuse and clear: 

Sanguin. 
Pain in left ovarian region: Laches. 
Bearing down of womb: Sepia. 
Menses scanty, delayed: Pulsat. 

too early and profuse: Platina. 

irregular and leucorrhcea between: 

Sepia. 

Oppression of chest: Pulsat., Spigel. 
Squeezed feeling about the heart: Lit. 

tigr. 
Palpitation of heart: Glonoin., Nux 

vom., Spigel 
Throbbing of carotid arteries: Bellad. 



Paralytic weakne?s of legs after attack : 

Thuja. 
Fidgety of legs: Zincum. 
Burning of soles of feet: Sanguin. 



784 NEURALGIA OK THE TRIGEMINUS. 

Icy coldness of whole body: Camphor a. Covers tightly, even when hot and per- 
Coldness internally, with heat ex- spiring: Hepar. 
ternally: Anac. 



Cold, sweaty hands and feet: Calc. card. Itching of skin, sleepless: Sulphur. 

Chilliness: Arsen., Pulsate Sanguin. Restlessness: Arsen., Coloc. y Thuja. 

Flushes of heat: Sanguin. Debility, prostration: Arsen. 

Perspiration cold: Camphora, Veratr. , , compelling to lie down: A mm. 

sonr: Arnica. card. 

smells like urine: Coloc. , , causing fainting: Veratr. 

during day and in morning, about Trembling" of the whole body: Agr. nitr. 

joints: Amm. carb. Hysterical spasms: Aur. met. 
Perspiration of palms of hands: A 



nac 



Neuralgia of the Trigeminus or Fifth Nerve, Prosopalgia, Neu- 
ralgia, Neuralgia Facialis, Dolor Faciei Fothergilli 
Tic douleureux. 

It attacks one or the other branch of the trigeminus, sometimes the n. 
supraorbitalis or infraorbitalis, 11. facialis, 11. inframaxillaris, and, therefore, 
some authors speak of a neuralgia supraorbitalis, neuralgia infraorbitalis, 
etc. The affection is almost always confined to one side; rarely does, it at- 
tack both sides, but there appears to be no difference in favor of one or the 
other side. An extension from one side to the other has bee^n occasionally 
observed. 

The pain is generally spoken of by the patient as indescribable, excru- 
ciating, coming on in paroxysms of shorter or longer duration, sometimes 
irradiating into the back part of the head and neck, down into the shoulder, 
intercostal spaces, breast and even the lower extremities. 

We likewise find the motor}" nerves affected, causing jerking of differ- 
ent muscles of the face, spasmodic closing of the eyelids, bending of the 
body double, trembling of the whole body, etc. We also find the vaso- 
motor nerves affected, causing pulsation of the arteries, swelling of the 
veins, redness, or paleness, and heat of the face. The whole affected side of 
the face assumes a different expression, becomes shining, glistening, greasy, 
sometimes appearing puffed and at other times emaciated. 

When the ramus ophthalmicus is affected, we observe a redening of the 
conjunctiva and flowing of tears; if, at the same time, the second branch is 
also affected, we observe a water}- and slimy discharge from the nose; and 
when the second and third branches suffer, it is often attended with a flow of 
saliva. 

Sometimes there has been observed a partial sweat in the face during 
the paroxysm; the hair of the affected side grows brittle and splits, or falls 
out. 

Therapeutic Hints. 

Aeon. Cheeks red and hot; the patient seems besides himself for pain, 
screams and rolls about in the bed or on the floor. 

Allium cepa. "Pain violent and continuous: chronic neuritis, which 
is wearing the patient out." (Gilchrist.) 



THERAPEUTIC HINTS TO NEURALGIA OF THE TRIGEMINUS. 785 

Arg. nitr. during the paroxysms, unpleasant, sour taste in the mouth. 
Wolf mentions Arg. nitr. as of general importance in this complaint. 

Asaf. " Hysterical restlessness and anxiety; sensation of numbness of 
bones of face; twitching and jerking in muscles, worse in afternoon; better 
in open air. Leftside." (Gilchrist.) 

Arseyi. Burning, stinging pain, as of red-hot needles, worse about 
midnight; face pale and distorted; puffed around the eyes; great restlessness; 
ameliorated by external warmth; typical paroxysms of a miasmatic orgin. 

Bellad. Cutting, tearing pain, shooting from the side of the face 
up into the temples, into the ear, and down into the nape of the neck; 
worse from touch and motion; hard pressure sometimes relieves; 
the paroxysms mostly occur in the afternoon; come and go suddenly; 
the face is generally flushed; the eyes water and the muscles of the face 
twitch; the patient cannot bear light or noise; the right side is the most fre- 
quently affected; after the abuse of mercury. 

Bismuth nitr. The most excruciating pains are somewhat relieved by 
taking cold water into the mouth and walking briskly about. 

Calc. carb. Pain from the right mental foramen along lower jaw to ear* 
attended with frequent urination; worse from cold air; better from warm 
air and warm applications. 

Caustic. Right side, from the cheek-bone to the mastoid process, worse 
at night; better from rubbing with a cloth dipped in cold water; chilliness; 
scanty menses. 

Cedron. " Unerring periodicity to the hour." (Gilchrist.) 

Chamom. The pain causes hot perspiration about the head, and ex- 
torts screams; the patient is wild and unruly, tossing and rolling about; 
menses unusually profuse. 

China. The pain is in the infraorbital and mixillary nerves, worse from 
the least touch, lying down, and in the night; great weakness after the par- 
oxysm. 

Chin, sulph. The paroxysms set in at the same hour every day; the in- 
tervals are free of pain, and there is no complication with gastric or other 
derangements. 

Cimicif. Especially when the neuralgia is a reflex pain dependent upon 
ovarian disturbances. "Pain in left jaw, in lower jaw, lower teeth and 
articulation of lower jaw; pain in right superior maxillary bone and teeth; 
heat in one side of face, with lassitude all over." (Gilchrist.) 

Coloc. Tensive tearing with heat and swelling, especially left side, also 
right side; motion and touch increase the pain; better in perfect rest, and 
from external application of warmth; brought on by chagrin and indigna- 
tion. 

Ferrum. During the paroxysms the face gets fiery red, sometimes only 
in one spot; cannot keep the head quiet, at the intervals the face looks 
earthy and pale. 

Gelsem. Orbital neuralgia in distinct parox}^sms of acute pain, accom- 
50 



786 THERAPEUTIC HINTS TO NEURALGIA OF THE TRIGEMINUS. 

panied with contractions and twitching of the muscles near the portion of 
the face affected; with extreme general nervousness and loss of control over 
the voluntary muscles, giving rise to odd, irregular motions. 

Hcpar. In chronic cases; the pain streaks from the cheek-bone into the 
temple, ear, alae nasi and upper lip of the affected side; it is worse in the 
fresh air, and better from wrapping up the face; at the same time coryza, 
hoarseness, much sweating and rheumatic pains elsewhere; especially after 
the abuse of mercurj^ or metallic preparations. 

Iris. Pain in the head, temples and eyes, attended with most distress- 
ing vomiting of a sweetish mucus, and occasionally (if attended by much 
straining) of some bile. 

Laches. Left side, orbital neuralgia; lachrymation; previous to the 
paroxysm rising of heat to the head; during the intervals a weak, nauseous 
feeling in the abdomen. Waking out of sleep the eyes feel as though they 
had been taken out and squeezed, and then put back again; malarial affec- 
tions. 

Magn. carb. Left or right side; shooting like lightning; worse from 
touch, draught, change of temperature; cannot stay in bed, must walk the 
floor. 

Mag7i. phosph. Supraorbital and infraorbital nerves pain at intervals 
and relieved by external warmth. 

Mercur. Tearing pains, worse at night in bed; it often starts from a 
decayed tooth and involves the whole side of the face, which may be red and 
swollen; profuse secretion of saliva; constant inclination to perspire; restless- 
ness and sleeplessness. Brought on by taking cold. 

Mezer. Ciliary neuralgia, especially after operations on the eye; pro- 
sopalgia, left-sided, from over the eye to the eyeball, cheek, teeth, neck and 
shoulder; lachrymation; conjunctiva injected; parts sensitive to touch; 
worse from warmth; periodical from 9 A. m., increasing to 12 m., and decreas- 
ing gradually until 4 p. m., leaving the patient perfectly free from pain. 
Also boring, pressive pains, coming like lightning, which leave the parts 
numb; they are worse from eating warm food, also from entering a warm 
room after walking in the fresh air; they are attended with chilliness and 
shuddering; twitching of the muscles of the affected parts, flow of saliva, 
redness of the fauces, burning in the throat, stiffness of the masseters, red 
spots on the nape of the neck, and formication in the skin of the chest; after 
the abuse of mercury, or in syphilitic patients. 

Natr. ?nur. Pain in the malar bones, worse when chewing; falling off 
of the whiskers; intermittent prosopalgia; after the abuse of quinine. 

Nux vom. Tearing pain in the course of the infraorbital and middle 
branch of the trigeminus, with redness and watering of the eye; flow of clear 
water from the nostrils and numbness of the affected side; the patient is 
morose, irritable, belches a great deal and is constipated; after the abuse of 
coffee, liquors, quinine, etc.; also intermittent prosopalgia, worse from noise, 
motion, cold air; better in a warm room, at rest and lying down. 



THERAPEUTIC HINTS TO NEURALGIA OF THE TRIGEMINUS. 787 

Phosphor. Drawing and tearing pain in the jaws, root of the nose, 
eyes and temples, worse from slightest movement and touch, cannot speak 
nor eat, attended with bloatedness of the face, congestion of the head, tearing 
on the top of the head, vertigo, and ringing in the ears; from taking cold 
over the wash-tub. 

Platina. Boring-pain, cramp-like; painful feeling of numbness in the 
malar bones and the mastoid processes and chin, as if the parts w 7 ere between 
screws, attended with anxiety, w r eeping and palpitation of the heart; profuse 
menses. 

Pulsat. Twitching, tearing pain, worse in the evening and in a warm 
room; in persons of a mild, tearful disposition, and phlegmatic temperament; 
inclination to looseness of the bowels; scant} 7 menses; after getting the feet 
wet; after the abuse of quinine. 

Rhodod. Right side; by w T ind and changes of weather, better from 
w r armth, and relieved while eating and for some time after. 

Rims fox. Drawing, burning, tearing pain in the face, and a feeling as 
though the teeth w r ere too long, attended with great restlessness, necessity to 
move about; relieved somewhat by the external application of cold; dysenteric 
stools, with jelly-like evacuations; after exposure to rain. 

Saiiguin. In upper jaw extending to nose, eye, ear, neck and side of 
head; shooting, burning pains; kneel down and hold head tightly to the 
floor. (Hering. ) 

Sassap. Quickly, lightning-like changing pains, over leaping to differ- 
ent localities. Heyer — Allg. H. Z. Bd., 115, p. 30. 

Sepia. Intermittent prosopalgia, with congestion of eyes and head; 
also during pregnancy; jerking, like electric shocks, upwards. 

Spigel. Tearing, shooting, jerking or burning pain in all directions, 
suddenly coming and going, attended with dark redness of the affected side; 
flow of water from the eyes and nose; twitching of the muscles in the face; 
difficulty of breathing; palpitation of the heart; rheumatic pains elsewhere; 
w T orse in damp weather, from touch and motion; after suppressed inter- 
mittents. 

Sta?mum. Intermittent supraorbital neuralgia from 10 A. m. to 3 or 
4 p. m., gradually increasing until attaining its acme, and then again de- 
creasing as gradually; after abuse of quinine. 

Staphis, The pain starts from the decayed tooth; is worse from slight 
and better from heavy pressure; it is attended with swelling of the gums, 
cold sweat in the face and cold hands. 

Stramo7i. Prosopalgia, with many nervous symptoms; spasms of the 
chest hindering breathing; swooning; weeping; twitching of the muscles of 
the face; frowning; jerks through the whole body; delirious talk, with open 
eyes. 

Sulphur. Intermittent periodic neuralgia every twenty-four hours, 
worse generally at 12 m. or 12 p. m., or midsummer or midwinter; chronic 
cases, when other remedies relieve, but do not cure; psoric tendency; scanty, 
black, tarry menstrual discharges. 



788 



DIGEST TO NEURALGIA OF THE FACE. 



Thuja. After suppressed gonorrhoea or eczema on the ear; worse after 
midnight. 

Veratr.. Drawing, tearing pain, attended with bluish paleness of the 
face; sunken eyes; coldness of the extremities; trembling and jerking; cold 
perspiration; great exhaustion; nausea and vomiting. 

Verbasc. Violent pain, jerking like lightning, or pressive, numbing; 
aggravated by pressure, sneezing, talking, chewing or a draught of air; ap- 
pears at the same hour every day, n a. m. till 4 p. m., and is attended with 
headache, redness of the face, vertigo, belching, and a discharge of tough 
saliva from the mouth. 

Zincum, Burning, quick stitches, and jerking along the course of the 
infraorbital nerve, right side, attended with bluish eyelids; numbness of the 
tongue; constricted sensation of the throat; worse from the slightest touch 
and in the evening. 



Digest to Neuralgia of the Face. 



NATURE OF PAIN. 

Boring". Mezer. y Platina. 

Burning: Arsen., Rhus tox., Sanguin., 
Zincuin. 

Cramp-like: Platina. 

Cutting: Bellad. 

Drawing: Phosphor., Rhus tox,, Veratr. 

Jerking: Sepia, Spigel., Verbasc., Zin- 
cum. 

Lightning-like: Magn. carb., Mezer., 
Verbasc. 

jumping (changing) quickly, loca- 
tion from head to back, etc., and back 
again: Sassap. (Heyer.) 

Like electric shock upwards: Sepia. 

Numbness in malar bones and mastoid 
process and chin, as if the parts were 
between screws: Platina. 

Pressive : Mezer. 

and numbing: Verbasc. 

Shooting : Bellad. 

Stinging, as of red-hot needles, worse 
about midnight: Arsen. 

Stitches along the course of right infra- 
orbital nerve: Zincuin. 

Tearing: Bellad., Mercur., Rhus tox., 
Spigel., Veratr. 

in the course of the infraorbital and 

middle branch of the trigeminus: Xitx 
vom. 

in jaws, root of nose, eyes and tem- 
ples: Phosphor. 

Tensive tearing, with heat and swelling, 
left side: Coloc. 



Twitching, tearing: Pulsat. 
Violent and continuous: Cepa. 

LOCATION AND DIRECTION OF 
PAIN. 

Ciliary, after operations on eye: Mezer. 

Orbital : Gelsem. 

, left side: Laches. 

From over the eye to eyeball, cheek, 
teeth, neck and shoulder: Mezer. 

Supra and infraorbital: Magn. phosph. 

Supraorbital: Stannum. 

Infraorbital and middle branch of tri- 
geminus: Nux vom. 

and maxillary: China. 

, right side: Zincum. 

Cheek-bone to mastoid process, right 
side: Caustic. 

and chin: Platina. 

Maxillary, superior: Natr. mur. 

, , and teeth: Chnic. 

, , to nose, eye, ear, neck and 

side of head: Sanguin. 

, , to temple, nose and upper lip: 

Hepar. 

Temples and eyes: Iris vers. 

Jaws, root of nose, eyes and temples: 
Phosphor. 

Right mental foramen along lower jaw 

to ear: Calc. carb. 

Left under-jaw, lower teeth, and articu- 
lation of lower jaw: Cimic. 

From decayed tooth : Staphis. 

, whole side of face red and swollen: 

Mercur. 



DIGEST TO NEURALGIA OF THE FACE. 



789 



Prom side of face into temple, ear, down 

nape of neck: Bellad. 
Right side: Bellad., Caustic, Coloc, 

Rh odod. , Zin cu m . 
Left side: Asa/., Coloc, Laches., Mezer. 
Right or left : Magn. card. 

PERIODICITY. 

Intermittent: Arsen., Gelsem., Magn. 

phosph., Natr. mur., Nux vom., Sepia. 
, at regular hours: Cedron., Chin. 

sul ph. 
Intermittent, from 9 a. m. to 4 p. m. ; 

Mezer. 
, from 10 a. m. to 3 or 4 p. m. : Stan- 

num. 

, from 11 a. m. to 4 p. m.: Verbasc. 

, 12 noon or 12 midnight: Sulphur. 

, afternoon: Asa/., Bellad. 

, after midnight: Thuja. 

Spells come and go suddenly: Bellad., 

Spigel. 
, gradually increasing to highest pitch 

and then again decreasing as gradually: 

Mezer. , St a nnum. 

AMELIORATION. 

External warmth: Arsen., Calc carb., 

Coloc, Magn. phosph., Rhodod. 
Warm room: Calc carb., Nux vom. 
Wrapping" up face: Hepar. 
In open air: Asa/., Pulsat. 
External application of cold: Rhus tox. 
Taking cold water in the mouth: Bism. 

nitr. 
Heavy, hard pressure: Bellad., Staphis. 
Rubbing with cold water: Caustic 
Moving head: Ferrum. 
Walking the floor: Magn. carb. 
Walking briskly about: Bism. nitr. 
Kneeling down and holding head tightly 

to floor: Sanguin. 
Rest: Coloc, Nux vom. 
While eating and for some time after: 

Rhodod. 

AGGRAVATION. 

Warmth: Mezer. 
Warm room: Pulsat. 

, after walking in fresh air: Mezer. 

Warm food: Mezer. 
Cold air: Calc carb., Hepar, Nux vom. 
Draught of air: Verbasc, Magn. carb. 
Change of temperature: Magn. carb. 
of weather: Rhodod. 



Damp weather: Spigel. 

Midsummer and midwinter: Sulphur. 

Evening: Pulsat., Zincum. 

Night: Caustic, China 

, in bed: Mercur. 

Touch: Bellad., Magn. carb., Spigel., 
Verbasc. 

, slightest: China, Mezer., Phosphor., 

Staphis., Zincum. 

Motion: Bellad. , Coloc , Nux vom.,- Phos- 
phor., Spigel. 

Talking: Verbasc 

Chewing: Natr. mur., Verbasc. 

Cannot speak nor eat: Phosphor. 

Lying down: China. 

Cannot stay in bed, must walk the floor: 
Magn. carb. 

keep head still: Ferrum. 

After sleep: Laches. 

CAUSES. 

Chronic neuritis: Cepa. 
Pregnancy: Sepia. 
Suppressed intermittents: Spigel. 
Malaria: Arsen., Laches. 
Taking cold: Mercur. 

, over wash-tub: Phosphor. 

Getting wet: Rhus tox. 

of the feet: Pulsat. 

Abuse of quinine: Natr. mur., Nux 

vom., Pulsat., Stannum. 

coffee, liquors: Nux vom. 

mercury: Bellad., Hepar., Mezer. 

Syphilis: Mezer. 

Suppressed gonorrhcea, or eczema on 

the ear: Thuja. 
Chagrin and indignation: Coloc. 
Chronic cases, when other remedies 

fail: Sulphur. 

ATTENDING SYMPTOMS. 

Swooning: Stamon. 

Delirious talk with open eyes: Stamon. 

Wild, unruly, tossing and rolling about: 

Chamom. 
Beside himself, screaming, rolling about: 

Aeon. 
Weeping: Platina, Stramon. 
Frowning: Stramon. 
Anxiety: Asa/., Platina. 
Tearful, mild disposition: Pulsat. 
Morose, irritable: Nux vom. 



Vertigo: Phosphor., Verbasc. 



79Q 



CERVICO-OCCIPITAL NEURALGIA. 



Headache: Verbose. 
Heat in head before spell: Laches. 
Congestion of head: Phosphor., Sepia. 
Tearing on top of head: Phosphor. 
Hot perspiration about the head: Cha- 



Congestion of eyes: Sepia. 

Conjunctiva injected: Mezer. 

Redness and watering of eves: Nux 

vom. 
Bluish eyelids: Zincum. 
Lachrymation: Laches., Mezer. 
Flow of water from eyes and nose: 

Spigel. 
, and twitching of muscles of 

face: Bell ad. 
Sunken eyes: Veratr. 
Light and noise unbearable: Bel lad. 
Ringing in ears: Phosphor. 
Flow of water from nose: Nux vom., 

Spigel, 
Coryza: Hepar. 



Face, cold sweat in: Staphis. 

, bluish pale: Veratr. 

, pale and distorted: Arsen. 

, bloated: Phosphor. 

, puffed around the eyes: Arsen . 

, flushed: Bel I ad. 

, red: Verbasc. 

, dark red on affected side: Spigel. 

, fiery red, sometimes only in one 

spot; during intervals earthy and pale: 

Ferrum. 

, hot on one side: Cimic. 

, red and hot: Aeon. 

, numbness of affected parts: Asa/., 

Mezer., Nux vom., Platina. 
Twitching of muscles: Asa/., Bel lad., 

Gelsem., Mezer., Spigel., Str anion. 
Stiffness of masseters: Mezer. 
Falling off of whiskers: Natr. mur. 



Mouth, sour taste in: Arg. nitr. 
Flow of saliva: Mercur., Mezer 

base. 



\ 'er 



Swelling of gums: Staphis. 
Teeth feel as if too long: Rhus tox. 
Numbness of tongue: Zincum. 
Fauces red, burning in throat: Mezer. 
Constricted sensation of throat: Zin- 
cum. 
Hoarseness: Hepar. 
Red spots on nape of neck: Mezer. 



Belching: Nux vom. 

Nausea and vomiting: / 'eratr. 

Vomiting of a sweetish mucus, or bile : 

Iris. 
Nauseous feeling in abdomen: Laches. 
Constipation: Nux vom. 
Dysenteric stools, jelly-like: Rhus tox. 
Looseness of bowels: Pulsat. 
Frequent micturition: Calc carb. 

Menses scanty: Caustic, Pulsat. 

, black and tarry: Sulphur. 

profuse: Chamom., Platina. 

Neuralgia is a reflex from ovarian 
troubles: Cimic. 



Breathing difficult: Spigel., Stramon. 
Palpitation of heart: Platina., Spigel. 
Formication in skin of chest: Mezer. 



Chilliness: Caustic, Mezer. 
Coldness of extremities: Veratr. 
Cold perspiration: Veratr. 

in face and cold hands: Staphis, 

Inclination to perspire: Mercur. 
Much sweating: Hepar. 

Restlessness: Arsen. 

, must move about: Rhus tox. 

and sleeplessness: Mercur. 

General nervousness: Gelsem. 



Lassitude all over: Cimic 
Weakness after paroxysm: China. 
Rheumatic pains elsewhere: Hepar., 

Spigel. 
Jerks through the body: Stramon. 
Trembling and jerking: Veratr. 
LOSS of control over muscles, with odd, 

irregular motions: Gelsem. 



Cervico-Occipital Neuralgia. 

Its seat is in the region of distribution of the sensory fibres of the upper 
four spinal nerves, most frequently only on one side, extending, therefore, 
over the upper part of the nape of the neck and occiput, over the lateral 



CERVICO-BRACHIAL NEURALGIA. 79 1 

region of the head, and in front towards the lower jaw. The occipitalis 
major frequently shows painful spots, one about half way between the 
mastoid process and the upper cervical spinous processes (occipital point), 
and the parietal point over the parietal eminence. Of the other nerves im- 
plicated such points can rarely be demonstrated. 

Compare Aeon., Be/lad., Calc. card., Caustic, Ignat., Kalmia lat., 
Laches., Nux vom., Pulsat., Rhus tox., Spigel., Sulphur. 

Cervico-Brachial Neuralgia 

Extends over the region of distribution of the four lower cervical nerves and a 
part of the first dorsal nerve, and may affect the back of the neck, the up- 
per, or the lower arm, even the hand and fingers. The painful points are nu- 
merous, but somewhat indefinite; they may be found: "over the brachial 
plexus from the axilla outwards; at the lower angle of the scapula; on the 
posterior surface of the shoulder; on the median at the elbow; at the emer- 
gence of the cutaneous medius and lateralis from the fascia of the forearm; 
on the ulnar above the internal condyle, and at the wrist; on the radial nerve 
where it winds around the humerus, and above the wrist, on the spinous pro- 
cesses of the four lower cervical, and two or three upper dorsal vertebrae, 
and at their sides where the posterior branches appear under the skin." 
(Erb.) 

Compare Aeon., Arnica, Arsen., China, Ferrum, Graphit., Ignat., Ly- 
cop., Phosphor., Rhus tox., Sepia, Staphis., Sulphur, Vetatr. 

Intercostal Neuralgia 

Has its seat in the region of distribution of the dorsal nerves, and not unfre- 
quently affects both sides of the chest, but most frequently the left side only 
between the fifth and ninth intercostal spaces. There is a feeling of tension, 
as though the patient were tightly bound around the chest, and occasional 
shooting pains in the direction of the intercostal nerves are occasioned by 
taking a long breath, by coughing, sneezing, sighing, or certain motions of 
the body; by pressure of the clothing or a slight touch, which generally is 
relived again by hard pressure. 

The painful points are in the region near the spinous process of the ver- 
tebrae, where the dorsal nerves emerge from the spine (vertebral points) ; in 
the middle portion of these nerves, where the ramus perforans lateralis 
emerges beneath the skin (lateral point); in the region close to the sternum, 
and in the abdomen over the rectus muscle (sternal and anterior point). 

Differential Diagnosis. — Pleurisy differs by its friction sound and 
fever. 

Angina pectoris by its fits of suffocation. 

■Rheumatism of the muscles of the chest by its more general diffusion 
over the chest and its aggravation by slightest movement. 



792 LUMBO- ABDOMINAL NEURALGIA. 

Compare Arnica, Arsen., Borax, Bryon., Calc. carb., Card, veg., Caus- 
tic, China, Cimic, Mercur., Rhus tox., Sepia, Spigel., Sulphur. 
After shingles: Mezcr., Secale corn. 

Lumbo- Abdominal Neuralgia 

Has its seat in the region of distribution of the lumbar nerves, and consists 
of pain in the lumbar region and on the abdomen, which is easily excited by 
raising a fold of the abdominal skin, or by touching it slightly, and by press- 
ure upon the region near the lumbar vertebrae. Frequently we find associ- 
ated with it a pain in different places of the crest of the ileum and on the 
seat; and also pain which extends from the inguinal region to the symphysis 
pubis and down into the scrotum or into the labia majora, which are refer- 
able to the superficial branches of the lumbar nerves. 

Its painful points are: " one or several in the lumbar region near the 
spinal column (lumbar point); one about the middle of the cresta ilii (iliac 
point) ; one or several above the symphysis pubis, at the side of the linea 
alba (abdominal point); not unfrequently one in the scrotum or labium 
ma jus; and lastly, and less constantly, one in the inguinal region or in the 
portio vaginalis uteri, or in the corresponding side of the vault of the 
vagina." (Erb.) 

Compare Argeiit., Bellad., Chi?ia, Kalmia /at., Nux vom., Put sat., Rhus 
tox., Spigel., Staphis., Sulphur. 

Mastodynia, Neuralgia of the Mammae. 

Its seat is in the mammary glands, which are supplied chiefly from 
branches of the intercostal nerves. The breast becomes very painful, often 
without any visible change in its structure. In some cases, however, small 
tumors (neuromata) have been observed, which appear to be the starting- 
points of the neuralgia, and they either disappear soon or remain unaltered 
for years. The pain radiates sometimes into the axillae, into the back and 
down into the hips, and may be attended with vomiting. Lying on the 
affected side is impossible. Painful points may be found on the nipples or on 
the sides of the breast, or on the spinous processes of the second, third, 
fourth, fifth and sixth dorsal vertebrae. Mastodynia seems mostly connected 
with irregularities of menstruation, at which time it is generally the worst. 
But also lactation, external injury, anaemia, chlorosis and hysteria are 
counted among its causes. Its most frequent occurrence seems to be be- 
tween the ages of sixteen and thirty. 

Therapeutic Hints. 

Painfulness of the mammae before or during menstruation: Arge?it., 
Calad., Calc. card., Canthar., Cimitif., Conium, Kali card., Murex purp., 
Nitr. ac, Rhus tox., Tabac. 

During the nursing of the child: Crot. ligl., Ferrum, Phcll. aquat., 
Phosphor., Silic. 



SCIATICA, NEURALGIA ISCHIADICA. 793 

Sciatica, Neuralgia Ischiadica, Ischias postica, Malum Cotunnii. 

Its seat is in the sciatic nerve, though not always in its entire length. 
Most frequently we find the pain extending from the nates down the posterior 
part of the thigh to the bend of the knee, down along the fibula to the ex- 
ternal ankle, heel and external portion of the foot; the internal border of 
the foot is exempt ; sometimes the pain is felt only in the sole of the foot 
(neuralgia plantaris), and seldom in the dorsum of the foot and toes. In 
rare cases both extremities are affected at the same time. The pain generally 
commences mildly and gradually grow T s worse; sometimes it is paroyxsmal, 
generally worse towards evening and in the night, sometimes only during the 
day. Slight touch aggravates or provokes the pain, while a hard pressure 
sometimes gives relief. With some the pain is ameliorated by moving about 
constantly, while others cannot bear the slightest motion, so that coughing, 
sneezing, pressing at stool are almost killing operations to them. Sometimes 
the pain is attended with a cold sensation in the affected extremity, followed 
by heat. In other cases we find reflex symptoms of the motory nerves, mani- 
festing themselves as cramps in the calves of the legs and in the soles of the 
feet. It has even been observed that during violent paroxysms the heel was 
drawn up towards the buttock of the affected limb. 

Painful points are: "a point close to the sacrum, in the immediate 
vicinity of the posterior superior spine of the ileum ; a point where the sciatic 
nerve emerges from the pelvis; a point at the lower border of the gluteus, 
where the posterior cutaneous nerve emerges; a painful line corresponding to 
the course of the tibial nerve in the popliteal space; a point over the head 
of the fibula; a point behind the outer ankle-bone and another behind the 
internal malleolus; several points on the dorsum of the foot, and occasionally 
points on the posterior surface of the thigh and on the calf of the leg, where 
the cutaneous branches perforate the fascia." (Brb.) 

The following Diagnostic sign is mentioned by Beurmann in Arch, de 
Phys. Norm et Pathol.: ' ' The patient is made to lie in his bed on his back, and 
is told to allow the affected leg to lie perfectly passive. If now, with the leg 
fully extended the physician flexes it at the hip, the patient at once expe- 
riences acute pain, darting along the course of the nerve from the buttock 
downwards, and which is most severely felt in the neighborhood of the great 
trochanter. If, however, the leg be first flexed upon the thigh before the 
thigh is flexed upon the abdomen, it will be found that no such pain results 
from the movement. It would seem that this pain is due to tension of the 
sciatic nerve, which with the first of these movements is considerable, but 
which does not take place with the second. That this hypothesis is correct, 
Beurmann abundantly proves by various experiments which he conducted on 
the dead subject. This sign of sciatica appears to possess very considerable 
diagnostic value, and will probably suffice at once to disinguish sciatica from 
several conditions which may simulate it, such as crural neuralgia, hip- joint 
disease, etc." 



794 THERAPEUTIC HINTS TO NEURALGIA ISCHIADICA. 

In regard to its Causes we are very much in the dark. Atmospheric 
influences, however, such as damp, cold weather, seem to be very apt to bring 
it on. Therefore w T e find among the exciting causes, getting wet, sleeping on 
the damp ground or within moist walls, or taking cold in general. Likewise 
are mentioned direct influences upon the nerves, such as pressure of narrow 
boots, wounds from blood-letting, carcinoma, aneurisms, pressure of the 
pregnant uterus, deliveries by the forceps, diseases of the vertebrae and neu- 
roma. 

Therapeutic Hints. 

Aeon. " The pain extended the entire limb, at first dull and dragging, 
soon becoming acute, tearing, lancinating, darting like lightning along the 
entire nerve, from above downward, and accompanied hy numbness and 
tingling. Feet cold with occasional cold sweat. In the toes sharp shooting 
pains, alternating with numbness and tingling. " (Thos. Xichol.) 

Arg. nit? . Periodical pain from hip down to knee, with paralytic weak- 
ness and wasting away of the limb; during paroxysm sensation of expansion 
in limb; worse morning and noon. 

Arnica. When caused by overexertion, marching, fracture of limbs, con- 
finement, etc., with formication and lame feeling; necessity to change the 
position of the limbs constanthy, because ever} T thing upon which he lies seems 
too hard. 

Arsen. The burning pain is attended with anguish and restlessness, 
and is worse about midnight; brought on \>y staying in cold, damp cellars; 
it is somewhat relieved by external warm applications; intermittent fever. 

Bellad. Feverish; inclined to weep; wants to sleep and cannot sleep; 
pain worse from touch and motion; from least draught of air; from after- 
noon till midnight; better from letting limb hang down, and after perspiring; 
from warmth and when in erect position. 

Bryon. Better during rest and worse on motion. 

Chamom. Pain excruciating; the patient acts as if beside himself; 
after anger or vexation. 

Calc. carb. If caused by working in water; or in case of complication 
with affections of the spinal bones; the pain starts from the small of the 
back, extends down into the limbs and keeps them in constant uneasiness. 

Caustic. Tearing pain on the outer side of left limb from above down, 
as if the muscles were pinched; constant desire to move the foot. (Maren- 
zeller. ) 

Cimicif. Causes many reflex pains in different parts, dependent upon 
ovarian or uterine irritation. 

Coffea. Tearing, stitching pain, in irregular spells, worse in the night, 
with restlessness and sleeplessness. 

Coloc. Tearing downward, posteriorly, from hip to thigh, leg and foot, 
left or right side, during the day, not at night; worse from motion and press- 
ure; must limp when walking, and be careful not to press the limb when sit- 



THERAPEUTIC HINTS TO NEURALGIA ISCHIADICA. 795 

ting; feels best when lying still. During paroxysm sweat and thirst. Eye- 
lids burn even after sound sleep. After indignation. 

Dioscorca. Pain in right leg, worse on motion; entire relief when lying 
still. (W. J. Martin.) 

Ferrum. Remitting pains; worse in the night, driving out of bed; al- 
though at first scarcely able to stand upon the affected limb, by continued 
motion and walking about, the pain gradually becomes milder; pain in the 
left shoulder; the face is pale, emaciated, but flushes easily. 

Gnaphal. Intense pain along the sciatic nerve, which is continued to 
its larger ramifications; feeling of numbness, occasionally taking the place of 
the sciatic pains, and then exercise on foot is excessively fatiguing. 

Hepar. The pain is worse from motion, touch and exposure to air; 
better from being wrapped up and keeping quiet. 

Ignat. Throbbing pain in the hip, as though the joint would burst; in- 
termittent, at first every other day — later, daily, attended with chilliness and 
thirst, followed by heat without thirst; disappearing during the summer 
season and reappearing in the winter. 

Iris vers. Burning and sudden shooting down the limb, causing lame- 
ness; worse from moderate, not altered by violent motion. 

Kali bichr. Pain relieved by walking and flexing the leg; worse from 
standing, stitting or lying in bed. 

Kali hydr. Nightly tearing in right thigh and knee, worse lying on 
affected side; abuse of mercury; syphilitic taint. 

Laches. Pain constantly changing locality, now in the head, now in 
teeth, now in the sciatic nerve, attended with nervousness, palpitation of 
the heart; burning like fire in the hypogastrium, lumbar region and behind 
the sternum; flushes of heat; suppressed menses; constipation. 

Ledwn. Laming pain in the hip-joint, worse in bed, when getting 
warm; the affected limb is cooler than the remainder of the body; general 
coldness and chilliness. The pain frequently commences below and ascends. 
Great tenderness of the soles of the feet. 

Lycop. Pain in the hip, stiffness and weakness, and formication of the 
affected limb; cold feet; incarcerated flatulence and constipation; urine high 
colored, turbid, or depositing a red, sandy sediment. 

Menyanth. The pain is of a crampy nature, and when sitting, the 
limbs are jerked upwards spasmodically. 

Mertur. Drawing, tearing pain, worse at night in bed; restlessness; 
great inclination to sweat, without any relief; syphilitic taint. 

Mezer. Drawing pain through the affected limb, with sensation of in- 
ternal heat in the limb by external coolness of the skin; worse from touch 
and motion, in evening and at night; better in the open air. 

Natr. mur. Chronic cases with contraction of hamstrings; intermittent; 
abuse of quinine. 

Nux vom. The pain is drawing, tearing, from below upwards, better 
from hot water application; constipation; during stool, great pain along the 



796 DIGEST TO SCIATICA. 

affected limb down into the foot; sedentary life; alcoholic drinks; previous 
use of all sorts of liniments, etc. 1 

Plumbum. Drawing, pressive pains in the sciatic nerve in the posterior 
part of the thigh, down to knee, with difficult walking and great exhaustion 
after walking; tubercular diathesis, with dry hacking cough. 

Phytol. Neuralgic pain on the outer side of the thigh; right side; press- 
ing and shooting, drawing and aching; worse from motion and pressure, and 
worse in the night; syphilitic taint. 

Pulsat. Pain getting worse towards evening and in the night with in- 
clination to constantly change position; worse in warm room; better in open 
air. 

Rhus tox. The pain is attended with numbness, formication, paralytic 
stiffness of the affected limb; it is worse during rest, and when commencing 
to move; better from dry heat; it is mostly brought on by exposure to wot, 
by straining and lifting. 

Ruta. Pain as if in the bones, worse in rest, must constantly be mov- 
ing about during the paroxysm; hamstrings feel shortened; after injuries, 
contusions, etc. 

Sepia. During pregnancy, pain in paroxysms from three to five o'clock 
a. m., with considerabe swelling of the veins of the affected limb; also in 
chronic cases, w T hen the pain localizes itself in the heel of the affected limb; 
better during rest. 

Stilli?ig. Left side; syphilitic and gonorrhceal origin, 

Sulphur. In chronic cases, when all other remedies fail; after the sup- 
pression of tetters. 

Tellur. Worse when lying on the affected side. 

Vale?\ The pain is unendurable while standing, with a feeling as if the 
thigh would break off. 

Zinc. ox. Pain in the small of back at night, on turning in bed; feeling 
of lameness extending to hips; bruised pain especially in left lower limb, or 
in hip and knee; painful tension of muscles when moving; pulsation and 
buzzing in ears. (F. W. Payne.) 

Digest to Sciatica. 

PAIN. Excruciating.' Ghamom. 

Aching": Phytol. Formication: Arnica, Ly rop., Rhus tox. 

As if in the bones : Ruta. Lame feeling": Arnica., Ledum, Zinc. 

Bruised : Ztnc. ox. ox. 

Burning: Iris. Intense, changing with numbness: Gra- 
, with anguish and restlessness: phit. 



Arscn. 



Numbness : Aeon., Rhus tox. 



Crampy ; Menyanth. Intermittent, periodical, remittent: 
, with stiffness in hip and ham: Arg. nitr., Arsen., Ferrum., /gnat., 

Bellad. Natr. mur., Sepia. 

Drawing: Mercur., Mezer., Nux vom.. Irregular spells : Coffea. 

Plumbum, Phytol. Pressive : Plumbum, Phytol. 

Dragging: Aeon, Shooting: Iris, Plumbum. 



DIGEST TO SCIATICA. 



797 



, like lightning downwards: Aeon. 

Stiffness and weakness: Lycop. 

Stitching: Coffea. 

Tearing: Aeon., Caustic, Coffea, Coloc., 

Kali hydr., Mereur., Nux vom. 
Tingling: Aeon. 
Throbbing, as though joint would burst: 

Ignat. 

LOCATION AND DIRECTION. 

Right side: Calc. earb., Diosc., Kali 
hydr., Phytol., Tellur. 

Leftside: Bellad., Calc. card., Caustic, 
Stilling: 

, lower limb, or in hip and knee: 

Zinc. ox. 

Hip-joint: Ignat., Ledum. Lycop. 

Hamstrings feel shortened: Ruta. 

Outer side of thigh: Phytol. 

Heel: Sepia. 

Changing locality, now in head, now 
in teeth, now in sciatic nerve: Laches. 

Down the limbs: Aeon., Graph it., Iris 
vers. 

, outer side of left limb: Caus- 
tic. 

from the small of back, keep- 
ing them in constant motion: Calc. 
earb. 

From hip down to foot: Coloc, Nux 
vom. 

to knee: Arg. nitr. 

, on posterior part: Plumbum. 

From below upwards: Ledum, Nux 
vom., Zinc. ox. 

Lame feeling extending to hips: Zinc, 
ox. 

BETTER. 

During rest: Bryon., Sepia, Hepar. 
When lying still: Coloc 

, entirely relieved: Diosc. 

When letting limb hang down: Bellad. 
When walking : Bellad., Ferrum, Kali 

bichr., Rhus tox. 
When flexing the leg: Kali bichr. 
Constant desire to change position: 

Pulsat. 

to move the feet: Caustic, Zincum. 

Warm applications: Arsen. 
Hot water application: Nux vom. 
Dry heat: Rhus tox. 
Wrapping up: Hepar. 



From warmth: Bellad. 
In summer : Ignat. 
In open air: Mezer., Pulsat. 
After perspiring: Bellad. 

WORSE. 

Morning and noon: Arg. nitr. 

During day only: Coloc 

Evening and night: Mezer., Pulsat. 

Afternoon until midnight: Bellad. 

Night: Coffea, Kali hydr., Mereur., Phy- 
tol., Zinc ox. 

, driving out of bed: Ferrum. 

Midnight: Arsen. 

3 to 5 A. M. : Sepia. 

Getting warm: Ledum. 

In warm room: Pulsat. 

In bed: Ledum., Mereur., Kali bichr. 

Driving out of bed: Ferrum. 

Least draught of air: Bellad. 

Exposure to air: Hepar. 

In winter: Ignat. 

In rest: Rhus tox. 

Must change position, couch feels too 
hard: Arnica. 

Must constantly be moving: Rhus tox., 
Ruta. 

In lying on affected side: Kali hydr., 
Tellur. 

While sitting: Bellad., Kali bichr. 

, must be careful not to press the 

limb: Coloc. 

While standing: Kali bichr. 

, thigh feels as if it would break off: 

Valer. 

When walking: Coloc 

, fatiguing: Graphit., Plumbum. 

When commencing to move: Rhus tox. 

From moderate, not altered by violent 
motion : Iris. 

Motion: Bryon., Diosc. 

and pressure : Coloc. , Phytol. 

and touch: Bellad., Hepar, Mezer. 

On pressing at stool: Nux vom. 

On turning in bed: Zinc. ox. 

BROUGHT ON BY : 

Indignation: Coloc 

Grief: Ignat. 

Anger or vexation: Chamom. 

During pregnancy: Sepia. 

Intermittent fever: Arsen. 

Tubercular diathesis: Plumbum. 

Spinal affections: Calc. earb. 



79 8 



CRURAL NEURALGIA. 



Syphilis: Kali hydr., Jfercur., Phytol., 

Stilling. 
Suppression of tetters: Sulphur. 
Alcohol and quack medicines: Mux vom. 
Quinine: Natr. mur. 
Mercury: Hepar, Kalihydr. 
Cold, damp cellars: Arson. 
Working" in water: Calc. card.. Rhus 

tox. 
Straining 1 , lifting, overexertion: Arnica, 

Rhus tax. 
Injuries, contusions: Arnica, Ruta. 
Sedentary life: Nuxvotn. 

ATTENDING SYMPTOMS. 

As if beside himself: Chamom. 

Weeping: Bellad., Pulsat. 

Anguish and restlessness: Arsen. 

Eyelids burn: Coloc. 

Pulsation and buzzing in ears: Zinc. ox. 

Face pale, flushing easily: Ferrum. 

Hypogastrium, lumbar region and be- 
hind sternum burning like fire: Laches. 

Constipation: Laches., Nux vom. 

and flatulence: Lycop. 

Urine bigh colored, depositing red sand: 
Lycop. 

Left shoulder, pain in: Zinc. ox. 

Affected limb, paralytic, weak and wast- 
ing away: Arg. nitr. 



, paralytic stiffness: Rhus tox . 

, painful tension of muscles when 

moving: Zinc. ox. 

, lameness: Iris. 

, stiffness in hip and ham: Bell ad. 

, sensation of expansion: Arg. nitr. 

, swelling of veins: Sepia. 

, contraction of hamstrings: Natr. 

mur. 

, tenderness of soles of feet: Ledum. 

Limbs are jerked upwards when sitting: 

Menyanth. 



Chilliness: Pulsat. 

and thirst: Lgnat. 

and coldness general: Ledum. 

Cold feet : Aeon., Lycop. 

Cooler, affected limb, than the rest of 
body: Ledum. 

Feverish: Bellad. 

Heat without thirst: lgnat. 

, internal, in limb, and external cool- 
ness: Mezcr. 

Flushes of heat: Laches. 

Sweat and thirst: Coloc. 

without relief: Mercur. 

Restlessness and sleeplessness: Arsen., 
Bella d., Coffea, Mercur. 

Cold sweat of feet: Aeon. 



Crural Neuralgia, Ischias Antica. 

Its seat is the crural nerve; the pain is felt from the inner and lower 
portion of the thigh, down to the inner portion of the knee, the inner ankle, 
the inner portion of the foot, and the big and second toe. 

As Causes have been named : uterine swellings, especially of a cancerous 
nature; inflammation of the hip- joints, and crural hernia. 

Therapeutic Hints. 

Coffea, Phytol, Staphis. 
Compare Neuralgia and Sciatica. 

Anaesthesia. 

Anaesthesia takes place from two causes: 

i. Either from an inability of the sensory nerves to convey the external 
impressions to the central organs; or — 

2. From an inability of the central organs to perceive external impres- 
sions. 

The first is the case, for example, where a nerve has been cut through. 
Any irritation below that cut, towards the periphery, is not perceived any 



ANESTHESIA OF THE TRIGEMINUS. 799 

more by the central organs; that part may be pinched, burned, etc., but pain 
is not felt. The latter may have its source in a disease of the spine or of the 
brain. In both cases the want of feeling is chiefly associated with paralysis 
of the corresponding parts. 

The degree of such anaesthesia varies from a mere numbness to torpor 
and deadness of the part. Its influence upon the vegetative functions in the 
affected parts shows itself as: decrease in natural warmth; slowness of capil- 
lary circulation; want of perspiration; subcutaneous oedema; livid color of 
the skin; brittleness of the nails; ecchymosis, and blisters filled with bloody 
serum, especially on the toes and fingers. 

Of the different forms of this affection I shall mention only the follow- 
ing: 

Anaesthesia of the Trigeminus. 

According to the extent to which this nerve has lost its ability to convey 
external impressions to the sensorium, we find a want of feeling in the corre- 
sponding portions of the skin and mucous membranes. The patient does not 
feel any external irritation in these parts; when eating, knows not whether he 
holds anything in the affected side of the mouth or not; the saliva runs out 
of the mouth without his knowledge; and the glass held on his lips seems 
to him broken off where it touches the affected side. In addition, there is 
likewise found weakness of sight, loss of smell and taste. 

The reflex motion of the muscles of the face is gone, the eyelids do 
not shut when the conjunctiva is touched, and the patient does not sneeze 
when the mucous membrane of his nose is irritated. Also the voluntary 
muscular motions of the affected side are more torpid, and the pupil is con- 
tracted and immovable. 

The seat of the affection is, according to Romberg's observations, more 
towards the periphery of the fifth pair of nerves, when the anaesthesia is 
limited to some of its fibres. 

When, however, the anaesthesia affects not only the external surface of 
the face, but also the corresponding cavity of the eye, then the cause lies in 
one of the main branches of the trigeminus, either before or after its exit 
from the skull. When the anaesthesia extends over the whole ramification 
of the trigeminus, the cause of the affection then lies in the ganglion Gasseri, 
or immediately below it in the nerve. 

When, however, the affection is combined with disturbances of other 
cranial nerves, its seat lies in the base of the brain. A central anaesthesia 
affects crosswise, and involves at the same time other sensory and motory 
nerves of the head and body. 

Central Causes are: apoplexy, softening and tumors of the brain. 

Peripheric Causes: inflammation; softening; hardening and atroplry of 
the nerve and of the ganglion Gasseri. Likewise the severing of the nerve 
or of one of its branches by surgical operations, or other external injuries, blows, 
wounds, etc.; or pressure upon it in consequence of tumors or foreign bodies, 
like musket balls, or fracture of the petrous portion of the parietal bone. 



BOO SPASM. 

These causes show at once all that might be said about its prognosis 
and curability. 

Just as the sensory nerves may be morbidly affected in a two-fold man- 
ner, either by an increase or a loss of their sensibility, so also are the morbid 
affections of the motory nerves of two kinds, either spasm, cramp, hyper- 
kinesis : or paralysis, akinesis — that is, increased or lost motility. 

Spasm, Convulsion, Cramp, Hyperkinesis. 

Spasms manifest themselves under different forms: i. Either as short, 
slight jerks of certain muscles; or, 2 as, violent, frequently-repeated contrac- 
tions of the same or different sets of muscles (clonic spasms); or, 3, as hasty 
motions which, although regular, are deficient in purpose and rhythm or are 
automatically repeated; or, 4, as irregular, misdirected motions (in-coordi- 
nated spasms); or, 5, as trembling or tremor; or, 6, as a continuous rigidity 
of one or more sets of muscles (tonic spasms); and, 7, as a permanent con- 
traction of certain muscles (contractures). Their violence and extent are 
very different, and do not always correspond to the importance of their cause. 
Grave disorders in the central organs may be attended with but slight 
spasms; whilst, vice versa, 2. slight reflex irritation may cause the most vio- 
lent convulsions. 

Their Causes are various: I may mention as predisposing ones, the age 
of childhood — the younger the child, the greater the predisposition. Almost 
any acute disease may be attended by spasms at the age, and frequently is 
preceded by them. Even in chills and fever, little children have spasms in- 
stead of a chill. As special forms of spasms in this early age I may mention 
eclampsia and trismus. In later years, up to the time of puberty, we find a 
predominating disposition to the different forms of chorea, stammering and 
squinting, and likewise the beginning of epilepsy. From the time of puberty 
to middle age we find hysteria, epilepsy, eclampsia and tetanus. In still later 
years we find writing spasm and tremor. The female sex seems to be more 
disposed to spasms than the male. 

As Exciting Causes we may mention — 

1. Mental emotions: fear, fright, anger, terror. Even the sight of con- 
vulsions has caused them in others. Epileptic fits have become epidemic in 
this way among the pupils of a whole asylum. 

2. Diseases in the central organs and their membranes, like apoplexy, 
softening, encephalitis, tumors, tubercles, inflammation of the cerebral and 
spinal membranes, and morbid processes in the bones which encase the cen- 
tral organs. 

3. Peripheric irritations of the nervous system, by strong light, tickling; 
also by wounds, blows and bruises of some organs, like the testicles or the 
uterus, or by irritation of large surfaces, like the mucous membranes — for 
example, the intestinal canal by indigestible food or worms, or the external 
skin by sudden taking cold, etc. 

4. Various conditions of the blood, such as (according to Marshall Hall ) 



SPASMUS FACIALIS. 8oi 

great loss of blood or stagnation of blood within the brain; so, also, qualita- 
tive changes of the blood in exanthematic fevers, in pyaemia, uraemia and 
eholaemia. 

5. Certain poisons: alcohol, narcotics, strychnine, secale, lead and 
mercury. 

The Prognosis of spasms depends entirely upon their causes. When 
they appear in consequence of organic lesions in the central organs, they are 
of a much graver nature than when in consequence of a mere peripheric 
irritation. * 

Spasms which appear during the beginning or during the course of other 
diseases, like exanthematic fevers, are a sign that the disease, with which 
they are combined, is of a violent character, but are not quite so bad a sign; 
when they occur in children as in grown persons. Spasms from blood poi- 
soning in uraemia and eholaemia are always a bad prognostic sign. 

I shall now speak of the different forms of Spasmodic Diseases. 

Spasmus Facialis, Mimic Spasm of the Face. 

It affects those muscles of the face which are supplied by the seventh 
pair of nerves, either on one or both sides. 

In its clonic form it causes the most awkward appearance of the face; 
whilst one side looks perfectly quiet and natural, the affected side is continu- 
ally in motion, cutting all sorts of capers and jerks. The will has not the 
slightest influence over these distortions. They come on unprovoked, and 
may last a shorter or longer time. In some cases they are brought on by a 
usual effort to talk, chew, etc., disturbing these natural muscular actions 
greatly. 

The tonic spasm is different. The face appears as though, during a dis- 
tortion, it had suddenly become rigid, stiffened, so that it does not partake 
of the motions of the sound side, which manifests itself especially in laughing 
or whistling. This rigidity might give occasion to confound it with paraly- 
sis of the face. However, chin, lips and nose are drawn towards the affected 
side; the corner of the mouth of the affected side is drawn downwards, whilst 
the eyebrow is drawn upwards. The eyelids of the affected side cannot be 
perfectly closed, and the mouth not perfectly opened, thus interfering with 
talking and chewing. The muscles of the affected side are hard to the touch, 
and the patient has a feeling as if they were stretched. 

As the most frequent Cause of this complaint, may be mentioned: sud- 
denly taking cold by exposure to a sharp, piercing wind, rain or snow driven 
into the face. Likewise external injuries, especially bruises of the bones of 
the face and skull, decayed teeth, etc. Violent mental emotions, like anger 
or terror, and hysteric conditions have also been observed as causes of this 
complaint. 

Therapeutic Hints. 

When caused by exposure to cold : compare Bellad. , Hyos. , Mercur. 

When caused by external injuries : Arnica, Hyper. 
5i 



802 MOGIGRAPHIA. 

When caused by diseasese of the bones, decayed teeth: Hepar, Mercur., 
Silic 

When caused by anger: Nux vom. 

When caused by fright and terror: Hyosc, /gnat., Opium. 

Constant winking of the eyelids: Anac, Bel/ad., Stramon. 

Risus sardonicus: compare Aeon., Alum., Anac, Asa/., Bellad., Bovista, 
Calc Carb., Cicuta, Conium, Crocus, Cuprum, Hyosc, Natr. mur., Nux 
mosc/i., Phosphor., Platina, Ra?i. seel., Sepia, Stramon., Veratr , Zincum. 

Mogigraphia, Graphospasmus, Writers' Cramp, Pianists' Cramp, 

etc. 

It commences first as a mere tired feeling of the hand, after long-con- 
tinued writing. By and by this feeling increases, and the writer has to 
make pauses frequently in order to rest the hand; lastly, it is quite impos- 
sible to hold the pen, and to write, because, ist, either a spasm of the ex- 
tensors draws the fingers asunder, or, 2d, a spasm of the flexors of the first 
three fingers, or of only one of them, makes it impossible to hold the pen. 
Such spasms may be clonic or tonic. Sometimes the thumb and fingers are 
only slightly drawn together, and writing might be possible, if it were not 
for the strong trembling which attacks the hand and the whole arm up to the 
shoulder, as soon as writing is attempted. 

If writing be attempted with the other hand, it is not long before the 
same spasms attack it also. 

It is quite remarkable that all other manual acts can be easily executed, 
although in some cases cramps and tremors attend them likewise. 

Similar spasmodic affections have been observed also in the habitual per- 
formances of shoemaking, milking, playing musical instruments, setting type, 
sewing, etc. Its causes seem to be overexertion in writing, or disturbance in 
the co-ordinating apparatus. It is increased by anxiety and constant think- 
ing of it. 

The most important remedies are Bellad., Caustic, Gelsem., Ignat., Nux 
vom., Ruta, Secale, Silic, Stannum, Siaphis., Zincum. Light and large pen- 
holders ought to be used. 

Chorea, St. Vitus' Dance 

Is defined now as a neurosis, the seat of which is supposed to be at times in 
the brain alone, at times in the entire nervous system; it is characterized by 
incessant inco-ordinate twitchings and jerkings of groups of muscles, either 
spontaneous in origin or excited by voluntary impulse, exclusively occurring 
in the waking state and accompanied by more or less developed psychical 
disturbance. (Von Ziemssen.) Dr. J. Lawrence Newton recognizes five 
forms: the true cerebral, the spinal, the uterine, the intestinal and rheumatic 
form. Chorea is prominently an affection of the period of bodily develop- 
ment, but is seen also: during pregnancy; in consequence of disturbances of 



THERAPEUTIC HINTS TO CHOREA. 803 

menstruation and blood formation (chlorosis, anaemia), and is frequently con- 
nected with articular rheumatism. As Exciting Causes have frequently 
been observed: mental emotions, such as fright, or fear, etc. 

Symptoms. — 1 . Involuntary movements sometimes extend to all the mus- 
cles which obey the will; sometimes the) 7 are confined to certain groups of 
them, oftenest to the upper half of the bod} 7 ; sometimes only one side is 
agitated, and in exceptional cases we find a crosswise agitation — an arm of 
the one, and the leg of the other side. Again, involuntary movements some- 
times commence in a few muscles of the whole body. We then find the 
whole body in constant agitation, jerking, swinging, a ludicrous and some- 
times pitiful sight. There is no interruption of these irregular motions, ex- 
cept during sleep, which is generally restless and unrefreshing; and even 
then they recur, although in a less degree, when the patient dreams. On 
waking the same tumultuous scene commences again. 

2. The regular voluntary movements of the body are thus greatly inter- 
fered with, and at last cannot be executed at all. Dressing, writing and 
playing instruments become impossible, talking difficult, and exertions to 
overcome the difficulty have always had the contrary effect — increase of 
spasmodic action. 

3. The reflex motions, however, are not disturbed. If the patient itches 
somewhere, he can scratch himself without any trouble; so can he sneeze, 
cough and evacuate bladder and bowels, etc. 

4. All other involuntary movements of the body are perfectly free in their 
action; there is no interference in breathing, in the pulsations of the heart, 
nor in the act of swallowing, and the peristaltic motions of the intestines are 
normal. 

5. The sensibility is in most cases normal. ■ 

6. The mental functions, however, suffer considerably from a long dura- 
tion of the disease. The patient at length shows a loss of memory, weak- 
ness of mental capacity, and in some severe cases even imbecility of mind; 
the disposition becomes fretful, irritable and peevish. 

Chorea is of a chronic nature and its duration extremely variable. It 
is apt to recur and relapses are especially frequent after mental excitement. 
Under judicial homoeopathic treatment it is in most cases easily cured. 

Therapeutic Hints. 

Agar. The spasmodic motions range from simple, involuntary motions 
and jerks of different muscles to a dancing-like turning of the whole body; 
or attack crosswise, an upper right and a lower left extremity, or vice versa; 
frequent nictitation of the eyelids; redness of the inner canthus of the eyes; 
flow of tears from the eyes; sensitiveness of the lumbar vertebrae; ravenous 
appetite, but difficult swallowing; cervical glands swollen; worse during the 
approach of a thunder-storm. 

A st. rub. Trembling jactitation of arms and legs; unable to feed her- 



804 THERAPEUTIC HINTS TO CHOREA. 

self or to walk; frequent, clear, profuse urine; after fright and mental de- 
pression. 

Bel lad. Throwing the body forward and backward in lying, a kind of 
constant changing from emprosthotonus to opisthotonus; boring the head 
into the cushion; grating of the teeth; sore throat; numbness in the fingers; 
soreness of the last lumbar and the first dorsal vetebrse; after mental excite- 
ment; fright. 

Calc. carb. Sometimes only one-sided involuntary motions; sometimes 
amounting to falling down; exceedingly headstrong; period of second teeth- 
ing; worm symptoms; scrofulous habit; onanism. 

Cauloph. In young girls with menstrual irregularities. 

Caustic. Distortion, twisting and jerking of the limbs, even in the 
night, preventing sleep, paralysis of the tongue and the right side of the 
body; after suppressed eruption on head. 

Wm. Gross mentions a peculiar case of a young girl, who had the fol- 
lowing paroxysms: the child would lie down on her stomach, and inserting 
one of her knees into the hollow of the other knee, and drawing her feet 
upwards upon the buttocks, her body would commence jerking forward 
and backward, simulating the movements exercised during coitus; at the 
same time the muscles of her face became contorted, like risus sardonicus. 
After the attack the child was exhausted, but during the intervals she 
showed no particular symptoms; the spells were worst in the morning. 

Cimicif. Chiefly on the left side only; worse during the menstrual 
period; after suppression of the menses; from rheumatic irritation; frequent 
alternation of heat and cold in different parts of the body. 

Cina. The distortions often commence with a shriek, extend to the 
tongue, oesophagus and larynx, and continue even through the night; they 
are attended with frontal headache; enlarged pupils; dark rings around the 
eyes; itching of the nose; pale, yellowish, earthy face; ravenous appetite; 
pain around the umbilicus; hard stools; turbid urine; emaciation; all point- 
ing to irritation of the intestines hy worms. 

Coccul. Involuntary motions with the right arm and right leg ; they 
cease during sleep; face puffed, somewmat bluish; hands look as if frozen; 
paralytic symptoms. 

Crocus. Jerking in the muscles; spasmodic contractions of single sets 
of muscles; jumping, dancing, laughing, whistling; wants to kiss everybody; 
congestion of the head with bleeding of the nose; suppressed menses. 

Cuprum. Commences in one arm and spreads over the whole body, 
causing the most terrible contortions and awkward movements; inability to 
speak, or only imperfectly; after fright. 

Hyosc. Throwing about of the arms; misses what he reaches for; con- 
stant falling of the head from side to side; tottering gait; very talkative, or 
loss of speech; laugh at everything that is told to him; smiling, silly ex- 
pression of countenance; after typhus. 



THERAPEUTIC HINTS TO CHOREA. 805 

Ignat. Especially when caused by fright or other mental excitement; 
worse after eating; better when lying on the back. 

La 11 roc. She tears her clothing; strikes at everything; spasmodic 
deglutition; indistinct articulation; she gets angry because she cannot be 
understood; idiotic expression of the face; cold clammy feet up to the knees; 
she can neither stand nor sit, nor lie down, on account of the incessant 
motion; wasting away; after fright. 

Lil. tigr. Convulsive contractions of almost all the muscles of the 
body, and a feeling as if she would go crazy if she did not hold tightly upon 
herself. 

My gale. Constant jerking of head to the right side, occasionally drops 
his head suddenly on his shoulder, sometimes he twists his head around to 
the right shoulder; twitching of the muscles of back and arms; pain in 
knees when walking; in attempting to control these involuntary motions, he' 
loses his breath, until he takes a deep inspiration Twitching of muscles of 
face and upper extremities; convulsive movements of the shoulders; lower 
extremities in constant motion; drags her legs when walking; mouth and 
eyes open and shut in rapid succession. (Howard.) 

Nat?\ mur. Chronic cases after fright or suppression of eruptions on 
the face; worse during full moon; paroxysms of jumping up high without 
taking notice of the things around him, thus hurting himself sometimes con- 
siderably; or mere jerkings of the right side and the head. 

Nux vom. When attended with a feeling of numbness in the affected 
parts; also after much drugging. 

Opium. Twitching and trembling of head and arms; throws limbs or 
stretches arms at right angles to body after fright. 

.Phosphor. He walks like one paralytic, without noticing it himself; 
twitching of the limbs; great exhaustion; after Calc. carb.\ during second 
dentition; in general, during the period in which the body is growing. 

Secale. The morbid contractions usually commence in some muscles of 
the face and spread thence over the whole body, and increase even to danc- 
ing and jumping motions. 

Sepia. Convulsive motions of the head and limbs; when talking (which 
is only a stammering), jerking of the muscles of the face; general muscular 
agitation; desire to constantly change position and place; ringworm-like 
eruptions on the skin every spring. 

Sticta. She cannot keep her feet to the ground; they jump and dance 
around in spite of her, unless held fast; when lying down, her limbs feel as 
though they were floating in the air as light as feathers. 

Stramon. The convulsive motions are often crosswise, or violent all 
over; preceded by formication in the limbs and a melancholy mood; worse 
during the equinoxes; inclination to pray; loss of memory; stammering; 
loss of speech; putting hands to the genitals. 

Sulphur. In chronic cases; after suppressed eruptions; weak, faint, 
hungry spells about 10 a. m. 



806 HYSTERIA. 

Taj-ant. Trembling of the body; all the limbs are agitated; is in con- 
stant motion; can run better than walk; feels best in bed. Spasms subside 
on hearing the notes of a hornpipe; music lessens the symptoms. 

Ver. vir. Most violent distortions of the body, universal, unaffected by 
sleep; lips embossed with foam; waked up by a continual champing of the 
teeth; inability to swallow; intense sexual excitement. 

Viscum alb. Common mistletoe, is a popular remedy in England. 

Zinaim. Especially in those cases in which the general health suffers 
much from the disease, with great depression of spirits; worse after drinking 
wine. 

Hysteria. 

This hydra-headed complaint must be classed among the neuroses, in 
which at times part or the whole nervous system participates, without the 
presence of any apparent anatomical basis. Its most constant feature consists 
of an abnormal irritability, with neuralgic pains, and hallucinations in the 
sensor} 7 , and convulsions in the motor sphere; or the reverse, anaesthesia and 
paralysis. Although unmistakably a connection exists in many cases between 
the female genital organs and this complaint, it is nevertheless an erroneous 
assumption that hyseria is a disease exclusively peculiar to the female sex. 
However, the female sex does contribute the largest number of patients, 
especially during the ages between ten and thirtj* years; after the climacteric 
period its occurrence is rare. 

As important Etiological data must be mentioned: a peculiar psychi- 
cal constitution, liable to changing emotions and little strength of will; dis- 
orders of the female genital organs, menstrual disturbances, non-gratification 
of the sexual appetite, or over-irritation; persistent depressing mental emo- 
tions, such as the sense of failure in one of the objects of life (childless women 
and old maids), love-sickness and jealousy, injured vanity and wounded 
pride, self-reproach because of secret sins, grief and anxiety, etc. ; educational 
influences, such as too great indulgence, or too great demands upon the 
mental capacity, by overburdening with lessons and overstimulating the 
ambition. 

The Symptoms of hysteria are exceeding^ various and variable. We 
find in the sense of sight, photophobia, or dislike to particular colors, such as 
the red, or subjective light-phenomena, such as simple flashes, sparks, or 
more complicated figures, phantasms, and even visionary hallucinations; in 
the sense of hearing, oversensitiveness, or ringing, blowing, roaring, or hear- 
ing of voices; in the senses of smell and taste, various kinds of idiosyncrasies, 
such as aversions to different sorts of scent or taste which are not unpleasant 
to others, or a desire to smell asafcetida, or to devour chalk, coal and other 
such things; in other sentient nerves, all kinds of pain and abnormal sensa- 
tions, such as headache, tickling cough and pain in the larynx, soreness of the 
mouth and tongue, neuralgia of the mammary glands, heavy dull pain and 
oppression in the chest and about the heart, cardialgias and gone feeling in 



HYSTERIA. 807 

pit of stomach, tightness in the epigastrium, pains in the hypochondria, in 
the bowels, in the ovaries, in the womb, in the external genitals, in the 
bladder and urethra, in the coccygeal region, in the back — spinal irritation, 
and in the extremities. 

Or we find anaesthesia of the sense of touch, or in some of the limbs, or 
in a portion of them, or on one-half of the body, especially the left, and but 
rarely, over the whole surface of the body. With the loss of cutaneous sensi- 
bility a similar loss of sensibility of the above detailed symptoms in the mus- 
cles, as well as in the hands and joints, may be united, and it may extend 
over the mucous membranes of eyes, nose, mouth, respiratory organs, genital 
organs and urinary passages. In the higher senses, amblyopia, amaurosis 
and deafness have been observed. 

We find also spasms of various descriptions, such as globus hystericus in 
the throat, or the rising of a ball from the region of the symphysis toward 
the stomach; spasmodic breathing, singultus, yawning, convulsive laughing 
or crying, or screaming; spasmodic retention of urine, spasm of the con- 
strictor ani; local spasms in all possible sections of the muscular system of 
the head, trunk and extremities, even general convulsions, or similar to 
chorea and epilepsy. Or we find paralytic conditions of the pharynx and 
oesophagus (hindering deglutition), of the bowels (preventing a spontaneous 
expulsion of gases and feces), of the vocal cords (producing aphonia), of the 
bladder (causing retention of urine), of the extremities, either in the hemi- 
plegic or paraplegic form, or crosswise, or of only one extremity, or of all 
four. In the palsied extremities a permanent contractioa not unfrequently 
develops itself. Both paralysis and contraction may last for years and ma}^ 
be cured by all kinds of moral influences, or resist them all. 

We also find changes in the circulation, powerful palpitation of the heart, 
or weakness of its action, pale and cold extremities, red face and hot head, 
with perspiration; also unilateral sweating — all alternating with normal con- 
ditions. 

In some cases haemorrhages have been observed from the nose, throat, 
stomach and lungs, and in rare cases from different portions of the skin 
(stigmatization), all mostly of a vicarious nature; salivation or its opposite, 
abnormal dryness of the mouth, occurs sometimes after hysteric fits; the hys- 
terical vomiting of large quantities of fluid seems to be in connection with a 
suppression or lessening of the renal secretion, and therefore likewise of a 
vicarious nature. The urine is often copious, clear, of low specific gravity 
(urina spastica) and frequently voided, especially after spasmodic attacks; at 
other times its secretion is diminished and coupled with spasmodic closure of 
the neck of the bladder, so that the small quantity which exists must be re- 
moved by the catheter. Iyeucorrhcea has often been found to increase after 
hysterical attacks. 

The hysterical attacks themselves vary greatly in their forms, according 
as more or less a similar loss of sensibility of the above detailed symptoms 
combine in greater or less intensity. One form has been styled the hystero- 



808 THERAPEUTIC HINTS TO HYSTERIA. 

epileptic, on account of the similarity of its convulsions to epilepsy, another 
the cataleptic, another the hysterical trance, to which some have added som- 
nambulism, sleep-walking, magnetic sleep, hypnotism and ecstasy — an ex- 
hibition of elasticity of the term ' ' hysteria ' ' that leaves nothing to wish for 
and is truly marvelous. 

Therapeutic Hints. 

Being a functional disorder, hysteria is certainly amenable to treatment. 
Quite important here is the personal, psychic and moral influence of the 
physician upon his patient. The remedial agents are necessarily very 
numerous in a disease of so varied and variable a character. I shall, how-' 
ever, confine my remarks to but a few characteristic hints of the several 
remedies, and refer for fuller descriptions to the chapters on spinal irritation, 
neuralgia, spasms, paralysis and uterine disorders. 

Aeon. Fear to go into crowds; fear of death and predicting the hour 
of her death. 

Agar. Crosswise complaints. 

Anac. Forgetful, and irrestible desire to curse and swear. 

Arsen. Spasmodic dyspnoea, with fear of death. 

Asa/. Dryness of oesophagus; globus hystericus. 

Auru?n. Melancholy; longing for death; palpitation; alternate laugh- 
ing and crying. 

Bellad. Congestions to head; spasms; hallucinations. 

Calc. carb. Fears she will lose her reason; coldness in and on head; 
cold, damp feet; palpitation after eating; chorea-like and epileptiform 
spasms. 

Cazistic. Paresis of upper eylids. 

Chamom. Exceedingly irritable, peevish and impatient. 

Coccul. Tickling cough; choking in throat; oppression of chest; 
paralysis of tongue or pharynx. 

Coniu?n. Old maids; non-gratification of the sexual appetite; globus 
hystericus. 

Cuprum. Spasmodic affections. 

Gelsem. Paralytic symptoms in throat, in limbs; spasms from reflex 
irritation; cataleptic immobility, w T ith dilated pupils, closed e} 7 es, but con- 
sciousness. 

Hyosc. Illusions; silly expressions and silly actions; jealousy; disap- 
pointed love. 

Ignat. Choking in throat and constriction of chest, with sighing- 
breathing; tickling cough which may be suppressed by an effort of will; 
feeling of goneness and gnawing in pit of stomach; grief. 

Iodium. Rapid failing of strength and emaciation in spite of eating 
freely. 

Laches. Sensation of a lump in throat which descends on swallowing, 



THERAPEUTIC HINTS TO HYSTERIA. 809 

but returns at once; suffocating sensation, with constant efforts to remove all 
external pressure from throat and chest; feels worse on walking; jealousy. 

Lil. tig?'. Hurried manner without accomplishing anything; weak, 
nervous; uterine; palpitation. 

Lycop. Full and satiated; rumbling in upper left side of abdomen; 
sandy or pale urine. 

Magn. mur. Fainting fits at dinner, nausea and trembling, relieved 
by eructations; spasmodic complaints. 

Merc. sol. Profuse saliva; perspiration without relief. 

Moschus. Anguish and fear of death; swooning; tetanic spasms. 

Natr, mur. Desire for salt; somnambulic states; pain in urethra after 
micturition. 

Nitr. ac. Longing for fat, herring, chalk, lime, earth; twitchings in 
various parts; trembling; great weakness. 

Nux mosch. Inclined to laughter; drowsy; great dryness of mouth ; 
leucorrhcea in place of menses. 

Nux vom. Pressure and pain in pit of stomach; belching; longing for 
chalk; tendency to faint; chronic spasms, with numbness. 

Pallad. Feels best in company and wants to be nattered; easily wounded 
pride. 

Phosphor. Alternation of laughing and weeping; sense of weakness in 
abdomen; dry, hard stools; increased sexual desire. 

Plati?ia. Pride, haughtiness; illusions; spasms alternating with cata- 
lepsy, or with dyspnoea; sexual erethism; physical symptoms alternate with 
mental symptoms. 

Pulsat. Mild, tearful, yielding, timid; peevish; changeable; loss of 
smell and taste; no appetite and no thirst; increased mucous secretion from 
orifices. 

Sabtna. Irritable in temper; abortion in third month. 

Sepia. Sensation of something twisting about stomach and rising to 
throat, with stiffness of tongue, speechlessness, and rigidity all over; spasms; 
fainting with profuse sweat; undisturbed consciousness and inability to move. 

Stannum. Feels fainty from going down stairs; cannot sit down slowly, 
drops down; rises without difficulty. 

Staphis. Great indignation on least occasion. 

Stramon. Hallucinations; desire for light; great sensitiveness; weep- 
ing and laughing alternately; sexual excitement. 

Sulphur. Flushes of heat; heat on top of head; cold feet; sensation 
of hunger in forenoon. 

Tarant. Choreic restlessness of limbs; music has a soothing influ- 
ence. 

Valer. Ecstasy; overexcitable, changeable disposition and ideas; jerk- 
ing, twitching, trembling. 

Verat? . alb. Cold sweat on forehead and elbows. 

Zincum. Fidgetiness of feet and lower extremities. 



8lO NEURASTHENIA. 

Neurasthenia. 

Here we find an old acquaintance presenting itself in a new garb. Who 
is the physician that has not met nervousness in constantly varying forms, 
even up to nervous prostration, repeatedly in daily practice? 

Neurasthenia is a weakened condition of the nervous system (Nerven- 
schwaeche) with a resulting diminution of nerve-force. If we attempt to 
trace this weakness to a material cause, we will find ourselves disappointed, 
for this is a disease without a corresponding demonstrable tissue change. 
Neurasthenia is therefore not fatal unless some other destructive disease in- 
tervenes. 

The symptoms vary amazingly. From mere local disturbances in single 
parts, the entire nervous system may be involved, thus weakening the intel- 
lectual vigor and w 7 ill power by degrees, or result in depression of the emo- 
tional spheres. We find therefore loss of memory, inability to perform con- 
tinued mental work, and even great depression of spirits — melancholic and 
hypochondriacal states of the mind. 

Among the somatic symptoms sleeplessness is a most prominent one. 
Notwithstanding the greatest fatigue, weariness and exhaustion a continual 
mental irritation and erethism of the cortical portion of the brain does not 
allow the tired frame to settle into repose, but keeps it continually on the 
go in certain circles of consciousness, mostly of a troublesome nature, and 
thus increases the general exhaustion, and the broken-down feeling in mind 
and body. 

Neurasthenia shows itself in different forms. The cerebral form is 
characterized by physical and sensorial functional disturbances most fre- 
quently brought on by mental over-exertion and emotional excitement. 
The spinal form is characterized by neuralgic pains in the skin, muscles, 
joints and great exhaustion from least exertion, attended by palpitation of 
the heart, perspiration, oppression and anxiety, with jerking of limbs, 
hindering sleep; numbness and paretic inability to use the muscles. Its 
cause is most frequently severe illness, puerperal fevers, sexual excesses and 
emotional excitement. 

The cardiac form, neurasthenia cordis, is characterized by attacks of 
intermittent disturbances of the action of the heart, for instance, as if the 
heart were going to stand still with pain or pressure; vibration in the region 
of the heart; it is usually brought on in persons inclined to asthma by emo- 
tional excitement, from warm baths and excessive use of tobacco. 

The gastric form is characterized by stupefaction, pressure, feeling of 
intoxication, rush of blood to the head, flickering before the eyes, noise in 
the ears, nervous excitation, palpitation of the heart, alternating feelings of 
chilliness and heat, drowsiness, fullness in the stomach, pulsatio epigastrica, 
eructations, formation of gas, nausea, heart-burn. It is the result of defec- 
tive innervation and is often spoken of as nervous dyspepsia 

The sexual form in man is characterized by a timid and depressed dispo- 



THERAPEUTIC HINTS TO NEURASTHENIA. 8ll 

sition, little self-esteem, hypochondriacal mood, and relaxed posture. He 
is easily embarrassed, which is manifested by tremor, clumsiness and even 
ataxia, when being observed. 

The cause is usually sexual excesses, masturbation, or enforced absti- 
nence, with continuous sexual excitement, leading to pollutions and to^ early 
ejaculations during coitus. This has a depressing influence which leads to 
hypochondriasis and melancholia, and eventually a disturbance of the centre 
of erection, bringing about a psychic impotence. The patient believes him- 
self a victim of tabes dorsalis, being strengthened in this belief by the 
existence of neuralgic pains in the region of the plexus lumbo-sacralis. 
(Kraft-Ebing.) 

The sexual form in women is characterized in the beginning by symp- 
toms in the lumbar region, and especially effecting the regions which" stand 
in consensual connection with the sexual organs -(stomach, oesophagus, 
breasts, larynx, thyroid glands and trigeminus. 

The cause is similar to that in men: abusus veneris (especially mastur- 
bation, coitus reservatus et interruptus. The analogues to the pollutions 
in men are lascivious dreams with spastic contractions of the tubes and of 
the uterus and discharge of the secretion of the genital organs with volup- 
tuous excitement. The morbid development dates frequently from the time 
when puberty develops or climaxis begins' 

It is a remarkable fact that Neurasthenia has been spoken of so largely on 
this side of the water, and that it is almost considered a specific American 
disease. This does not denote that neurasthenia is confined alone to this 
country, but it seems to exist here to quite a conspicuous degree. As a reason 
for this has been given the preponderance of the nervous constitution and 
the undeniable hasty pursuit after gain and wealth, beside the ambitious 
striving to reach certain social or political positions, so characteristic of the 
American people. But even this does not seem to hit upon the precise 
cause, for mad chases after riches and influence exist everywhere. When 
we, however, find that people who cannot bear to indulge here in any kind 
of stimulation, whilst in England or on the Continent they loose this irrita- 
bility, it seems that the cause might be looked for in the different climates 
of these countries, and this difference is the apparently greater dryness of 
the atmosphere here, compared with Europe. 

Dr. Kraft-Ebing recommends for treatment a tonic diet, with as much 
protein and fat containing substances as possible, whilst stimulants should 
be avoided. Among the physical remedies are recommended a sojourn in 
the mountains; hydropathy; electricity as general Faraditzaion or electri- 
cal baths. Of medicinal substances are recommended: Iron, Arsenic, 
Strychnine^ Phosphor., Secale, Opium, Zinc, Cocaine, Damiana, Quinine, dif- 
ferent sedatives, and hypnotics. 

Therapeutic Hints. 
If the theory of climate be found correct it will certainly not be good 



8l2 CATALEPSY. 

advice to send such patients into high altitudes, but rather, if they can afford 
it, to the moist climate of England. 

Special remedies for nervous weakness ( Nervenschwseche ) we already find 
mentioned by Jahr in his "Handbook," with the following indications. If 
caused by: 

Abuse of coffee: Cham., Ign., Merc, Nux vom., Sulph. 

Exertion of body: Am., Calc. c, China, Corr., Rhnstox. 

Exertion of mind, by reading, writing, etc.: Bell., Cale. c, Lack., Natr. 
mur., A T ux vom., Puis., Sulph. (Pic. ac., Sil.). 

Mercurial remedies: Hepar, Lack., Nitr. ac., Sulph. 

Narcotic substances: Carbo veg., Cham., Cqff., Lach., Merc, Nux vo?n., 
Puis., Sulph. 

Night waking: Bry., Carbo veg., China, Cocc, Natr. mur., Nux vom., 
Puis., Sclen., Sulph. 

Sedentary life: Lach., Nux vom., Sulph. 

Spirituous liquors: Aeon., Bell., Coffea, Lach., Nux vom., Puis., Sulph. 

Other useful remedies besides those given above, which will be found 
indicated, are: Ars. , Lye, Phos., Phos. ac, Picric ac, Sil., Staph., Sepia, 
Zinc 

Catalepsy- 
Is a sudden loss of all voluntary motory power, so quickly befalling all 
muscles that the different parts of the body remain precisely in the same po- 
sition in which the attack finds them, thus making the patient appear like a 
statue. At first the muscles are rather rigid; but the}' gradually grow more 
pliant, assume a waxy flexibility,. so that the limbs may be brought into any 
position, in which they continue to remain. The sensibility and conscious- 
ness of the patient is usually gone; he perceives nothing and recollects noth- 
ing; whilst in other cases some sensibility seems to remain; and in still others, 
sensibility and consciousness are entirely undisturbed. The patient sees, 
hears and knows everything that is going on around him, but is perfectly 
unable voluntarily to move a single muscle of his body; the link which 
makes the body an instrument of the soul seems broken. Such fits end, in 
simple forms of the disease, often quite as suddenly as they come on. The 
patient 'draws a long breath, sighs, yawns, and acts as though he were waking 
out of a deep sleep, and goes on with his interrupted work without even sus- 
pecting that anything had happened to him. Such attacks sometimes follow 
others at short intervals, and they ma)' last only a few minutes at a time. 
Graver attacks lasts hours and days. Skoda mentions one that lasted several 
months. 

Cataleptic spells are frequently combined with hysteria, melancholy, 
ecstasy, St. Vitus' dance, somnambulism and other nervous derangements. 
The disease is of rare occurrence and its real exciting causes seem to be 
mental agitation, anger, fright, sudden joy or fear, grief, disappointment, 
vexation, ecstasy or religious excitement, etc. 

Catalepsy is, by itself, not fatal. 



epilepsy. 813 

Therapeutic Hints. 

If caused b}^ anger and vexation: Chamom., Bryon. 

If caused by fright: Aeon., Bellad., Ge/sem., Ignat., Opium. 

If caused by sudden joy: Coffea. 

If caused by grief: Ignat., Phosph. ac. 

If caused b}' jealousy : Hyosc., Laches. 

If caused by sexual erethism : Platina, Stramon. 

If caused by disappointed love : Ig?iat. , Laches. 

If caused by religious excitement: Stramon., Sulphur and Veratr. 

Epilepsy 

Is characterized by spells of sudden loss of consciousness and motor disturb- 
ances, under the form of more or less extensive convulsions. These spells 
recur at irregular periods in r :he beginning; the intervals are usually free 
from morbid symptoms; later, however, they are marked by various mental 
and bodily disturbances. The real seat of the disease has been sought in the 
pons and medulla oblongata, although a participation of other parts is not 
denied. Constant anatomical changes are thus far unknown, yet according 
to the latest investigations, certain histological changes in the bulb of the 
medulla seem to take the lead of all the others. 

One of its most prominent Causes is a hereditary disposition, develop- 
ing the disease usually before puberty, or not later than the twentieth year. 
Other occasional causes are: lesions of peripheral nerves, of the brain or the 
spinal cord ( "reflex- epilepsy "); psychial impressions and emotions, sexual 
irregularities, digestive disturbances, overexertion and great fatigue. In 
short the list of causes is a very large and varied one, and in many instances 
the cause may be as obscure as the nature of the disease itself. 

The epileptic seizures are in about one-half of the cases preceded for a 
day or two by one or the other, or several of the following Premonitory 
Symptoms: sadness and dejection of spirits, or excitement, loquacity, irri- 
tableness, quarrelsomeness or distrust; dizziness, headache and confusion of 
the head; dark coloration of the skin of the face and neck (rare); unusual 
deep sleep and general well-feeling, or restless sleep and leaden weight in 
limbs or slight trembling; voracious appetite, bad smell from the mouth. 

The immediate prodroma or so-called aura epileptica, which must not 
literally be taken only as a sensation of breath blowing upon the patient 
(scarcely ever recognized) . but in the wider sense as symptoms which pre- 
cede immediately the outbreak of the fit, and which last but a short time — 
these immediate prodroma are of great variet3 T . We have sensitive aura, 
consisting of tickling sensation., or dragging, tearing pain from the periphery 
(tips of toes or fingers) towards the head; one-sided headache; pains in epi- 
gastrium; or loss of feeling in one extremity, or one-half of the* face, taking 
a centrifugal direction. 

A vasomotor aura consisting of: paleness, coldness and numbness of one 



8 14 EPILEPSY. 

extremity , commencing on the fingers and toes; or redness in spots in various 
parts of the body; a motor aura consisting of: spasms, trembling or shaking 
motion of different groups of muscles, rumbling in the bowels, straining at 
stool and on passing water, drawing up of the testicle, palpitation, etc. The 
aura of the special senses consists of: impressions of light and color, or seeing 
of corporeal figures; hearing of sounds and voices; sensations of disagreeable 
smell; sensations of a sweet taste. In isolated cases a profuse secretion of 
tears or perspiration, or an abundant flow of saliva has been observed. 

Of these various premonitory symptoms in the individual case, one or 
several, or none at all may be present; or the one or the other, or several of 
them may occur repeatedly, without being followed by an actual attack. 

The seizure itself is characterized by a loss of consciousness and general 
convulsions. The loss of consciousness is either sudden and complete, the 
patient being stricken down as if by lightning, without regard to attitude or 
surroundings; or a little more gradual, tarrying a second or tw T o, so that the 
patient can assume some recumbent position voluntarily, to save himself from 
injury by falling. 

The convulsions are, in rare cases, preceded by a short and sudden relax- 
ation of all the muscles; generally they commence with a tonic spasm, the 
extent of which is variable, attacking either the entire muscular frame, or 
one-half of the body (opisthotonus emprosthotonus) , or only some groups of 
muscles, those of face, throat and larynx — the unearthly shriek in some cases 
is caused by a laryngeal spasm — or the tonic spasm is wholly wanting, and 
the scene begins at once with clonic tw T itchings. During the stage of tonic 
spasm the color of the face is not in all cases alike; in some the attack begins 
with pallor, or in others with a dark redness of the face, or the color changes 
from pallor to redness. All this often lasts only a few seconds, sometimes 
from one-quarter of a minute to one minute. 

The clonic spasm now following, attacks almost all the voluntary muscles 
of the extremities, trunk and head, and its violence is often so great as to 
cause fractures, dislocations, breaking of teeth, deep lacerations of the tongue 
and rupture of muscles. This tumultuous state is at times interrupted by 
tonic spasms, so that the patient again becomes rigid. The face assumes a 
c3 7 anotic color, the eyeballs protrude, and respiration is forcibly quickened, 
and at times arrested. After the lapse of from half a minute to three min- 
utes, and only in very exceptional cases still longer, the convulsions either 
stop suddenly, or wear off by degrees until the patient lies quiet, with relaxed 
muscles, in a deep coma for some minutes longer, when the turgor diminishes 
and consciousness finally and gradually returns; or the paroxysm is immedi- 
ately followed by a deep sleep, varying from half an hour to several hours 
and longer. After consciousness is fully restored the patient feels tired, un- 
nerved, and as if bruised all over, or, in lighter cases, he may find himself 
wholly in his previous condition, and without recollection of what has hap- 
pened to him. 

The light form, Epilepsia mitior, is characterized by loss of conscious- 



EPILEPSY. 815 

ness without any visible outward spasms, or at most accompanied only by 
fixation of the e} r eball. 

The transition forms of epileptic attacks consist of spells with loss of con- 
sciousness and local spasms. 

The irregular forms of epileptic attacks are characterized by spasmodic 
symptoms of a local character with no loss of consciousness and sensation, or 
at the utmost with only a slight confusion and obscuration of the senses. 
Sometimes the spasms are entirely wanting, and are replaced by motions of 
walking and running. At other times there are recurring attacks of mental 
disturbance, such as the delirium epilepticum during which an inclination sets 
in to wander about, or to use obscene language, or to act indecently or fool- 
ishly. Very serious cases amount to a furious mania, in which the patient is 
driven by an irresistible force to perform acts of violence, to annihilate every- 
thing in his reach, to commit the most shocking murders, etc. The sufferers 
often relate afterwards that they have had hallucinations of a repulsive and 
frightful character. The average duration of this maniacal condition may 
last from tw T o to four days; it may past off in a few hours. 

The epileptoid states show themselves like epilepsy, also paroxysmally, 
and constitute the principal feature of the disease, while the symptoms of the 
intervals are so little pronounced that no other nervous or mental affection 
could be recognized in them. Of such the epileptic vertigo is the most fre- 
quently occurring and the best known. 

The frequency of epileptic paroxysms varies within extremely wide limits; 
some patients have one seizure a year, others several in one day. In many 
patients the attacks occur principally during the night, with others during 
the day. So exists also a great variety in regard to the forms of the attacks. 
Some have only hard or grave attacks, others only the light ones, while still 
others have all the different forms mingled in alternation. 

The inter-paroxysmal condition is characterized most frequently by a 
weakened memory, by a depression of spirits, by gloominess, irritability, 
nervousness, distrust and a disposition to get easily angered. Patients de- 
cline into marked hypochondria or melancholy; the physiognomy and bear- 
ing are altered, the lips of the patients grow thick, their features coarse, 
finally assuming the expression of imbecility. 

In regard to Differential Diagnosis, I shall mention only its simula- 
tion. An interesting case was detected by Dr. MacDonald upon the follow- 
ing grounds: " First, Clegg was a convict, sentenced to hard labor, — this 
furnished a strong motive for feigning, and suggested suspicion; second, the 
occurrence of a paroxysm during my visit to the ward; third, the readiness 
with which he spoke of his complaint, and called attention to the cicatrices 
on his face and head; fourth, the marked change in his facial expression 
when he supposed he was unobserved; fifth, during the spasms the thumbs 
were not closed within the palms, the nails were not livid, muscular rigidity 
could readily be overcome, and the hands, after being forced open, immedi- 
ately closed; sixth, the sphincters were not relaxed; and, seventh, there 



8l6 THERAPEUTIC HINTS TO EPILEPSY. 

were no ecchymoses, extravasations, or minute petechial spots observable 
upon forehead, throat, or chest. The presence or absence of pallor was not 
determined by observation in Clegg's case, nor was any value attached to 
the condition of the pupils." 

Prognosis. — As bad signs are to be reckoned: attacks which come in 
irregular groups; great frequency of the paroxysms; sudden attacks without 
any premonitory symptoms; vomiting, asphyxia, half-sided convulsions, with 
subsequent paralytic symptoms; long-continued coma, delirium, mania, stu- 
pidity after waking up. 

More favorable signs: short attacks and long intervals between; premon- 
itory symptoms before the attack; milder convulsions, with little embarrass- 
ment in respiration; brief or only partial loss of consciousness, and no dis- 
turbance of the health in the intervals. Still better is it, when the paroxysms 
become less frequent, shorter and milder. The outbreak of cutaneous erup- 
tions and ulcers is quite favorable. In regard to Causes, we find it unfavor- 
able when the disease is inherited, or is not cured during the age of puberty, 
or comes on in middle life, or is caused by disorganization of the brain or by 
continued peripheric irritations of the nervous system, like masturbation. 
More favorable are those cases which come on during the period of dentition, 
or are caused by disturbances in the nutritive functions, such as chlorosis, 
anaemia, lead or alcoholic poisoning; in fact, in all cases where it is possible 
to remove the cause. 

Therapeutic Hints. 

Agar. Nictitation of the eyelids; itching, burning and redness of the 
fingers and toes, as though they had been frozen; after fright; suppressed 
eruptions. 

Amy I niir. By inhalation. 

Arnica.™ "Sees eyes all around him sometime before and after the 
attack; feels sore and achy when sitting, especially when lying in bed; upper 
chest, head and face feel flushed and hot, while extremities are cold; anxious, 
wild expression of countenance; conscious during the whole paroxsym." 
(J. F. Edgar.) 

Arg. nitr. In boys with old-looking face; after chewing tobacco. 
Pupils dilated a day or two before the fit. 

Arsen. Preceded by a sense of warm air streaming up the spine into 
the head, vertigo; loss of consciousness and falling down. Afterwards con- 
fused and stunned. During the intervals, pressive pain in the occiput; burn- 
ing in the spine; sweet taste in the morning; after eating heavy food burning 
in the stomach and bowels; stool irregular, mostly diarrhceic, with burning 
in the anus; also burning in the glans penis during micturition; frequent 
cramps in the calves of the legs. 

Art. vulg. When there are a number of attacks soon after each other. 

Bellad. The convulsions commence in the arm; previously, and at the 
time, congestion of the head; throbbing in temples; during the attack " the 



THERAPEUTIC HINTS TO EPIEEPSY. 817 

right hand clutches at the throat;" " during the intervals, peevish, angry, 
scolding, swearing; or fearful and full of anxiety; vertigo; growing dark 
before the eyes; ringing in the ears; headache, with twitching in the face; 
flushes of heat in the face; red face; enlarged pupils; jerking and starting in 
sleep. 

Bufo. After fright or onanism; attacks at night followed by some, hours 
of coma; loss of consciousness and falling down; tonic and clonic spasms; 
turgescence and distortion of face; livid face; convulsive agitation of mouth 
and eyes; bites tongue; bloody salivation; involuntary emission of urine; re- 
peated shocks through the whole body; the lower extremities are more in 
motion than the upper ones; copious perspiration running down the face. 

Calc. ars. Pain and oppression in the region of the heart before the 
fit. 

Calc. card. Before the attack; chewing motion with the mouth; stretch- 
ing of the limbs; great restlessness; palpitation of the heart; sense of some- 
thing running in the arm, or from the pit of the stomach down through the 
abdomen into the feet. After the attack; headache; dizziness; sweat on the 
head; great thirst; canine hunger; vomiting and diarrhoea. During the in- 
tervals ; stupid, peevish; anxious about getting well; vertigo; headache be- 
fore breakfast; pale, puffed face; perspires easily, especially on the head; 
hardness of hearing; eats a great deal and yet loses flesh; thick, swollen 
belty; too frequent and too profuse menses; swelling of the glands about the 
neck. Causes: fright; protracted intermittent; suppression of chronic erup- 
tion. Worse during the solstice and full moon; excited by chagrin or fear; 
by drinking cold water; by letting the legs swing when sitting. Frequently 
indicated after Sulphur. 

Cauloph. Epileptiform spasms during or near the menses. 

Caustic. Before the attack; imbecility of mind; heat of the head, fol- 
lowed by sweat all over; great pressure in the pit of the stomach, extending 
all over the chest and hindering breathing. During the spell: sometimes 
bleeding of the nose; very red face; biting the tongue; drawing the head to- 
wards one side; urine is passed involuntarily. Afterwards: soporous con- 
dition; headache; noise in the head; exhaustion. During the intervals: on 
the scalp and glabella small, round, soft lumps; sweats easily on the head; 
stoppage of the nose; tongue coated white on both sides ; sour or sweetish, 
badly-tasting eructation, like ink or rotten wood; pain in the small of the 
back, and constant coldness of the shoulders and joints of the feet; great 
restlessness, which urges him to run away. Causes : suppressed eruptions; 
protracted intermittent; softening of the brain. Worse during new moon; 
drinking cold water as soon as the pressure in the stomach commences 
prevents the attack. 

Chin. ars. After the attack cold perspiration, eructations and a feeling 
of such utter prostration, that the patient believes he cannot endure it long. 
(Payne.) 

Cicuta. Epileptiform spasms from venous congestion of the abdomen in 
52 



8l8 THERAPEUTIC HINTS TO EPILEPSY. 

children and women. Bluish, puffed face; eyes staring upon one point; 
electric shocks; trembling; difficulty of being roused from sleep; small, 
painful ulcers on the edges of the tongue. 

Cimicif. Epileptiform spasms at or near the menstrual period. 

Coccul. For women of great nervous and paralytic weakness, with 
suppressed or very painful menstruation; vertigo with nausea. 

Cuprum. Before the attack: nausea, retching and throwing up of 
phlegm; bloated abdomen; drawing sensation in the left arm; the arm is 
drawn involuntarily close to the body; formication and tearing in the right 
hand; shuddering; gooseflesh; palpitation of the heart; or sudden shriek 
and falling down, without any premonitory signs. During the spell: the 
fingers become dead; involuntary discharge of urine; bluish color of the pit 
of the stomach and chest; chest and head covered with perspiration. After 
the spell: weeping; headache; profuse discharge of a clear, watery urine; 
long trembling and shaking of the right hand; sleep. During the intervals: 
anxiety, tendency to be frightened; burning in the chest and abdomen, with 
chilliness of the remainder of the body; burning and tearing in the small of 
the back; numbness of the arms. In clearly idiopathic cases, with no or- 
ganic lesions; worse about new moon; after mental excitement; fright. 

Digit. When caused by excessive nightly emissions or onanism, with 
great weakness of the genital organs. 

Gelscm. Epileptiform convulsions after suppressed menses, with severe 
spasms of the glottis; epilepsy, with dull feeling in the forehead and vertex, 
and some pain and fullness in the region of the medulla oblongata before the 
attack. 

Glojioin. Great congestion of the head and right heart; during the 
spasms he spreads his fingers and toes asunder. 

Hyosc. Before the attack: vertigo; sparks before the eyes; ringing in 
the ears; gnawing and sensation of hunger in the pit of the stomach. Dur- 
ing the spell: purple, bluish face; projecting eyes; shrieks; grating of teeth; 
foaming; discharge of urine. After the spell: soporous condition, snoring. 
During the intervals: tearing and beating in the right eye, which weeps and 
seems protruded; constipation. Causes: jealousy; disappointed love; grief. 
The attempt to swallow fluids renews the attack. 

Hyper. Epileptiform spasms, always after striking the bod}* against 
anything. 

Ignat. Epilepsy caused by fright and suppressed grief; especially suit- 
able for children. 

Indigo. Before attacks : furious, excitable, easily angered; between the 
attacks: exceedingly melancholic and timid, or gloomy. (L,. M. Kenyon.) 

Ipcc. Epileptiform spasms, with shrieks; opisthotonus; pale, puffed 
face and gastric derangements. 

Laches. The patient goes to sleep before an attack, and then is seized 
with a spasm ; creeping sensation from nape of neck down the spinal column ; 
giddiness; headache; peculiar feeling in throat; bloated stomach and bowels; 



THERAPEUTIC HINTS TO EPIEEPSY. 819 

cold feet. In those eases which are caused by onanism, or are in connection 
with morbid excitement of the sexual organs; fluor albus; frequent emis- 
sion of semen; also after jealousy. 

Nux vom. Painful spot in the abdomen in the region of the solar 
plexus; pressure upon this spot renews the attack; during interval, consti- 
pation; headache every morning; no appetite for breakfast and nausea after 
eating. 

CEnanth. croc. Recommended by Drs. Davidson and Oehme. 
Opium. Nightly attacks; combined with mental derangements; after 
the attack long, soporous sleep. 

Plumbum. Heaviness and numbness of the legs before the spell; 
swollen tongue; afterwards: long-continued stupid feeling in the head, and 
want of clear consciousness. 

Pul sat. Fits before menses; swelling of abdomen before menses; menses 
too light and scanty; headache principally over right eye; sensation of a 
lump rising in throat, which causes nausea while eating. (G. W. Cox.) 

Secale. Shows toxic-effects, which hint strongly to it, but its sphere 
of action has not yet been defined. 

Sepia. ' Fits every two, three weeks, usually in the morning; star- 
ing of eyes, turning of head towards left side, sense as of floating in the 
air, loss of consciousness. Several days before attack: noises in head and 
hardness of hearing and deep sleep. During pregnancy no attacks, but after 
confinement worse. During intervals flushes of heat, bodily restlessness, must 
move about. Sultry w T eather unbearable, also foggy. Before menses cutting 
pain in bowels, dryness of skin. Sepia* one dose, every seventh evening; 
better. Later, Pulsat*, Cup-turn*. Lastly, Sepia 200, better. From Oct. 
26th, 1876, to Nov. 26th, 1877. (Kunkel.) (Allgem Horn. Zeitg., March 
28th, 1882.) 

Silic. Before the attack : feeling of great coldness of the left side of the 
body; shaking of the left arm; slumber, with starting. The spasms spread, 
undulating from the solar plexus up towards the brain; violent screaming; 
groaning; tears drop out of the eyes; foam at the mouth. Afterwards: warm 
perspiration; slumber; paralysis of the right side; for scrofulo-rachitic indi- 
viduals; during sleep at night; worse about new moon. 

Stannum. Is recommended as one of the most important remedies, with- 
out particular indications; except that its sphere of action is said to have a 
strong bearing upon the genital organs of both sexes. 

Stramon. Epileptiform spasms; thrusting the head continually in 
quick succession to the right; continued rotary motion with the left arm; 
pain in the pit of the stomach; obstinate constipation; deep, snoring sleep; 
low-spirited; fear of death; desire to be alone. 

Sulphur, before the spell : Crawling and running as of a mouse down 
the back and arms; or a sudden feeling as if a mouse w T ere running from the 
right foot up the leg to the right side of the abdomen. After the attack, 
which consists of various convulsive motions, he wipes the tears from his 



820 



DIGEST TO EPILEPSY. 



eyes; soporous sleep; great exhaustion; jerkings in arms and about the 
mouth in cold air. Chronic cases always of psoric taint; suppressed eruptions. 

Tarant. During attack squinting of eyes which remain open; after- 
wards dejection and dizziness for twenty-four hours. 

Ver. vir. and Zizia are likewise recommended. 

Bromide of Ammonium (Kitchen), Bromide of Potassium (old school), 
Cya n ide of Potassiu m ( J . D uf ty ) . 

Digest of Epilepsy. 



BEFORE THE ATTACK. 

Loss of consciousness: Arsen. 

Imbecility of mind : Caustic. 

Furious, excitable, easily angered: In- 
digo. 

Some time before, sees eyes all around 
him: Arnica. 

Sense of floating in the air: Sepia. 

Vertigo: Arsen., Hyos., Laches. 

Headache: Laches. 

Dull feeling in forehead and vertex, pain 
and fullness in region of medulla : Gel- 
sem. 

Throbbing in temples, congestion: Bel- 
lad. 

Feeling of warm air streaming up the 
spine into head: Arsen. 

Heat of head, followed by sweat all 
over: Caustic. 

Several days before, noises in head: 
Sepia. 

Turning head towards left side: Sepia. 



Dilated pupils a day or two before: Arg. 

nitr. 
Staring eyes : Sepia. 
Sparks before eyes: Hyosc. 
Hardness of hearing several days be- 
fore: Sepia. 
Ringing in ears: Hyosc. 
Chewing motion with the mouth: Calc. 

card. 
Swollen tongue : Plumbum. 
Nausea, retching, throwing up of phlegm : 

Cuprum. 
Peculiar feeling in throat: Laches. 
Gnawing and sensation of hunger in pit 

of stomach: Hyosc. 
Pressure in pit of stomach, extending 

over chest and hindering breathing: 

Caustic. 
Bloated stomach and bowels: Cuprum, 

Laches. 



Pain and oppression in region of heart: 

Calc. ars. 
Palpitation of heart: Calc. card., Cup- 



Shaking of left arm : Silic. 

Drawing of left arm, which is drawn 
close to the body: Cuprum. 

Formication and tearing in right hand: 
Cuprum. 

Heaviness and numbness of legs: Plum- 
bum. 

Stretching of limbs: Calc. card. 

Sense of something running in the arm, 
or from the pit of the stomach down 
through the abdomen into the feet: 
Calc. carb. 

Crawling and running as of a mouse 
down the back and arms; or a sudden 
feeling as if a mouse were running 
from the right foot up the leg to the 
right side of the abdomen: Sulphur. 

Creeping sensation from nape of neck 
down to spinal column: Laches. 



Slumbering with starting: Silic. 

Deep sleep : Sepia. 

Goes to sleep and then is seized with a 

fit: Laches. 
Cold feeling of the left side of body: 

Silic. 
Cold feet: Laches. 
Shuddering, gooseflesh: Cuprum. 



Great restlessness : Calc. carb. 
DURING THE ATTACK. 

Conscious : Arnica. 

Loss of consciousness : Sepia. 

and falling down: Bufo. 

Shrieks: Hyosc, Ipec. 
Sudden shriek and falling, without pre- 
monitory signs: Cuprum. 
Groaning: Silic. 



DIGEST TO EPILEPSY 



821 



Congestion to head and heart: Glonoin. 

Drawing" head towards one side: Caustic. 

Thrusting" head in quick succession to 
the right: Stramon. 

Undulation from solar plexus up to 
brain: Silic. 

Head and chest covered with perspira- 
tion: Cuprum. 

Eyes projecting: Hyosc. 

staring upon one point: Cicuta. 

open and squinting: Tarant. 

and mouth convulsively moved: 

Bufo. 

, tears drop out of: Silic. 

Nose bleeding : Caustic. 

Face bluish, purple: Cicuta, Hyosc. 

distorted: Bufo. 

■ livid: Bufo. 

pale: Ipec. 

■ puffed: Cicuta, Ipec. 

very red: Caustic. 

turgescent: Bufo. 

Copious perspiration running down the 

face: Bufo. 
Mouth and eyes convulsed: Bufo. 

, foaming at the : Hyosc. , Silic. 

, bloody salivation: Bufo. 

Grating" of teeth: Hyosc. 
Biting tongue: Bufo., Caustic. 
Spasms of the glottis: Gelsem. 

Gastric derangements : Ipec. 

Bluish color of pit of stomach and chest: 

Cuprum. 
Urine, involuntary emission of: Bufo., 

Caustic, Cuprum, Hyosc. 



Left arm, rotatory motion with: Stramon. 

Bight hand clutches at the throat: Bel- 
lad. 

Fingers become dead: Cuprum. 

and toes are spread asunder: Glonoin. 

Convulsions commence in the arm: Bel- 
lad. 

Tonic and clonic spasms: Bufo. 

Lower extremities are more in motion 
than the upper: Bufo. 

Opisthotonus: Ipec 

Shocks through whole body: Bufo. 

Electric shocks ; trembling: Cicuta. 

AFTER THE ATTACK. 

Stupid and want of clear consciousness: 
Plumbum. 



Confused and stunned: Arsen. 

Sees eyes all around him: Arnica. 

Weeping: Cuprum. 

Dejected and dizzy for twenty -four hours: 
Tarant. 

Dizziness : Calc card. 

Headache: Calc card., Caustic, Cup- 
rum. 

Sweat on the head: Calc carb. 

Wipes tears from his eyes: Sulphur. 



Great thirst and canine hunger: Calc. 
carb. 

Eructations : Chin. ars. 

Vomiting and diarrhoea: Calc carb. 

Profuse discharge of clear, watery urine: 
Cuprum. 

Long trembling and shaking of right 
hand: Cuprum. 

Paralysis of right side: Silic 

Sleep : Cuprum. 

Slumber: Silic. 

Soporous sleep: Caustic, Opium, Sul- 
phur. 

and snoring: Hyosc 

Coma: Bufo. 



Cold perspiration : Chin. ars. 
Warm perspiration : Silic. 
Exhaustion: Caustic, Sulphur. 
Utter prostration : Chin. ars. 

DURING THE INTERVALS. 

Stupid, peevish: Calc carb. 
Desire to be alone: Stramon. 
Low-spirited: Stramon. 
Melancholy, timid, gloomy: Indigo. 
Anxious, wild expression: Arnica. 

about getting well: Calc. carb. 

Anxiety, easily frightened: Cuprum. 
, or fearful: Bellad. 

Fear of death : Stramon . 

Peevish, angry, scolding, swearing: Bel- 
lad. 

Mental derangements : Opium. 



carb. 



Vertigo : Bellad. , Calc carb. 

with nausea: Coccul. 

Headache before breakfast: Calc 

every morning: A r //.i- vom. 

over right eye: Pulsat. 

, occiput pressive: Arsen. 

, with twitching in the face: Bellad. 



822 



DIGEST TO EPILEPSY. 



Head, face, upper chest hot and flushed: 

Arnica. 

perspires easily: Calc. card., Caustic. 

On scalp and glabella, small, round, soft 

lumps: Caustic. 



Tearing and beating in right eye, which 
weeps and seems protruded: Hyosc. 

Pupils enlarged: Bel lad. 

Growing" dark before eyes: Bellad. 

Nictitation of lids: Agar. 

Ringing in ears: Bellad. 

Hardness of hearing: Calc. card. 

Stoppage of the nose: Caustic. 

Face flushed, hot, red: Bellad. 

pale, puffed: Calc. card. 

, in boys, old-looking: Arg. nitr. 

, jerkings about mouth and in arms 

in cold air: Sulphur. 



Tongue coated white on both sides: 

Caustic. 
, small painful ulcers on edges of: 

Cicuta. 
Taste, sweet in the morning: Arsen. 
Glands about neck swollen: Calc. card. 
Lump rising in throat, causing nausea 

while eating: Pulsat. 
No appetite for breakfast and nausea 

after eating: Nux vom. 
Eats a great deal and yet loses flesh : Calc. 

card. 
Eructations, sour or sweetish, badly 

tasting, like ink or rotten wood: Caustic. 



Pain in pit of stomach: Stramon. 

Burning in stomach and bowels after 
eating heavy food: Arsen. 

Constipation: Hyosc, Nux vom., Stra- 
mon. 

Irregular, mostly diarrhoeic stool, with 
burning in anus: Arsen. 

Painful spot in region of solar plexus; 
pressure on this spot renews the attack: 
Nux vom. 

Burning in abdomen and chest, with 
chilliness of remaining body: Cuprum. 

Thick, swollen bellv: Calc. card. 



Burning in the glans penis during mic- 
turition: Arsen. 
Frequent emissions of semen: Laches. 
Menses too light and scanty: Pulsat. 
too frequent and profuse: Calc. card. 



suppressed and painful: Coccul. 

Before menses, swelling of abdomen; 
Pulsat. 

, cutting pain in bowels: Sepia. 

Fluor albus : Laches. 



Spine, burning in: Arsen. 

Small of back, burning and tearing in; 

Cuprum. 

, pain in: Caustic. 

Arms, numbness of: Cuprum. 

Itching, burning and redness of fingers 

and toes, as though they had been fro- 
zen : Agar. 
Frequent cramps in calves: Arsen. 
Sore and achy when sitting or lying: 

Arnica. 
Chilliness of body, with burning in chest 

and abdomen: Cuprum. 
Coldness of shoulders and joints of feet; 

Caustic. 

of extremities: Arnica. 

Heat, flushes of, head, face and upper 

chest: Arnica. 

, in flushes: Sepia. 

Sweats easily about head: Calc. card. % 

Caustic. 
Dryness of skin: Sepia. 



Sleep, snoring: Stramon. 

, difficult of being aroused from: Ci* 

cuta. 

, jerking and starting in: Bellad. 

Restlessness, must move about: Sepia. 

, urges him to run away: Caustic. 

Sultry, foggy weather unbearable: Sepia . 
Paralytic weakness : Coccul. 

ATTACKS PREVENTED BY: 

Drinking cold water as soon as the 
pressure in the stomach commences; 
Caustic. 

Pregnancy: Sepia. 

ATTACKS WORSE OR EXCITED. 

Several right after each other: Art. vulg^ 
Every two or three weeks, usually in 

the morning: Sepia. 
In the night : Bufo., Opium. 

, during sleep: Si lie. 

During new moon: Caustic, Cuprum K 

Silic 
During solstice and full moon: Calc 

card. 
After mental excitement: Cuprum. 



ECLAMPSIA ACUTA. 823 



Grief: Hyosc, Ignat. 
Jealousy: Hyosc, Laches. 
Disappointed love : Hyosc. 



fright: Cuprum. 

chagrin or fear: Calc. card. 

Drinking cold water: Calc. card. 

Attempt to swallow fluids: Hyosc. Softening of brain : Caustic. 

Pressure upon a painful spot in the re- Chewing tobacco : Arg. nitr. 

gion of the solar plexus: Nux vom. Venous congestion of abdomen in 

Striking the body against anything: women and children: Cicuta. 

Hyper. Onanism: Bicfo., Digit., Laches. 

Letting the legs swing when sitting: Symptoms of genital organs of both 

Calc. card. sexes: Stannum. 

At or near the menses: Cauloph., Suppressed menses : Coccul., Gelsem. 

Clinic. Protracted intermittent: Calc. card., 

After confinement : Sepia. Caustic. 

Suitable for children: Ignat. Suppressed eruptions: Agar. , Calc. card. , 
scrofulo-rachitic individuals: Caustic, Sulphur. 

Silic. 
psoric taint: Sulphur. 

ATTACKS CAUSED BY: 

Fright: Agar., Bufo., Calc. card., Iguat. 



Calc. Carb. is frequently indicated after 
Sulphur. 



Eclampsia Acuta. 

This is an affection entirely analogous in its external symptoms to epi- 
lepsy — sudden loss of consciousness, frequently setting in with a shriek; tonic 
and subsequently clonic convulsions, which are followed by a comatose sleep. 
But it is entirely different from epilepsy, in that it always accompanies some 
other morbid derangement, with the course of which it either ceases or ends 
fatally. 

Notlmagcl, on the contrary, confines Eclampsia to such cases of epilepti- 
form spasms, ' ' which, independently of positive organic diseases, present 
themselves as an independent acute malady, and in which the same processes 
arise, generally in the way of reflex excitement, and the same mechanism in 
the establishment of the paroxysms, comes into play as in the epileptic 
seizure itself." 

Eclampsia Gravidarum et Parturientium, Puerperal Convulsions. 

Its occurrence is rather rare — one in about five hundred pregnancies, 
and perhaps less than that. During pregnancy it is of a very rare occurrence, 
and even then is scarcely ever noticed before the sixth month. It occurs 
most frequently during the act of parturition, seldom during the lying-in 
period. Primiparse are most subjected to it, and it sets in mostty during the 
dilatation of the os uteri, or immediately after the expulsion of the child. 
According to Frerichs, it has been observed that such women suffer frequently 
with albuminuria during pregnancy, though this is not invariably the case. 
During the lying-in time these convulsions are generally the commencement 
of inflammation of the womb. The attack itself is characterized by the same 
convulsive features as are described under epilepsy. When setting in during 
pregnancy these convulsions generally cause contractions of the womb and 



824 THERAPEUTIC HINTS TO ECLAMPSIA ACUTA. 

abortus; when at the beginning of labor-pains, they frequently retard the 
natural progress; but when towards the end of parturition, they are apt to 
hasten the expulsion of the foetus. After the birth of the child the contrac- 
tions of the womb generally cease; and this may give rise to haemorrhages, 
retention of the placenta and inflammatory processes of the womb. The 
convulsions themselves ma}* continue for hours afterwards, though they are 
mostly of less intensity. The influence upon the child is, according to Scan- 
zoni, not necessarily fatal; about one-half of them are said to die. The later 
the convulsions begin the greater is the chance for the child, and vice versa. 
The Prognosis is doubtful; the earlier they commence the more so. 

Therapeutic Hints. 

As albuminuria is frequently a forerunner of this terrible complaint, the 
patient ought to be carefully treated during pregnancy. Compare Albu- 
minuria. 

Atrop. sulph. (Szontagh.) 

Bellad. Deep red face; enlarged pupils; screaming; jerking and general 
convulsions; all of which are signs of cerebral congestion. 

Chin, sulph. Albuminuria; tetanic spasms with loss of consciousness 
during parturition and afterwards; swollen veins on the head and neck; pulse 
frequent, intermittent and weak. 

Cuprum. During the lying-in time; sour-smelling; sweat miliary erup- 
tion; anxiety; easily frightened; heaviness of the head; soreness of the 
abdomen to pressure; burning in the small of the back; numbness of the 
arms. " Spasms commence with cramps in fingers and toes; hands and feet 
turn outward." (Gw} T nn.) 

Gelsem. During pregnancy, and where there is an anaemic condition 
present; protracted labor; rigid os uteri. 

Hyosc. Cold perspiration; pale face; suffocating spells and convulsions 
during parturition; facial muscles greatly agitated. 

Ignat. Twitching of muscles of mouth and eyes; wild expression; eyes 
upturned; constantly attempting to pull her hair; laughing and crying; 
nervous, excitable. (I. D. Johnson.) 

Laches. The convulsions commence upon the left side of face, and con- 
tinue longer and are more severe about the neck and throat than elsewhere. 
(JVlinton. ) 

Opium. During parturition; cessation of labor- pains; coma; retention 
of stool and urine; after a fright. 

Platina. After parturition ; profuse haemorrhage; yawning; convulsions. 

Stratnon. Excited, scolding, striking, spitting, crying and laughing; 
face flushed, pupils dilated, in great terror. Spasms; writhing and floun- 
dering in manifold gyrations; every muscle in play. (O. P. Baer. ) 

Ver. vir. During parturition; also after blood-letting, during the puer- 
peral convulsions, causing furious delirium; cold, clammy perspiration, 



ECLAMPSIA INFANTUM. 825 

turgid and livid face; hideous expression of countenance; great activity of 
arterial system. 

Also compare the hints under the head of Epileps} r . 

Eclampsia Infantum, Convulsions of Children. 

By this term is understood convulsions of children, during which they 
lose their consciousness more or less completely, which come on in spells, run 
an acute course and are generally connected with some other morbid process. 
There exists no stricter definition as yet. 

Eclampsia attacks by preference boys • during the first years — stout as 
well as sickly — especially during dentition. It often breaks forth at the com- 
mencement of exanthematic fevers, also instead of the chill in intermittent 
fever; succeeds a sudden fright of the mother in the event of her suckling 
the child immediately. It may be caused by fright, fear of punishment, 
strong light, tickling, or violent pain; intestinal irritations from worms, in- 
digestible food, such as raisins, cakes, the pulp of oranges, etc. These con- 
vulsions are characterized by loss of consciousness; spasms all over; con- 
gestion of the head; cyanotic appearance of the face, or, in anaemic children, 
paleness of the face; snoring; rattling breathing; sometimes vomiting or in- 
voluntary discharge of urine and feces. They sometimes follow each other 
in rapid succession, and may terminate life unexpectedly in consequence of 
asphyxia; as a rule, however, they yield readily to the appropriate homoeo- 
pathic remedy. 

Therapeutic Hints. 

Aeon. Great restlessness; high fever; dry skin, after fright; from irri- 
tation of seat worms; from taking cold; in consequence of inflammatory 
affections of the spine; during teething. 

Apis. Shrieking; boring the head into the pillows; inflammatory affec- 
tions of the brain. 

Arsen. Spasms, preceeded by burning heat of the whole body, with 
constant licking of the dry, cracked lips; wants to drink constantly, but 
little at a time; is hasty in all its motions; grasps the tumbler or anything it 
wants eagerly; is very restless, w r ith anxious expression of the face. 

Bellad. Glowing red, as well as a pale face, with enlarged pupils; great 
heat in the head; great vascular erethism; drowsiness, with inability to sleep; 
starting and jerking during sleep; grating of teeth; especially during den- 
tition; scrofulous diathesis. 

Calc. carb. The anterior fontanelle remains wide open ; glandular swell- 
ing about the neck; teething process is either very slow or else too rapid; 
much perspiration about the head; greatly inclined to take cold; hard, swol- 
len abdomen; rather inclined to looseness of the bowels; often indicated 
after Bellad.; one of the most important remedies during dentition; scrofu- 
lous diathesis. 

Camphora. Anaemic subjects; coldness of the whole body. 



826 THERAPEUTIC HINTS TO ECLAMPSIA INFANTUM. 

Chamom. One cheek is red, the other pale; hot perspiration on the 
head, especially on the hairy portion; great thirst; bloated bowels; colicky 
pains; greenish discharges; sour vomiting; constant moaning and groaning; 
restlessness; the child wants to be carried about all the time. During sleep 
a suspicious working of the muscles of the face, as if smiling; during denti- 
tion; also, after nursing the breast of a woman laboring under the effects 
of a recent fit of passion. 

Cicuta. Especially when the child, without any premonitory signs, be- 
comes suddenly stiff, with his eyes fixed upon one point; also in violent 
spasms of the head and the upper portion of the body; with bluish and 
puffed face; also in convulsions from worms. 

Cuprum. In anaemic conditions; shrill cries during the attack; drowsy 
and stupid condition during the intervals, with nausea and vomiting of slime; 
bloated abdomen, with involuntary, thin discharges from the bowels; also 
when the child loses its breath from crying, and draws its feet spasmodi- 
cally upwards and backwards upon the nates. 

Cypripedium pub. In the premonitory stage, when there is a morbid 
irritability of the brain, in consequence of which the child is very excitable, 
laughs and plays at unwonted hours; is very wakeful and laughs even in 
sleep. 

Gelsem. During dentition, with sudden loud outcries; feverishness. 

Hyosc. Congestion of the head; bloated and dark face; protruding 
eyes; shrieks; foam at the mouth; involuntary discharges of urine; from 
fright or fear. 

Ignat. Violent convulsions; often tonic spasms predominant; nervous 
temperament; during dentition; during the commencement of exan thematic 
fevers; after fright, or when children have been punished. Fall asleep 
soon afterwards. 

Ipec. Pale face; nausea; vomiting; almost always when caused by eat- 
ing indigestible food; raisins, pound-cake, the pulp of an orange, etc.; or 
when the eruption of an exanthematic fever strikes in by taking cold. 

Mel Hot. During dentition with great congestion to the head. (Bowen. ) 

Opium. Trembling of the whole bod}', convulsive motions of the ex- 
tremities; soporous condition with snoring; retention of stool and urine; 
after a fright; or from nursing soon after a sudden fright of the mother. 

Platina. In anaemic subjects; tonic spasms without loss of conscious- 
ness; trismus; pale, sunken face; after the spell the child lies on its back, 
draws up its limbs and spreads its knees. 

Stannum. Renewal of convulsions with the cutting of every tooth; 
also in consequence of worms. 

Stramon. Congestion of the head; heat all over the body; red face; 
spasmodic thrusting of the head in all directions; profuse urine; deep, 
snoring sleep. 

Sulphur. Often when all other remedies fail; after suppression of erup- 
tions: diarrhoea in the morning; during the eruptive state of scarlatina. 



TREMOR. 827 

/ r er. vir. Convulsions with opisthotonus; anaemic subjects in conse- 
quence of diarrhoea. 

Zincum. Screaming and starting in sleep; anxious look when getting 
awake; heat of the body and nightly restlessness; twitching and jerking of 
different muscles, more on the right side than on the left; irritable mood; 
great appetite; bloated abdomen; involuntary discharge of urine. Accord- 
ing to Kafka, during dentition in children with anaemia. 

Tremor, Trembling. 

This affection is of very frequent occurrence, and of various forms. 
Sometimes the head trembles, while the motions of the arms go on normally. 
Some persons tremble during rest as well as when in motion; others, only 
during rest; a majority, however, during motion. During sleep all trembling 
ceases; also frequently when in a horizontal position, or in a position in 
which the trembling extremity rests firmly upon support elsewhere. Reflex 
motions are performed sometimes tremblingly, sometimes normally, while all 
automatic motions almost always remain undisturbed. Exertion of the will 
sometimes aggravates, sometimes masters the tremor; and during intense in- 
terest upon a subject it may cease entirely. Trembling may be partial, con- 
fined to the upper extremities, or extend over all the muscles, so that even 
the muscles of the face and jaws are involved. It is mostly of a transient 
character; sometimes part and parcel of a disease; sometimes, however, it 
becomes habitual, chronic, life-long. In children, it is found only occasion- 
ally, never of long duration. Old age is especially subject to it (tremor sen- 
ilis). We find it likewise more amongst women than men. Brain and spinal 
diseases (softening and atrophy) are mostly attended by it. 

It is brought on especially by the vapors of mercury; lead-poisoning; 
opium-eating, and abuse of alcoholic drinks and tobacco. It may be the 
result of typhus, and an effect of sexual excesses. Temporarily it may be 
caused by mental excitements, overexertions of the muscles, too much coffee 
or tea drinking, and too low a temperature. To the latter corresponds the 
trembling during the chilly stage of intermittents. Likewise we find trem- 
bling easily excited after being tired out, metally depressed, or exhausted 
in any way; and therefore it is frequently found during convalescence, after 
epileptic fits, catalepsy, neuralgia, and during the periods of menstruation 
and lactation. 

The mercurial tremor greatly resembles paralysis agitans (of which 
later), in its extent, its secondary paresis and the accompanying cerebral and 
psychical symptoms. The lead tremor is, as a rule, limited to the upper ex- 
tremities and some facial muscles (orbicularis, levator anguilioris), and is 
accompanied by numerous other symptoms of lead-poisoning. The alcohol 
tremor usually begins in the hands, from whence it may spread all over the 
body; it is worst in the morning during fasting, and alleviated by the use of 
spirits. The opium tremor is always associated with other opium symptoms, 
such as contracted pupils, constipation, etc.; and the nicotine tremor most 



828 PARALYSIS AGITANS. 

frequently attacks only one side, or at least one side more than the other, 
and is generally accompanied with various nervous disturbances, such as 
muscular weakness, dizziness, neuralgia, myosis, etc. 

Therapeutic Hints. 

Compare multiple sclerosis, paralysis agitans. 

Mercurial tremor : Carb. veg.\ China, Hcpar, Laches., Nitr. ac, Sulphur, 
etc. 

Lead tremor: Alum., Bcllad., Hepar, Nux vom., Opium, Platina, Stra- 
in on., etc. 

Alcohol tremor : Arsen., /pec, Nux vom., etc. 

Opium tremor: Bel lad., Chamom., Ipec, Mercur., Nux vom., etc. 

Nicotine tremor: Arsen., Chamom., Coccul., Cuprum, Ignat., Nux vom., 
etc. 

Other tremors : Calc. carb., Cicuta, Mercur., Opium, Plumbum, Platina, 
Pulsat., Rhus tox., Stramon., Sulphur. 

The feeling of internal trembling: Calc. carb., Iodium, Rhus tox., 
Staphis. 

Paralysis Agitans, Shaking Palsy, 

Consists of a gradually increasing motor weakness and a trembling in the 
voluntary muscles of the body; the latter preceding the paralytic symptoms. 
In its external manifestation it appears as a tremor of high degree; but dif- 
fers from it by its constantly increasing intensity, and by its liabilty to ter- 
minate in paralysis and death. 

It commences lightly, as a feeling of weakness, with slight trembling of 
the upper extremities of the head. The patient is still able to execute all 
voluntary motions, and the trembling at first is not constant and may be 
mastered by the influence of the will. In some cases the tremor is limited to 
only one-half of the body, but in others it increases in intensity and becomes 
a perfect shaking of the whole body, by which even the bed upon which the 
patient rests is set in motion. In general the trembling is independent of 
voluntary or passive movements, and by this it is distinguished from chorea 
and from the trembling in disseminated sclerosis of the nervous centres. 

Sleep, and easy position, which at first will stop the shaking, eventually 
lose this effect, and the skin of the patient becomes sore in different places 
from the friction occasioned by the continued shaking, which the patient is 
unable to control. There are, however, more or less frequent spells of remis- 
sion. In some cases the patient has an irresistible desire to run, either for- 
wards or backwards, which at first he can resist to a certain degree, succeed- 
ing in making some uncertain steps on his toes; but at once he falls into a 
hasty run, until he regains control over these involuntary motions. At 
length, however, he cannot walk at all, but must be held back from these 
pitching forward or backward motions. 

To all this are gradually added: general exhaustion, great sensitiveness 



PARALYSIS; AKINESIS. 829 

of the whole body, paralysis of the voluntary muscles, difficult deglutition, 
relaxation of the sphincters, with involuntary discharge of feces and urine, 
bed-sores, until, attended by the loss of mental capacity and delirium, death 
relieves the patient. 

Its Causes are obscure. It is said to have followed the taking of cold 
and after mental excitements; and its seat is supposed to be in the pons and 
upper part of the medulla oblongata, although most autopsies do not sustain 
this supposition; thus far its anatomical basis is undecided. 

The Prognosis is unfavorable. 

Therapeutic Hints. 

Compare Arsen., Bar. carl?., Caustic, Lycop., Mercui., Phosph. ac. y 
Rhustox.. Stramon., Tara?it., Zincum. 

Paralysis; Akinesis, 

Is an abolition of the faculty of exciting the normal function of the motor 
nervous apparatus and the muscles. A mere diminution of voluntary 
motion, attended with a sense of fatigue, is termed Paresis. The latter may 
gradually pass into paralysis. 
Paralysis may arise : 

1. From destruction of functional capacity of those parts of the cere- 
brum, or of the ganglia at the base of the brain, or of the cerebellum, in 
which volitional impulses are probably converted into motor excitations (cen- 
tral paralyses). 

2. From diminution or abolition of the conductivity of the motor nerves 
on any of their course, from their origin in the brain and spine to their ter- 
minations (paralysis ef conduction). 

3. From abolition of excitability and contractibility of the muscles 
(myopathic paralyses). 

The Causes of paralysis are: wounds, occurring of course more fre- 
quently in the peripheral nerves than in the brain or spine (traumatic para- 
lyses); diseases of parts in the neighborhood of the nerves, such as exostoses, 
caries, aneurysms, echinococci, enlarged glands, herniae, tumors, etc. ; diseases 
of the nervous system, such as neuritis, myelitis, encephalitis, cerebral and 
spinal apoplexies, softenings, scleroses, tumors, etc. ; disturbances of the cir- 
culation, such as ischsemia, embolism, thrombosis, venous statis, etc.; poison- 
ing of the blood by vegetable alkaloids, such as woorare, ergotine, nicotine, 
saponine, hydrocyanic acid, camphor, etc., and metallic preparations, such 
as lead, etc.; acute diseases, such as acute exanthemata, erysipelas, typhoid 
fever, cholera, dysentery, acute articular rheumatism, diphtheritis; chronic 
infectious diseases and cachexias, such as syphilis and scrofulosis; catching 
cold ; exhaustion of the nervous system, by forced marches, excesses in 
venery, night watching, excessive mental exertion, etc.; reflex action from 
some primary disease, injury or irritation of the nerves at the periphery — 
reflex paralyses. 



830 paralysis; akinesis. 

Paralysis may extend over a single muscle, or a group of muscles; over 
one-half of the body (hemiplegia), usually caused by a lesion in the brain 
on the opposite side, though it may also be of spinal origin; or over both 
halves of the body symmetrically, commencing usually in the lower extrem- 
ities and spreading to trunk and upper extremities (paraplegia). 

As concomitant and secondary symptoms of paralysis may be mentioned: 
relaxation or contraction of the affected muscles; want of all reflex and auto- 
matic movements, when there is interruption of the conduction in the peri- 
pheric motor nerves (or when the muscles are destroyed); an increase of re- 
flex activity so long as the reflex mechanism is not destroyed; associated 
movements in the paralyzed parts, in many cases where the paralysis is of 
centric origin above the centre of such associated movements; disturbances 
of automatic movements, especially of respiration in lesions of the lateral 
columns of the spinal cord in the dorsal and cervical regions; when the 
respiratory centre in the medulla oblongata is affected, asphyxia is soon pro- 
duced; in purely cerebral paralyses respiration continues undisturbed; reten- 
tion or involuntary passage of urine or of the contents of the bowels in 
various forms of paralyses; anaesthesia, if the disease affects a peripheric 
mixed nerve trunk, or when the cause of paralysis affects coincidently sen- 
sory nerves either in the brain or spine; hyperaesthesia of the parts and 
paraesthesia (formication, numbness, creeping, burning, etc.), inconsequence 
of irritations set up in the neighborhood of morbid processes, which cause 
paralysis; disturbances of the intellectual faculties are found only in paralysis 
of cerebral origin; coldness of the parts with passive hyper aeniia and cyanosis, 
especially in traumatic paralysis; atrophy of the skin, vulnerability of the 
skin, so that slight exposure to cold, pressure or irritation produces sores; 
deformity of the nails ; falling off of the hair on the paralyzed limb; atrophy 
of the muscles and bones ; cirrhosis of the muscles, and increase of the inter- 
stitial tissue; enlargement and hypertrophy of the lymphatic glands. All 
thesejtrophic changes are especially found in traumatic paralyses, less often 
in spinal, and still more rarely in cerebral paralysis. 

The Diagnosis between these three forms may be broadly stated as fol- 
lows: 

Peripheral paralyses are limited to the region supplied by one or a few 
nerve trunks; they are always associated with anaesthesia; reflex, automatic 
and associated movements are absent; spasms occasioned by central disease 
do not extend to the paralyzed muscles; trophic disturbances, especially 
atrophy of the muscles, are well marked at an early date; absence of all signs 
indicating spinal or cerebral disease. 

Spinal paralyses occur most frequently as paraplegia; attacking sym- 
metrical groups of muscles belonging to the lower exremities, trunk, belly, 
and upper extremities, progressively in accordance with the height which the 
disease has reached in the spinal cord (lumbar, dorsal or cervical regions); 
they are frequently accompanied by numbness, formication, etc., in the feet, 
by pain in the back, and a sensation of constriction around the body; they 



THERAPEUTIC HINTS TO PARALYSIS; AKINESIS. 83 1 

are characterized by incontinence or retention of urine, by priapism, pollu- 
tions, spermatorrhoea and impotence; respiration is affected only when the 
corresponding part of the cord is involved: myosis in cervical lesions; con- 
vulsive movements proceeding from the brain do not extend to the paralyzed 
parts; trophic disturbances may or may not be present; psychical affections 
and affections of special senses are usually absent. 

Cerebral paralyses, from extravasation of blood, embolism, tumors, etc., 
are usually hemiplegia upon the opposite side of the body; sometimes, how- 
ever, it is limited to particular nerves and plexuses; reflex actions are almost 
always preserved and frequently increased in energy; associated and auto- 
matic movements are usually unaltered; motor irritation (contractures, 
twitchings and spasms) are not unfrequent in the affected parts; epileptic 
convulsions occur also in the paralyzed parts; atrophy of the muscles scarcely 
ever occurs, except in paralysis of the pons; psychical disturbances and dis- 
turbances of the higher senses are quite characteristic, and frequently aphasia 
(intellectual) or alabia (peripheric disturbance of speech) occur. Cerebral 
paraplegia is very rare, and generally occurs in the form of two separate 
hemiplegise, one side being more severely attacked than the other. 

Myopathic paralyses commence in particular muscles and gradually 
spread to others, frequently from one muscular fasciculus to another; they 
are preceded by atrophy; they are accompanied by fibrillar contractions and 
pain in the muscles, a diminution of the electrical excitability, and the pres- 
ence of a demonstrable local cause. 

Therapeutic Hints. 

Aeon. From congestion of spinal cord, attended with numbness of the 
parts. 

s£sc. glab. Is recommended for paralytic affections of the lower ex- 
tremities. 

Ai.sc. hipp. For paralysis of the upper extremities; back and legs 
weak. 

Agar. Paralysis of lower limbs with slight spasms of arms; pain in 
lumbar region and sacrum; crosswise affections. 

Alum. met. Paralysis from spinal diseases; loss of sensibility of the 
feet; inability to walk except with open eyes, and in the daytime. 

Anac. After apoplexy; loss of memory; imbecility of mind; loss of 
will. 

Apis. mel. One side paralyzed, the other twitching; cerebral origin. 

Arg. nitr. Paraplegia from exhaustion. 

Arnica. In consequence of exudations within the brain or spine; in 
consequence of apoplexy, of concussions, of weakening diseases of protracted 
intermittent fevers and ischias. 

Arse?i. When associated with great prostration and neuralgic pains; 
also in spinal affections with gressus gallinaceus, and as an antidote to lead- 
poisoning. 



832 THERAPEUTIC HINTS TO PARALYSIS; AKIXESIS. 

Bar. carb. General paralysis of old age, with loss of memory and 
trembling of the limbs; also after apoplexy in old age, and especially in 
paralysis of the tongue. 

Bcllad. Apoplexy; congestion of the head; paralysis of the one and 
spasm of the other side of the body; paralysis of the face; locomotor ataxy. 

Cauloph. Paraplegia in consequence of retroversion and congestion of 
the womb after child-birth, with partial loss of sensation in the affected 
limbs; considerable emaciation, anaemia and general debilit}\ 

Caustic. Paralysis of the face or tongue or hemiplegia, with giddiness, 
weakness of sight, weeping mood; hopelessness; fear of death; drawing, 
lame feeling in the affected part; after exposure to severe, cold winds; 
catarrhal and rheumatic conditions; suppressed eczema or other chronic 
eruptions; apoplex}*. 

China. After great loss of blood. 

Cina. Paraplegia with unnatural hunger. ( Lounsbury. ) 

Coccul. Paralysis of face or tongue or pharynx; paraplegia; rheumatic 
lameness; in weakened and nervous subjects, who are inclined to fainting fits 
and palpitation of the heart; also when the paralytic affection originates in 
the small of the back after taking cold, with cold feeling of the extremities 
and oedema of the feet; likewise after apoplexy. 

Colchic. After a sudden suppression of general perspiration or of sweat 
of the feet by getting wet. 

Conium. Paralysis from periphery upwards; old women; humid tetters. 

Cuprum. After apoplexy, when there is congestion in the chest, strong 
palpitation of the heart, or slow, w T eak and small pulse; the eyelids keep 
closed and twitch; when opening the eyes, the eyeballs move about; paraly- 
sis after cholera and typhus; paralysis commencing at the periphery and 
progressing towards the centre. 

Curare. Nervous debility from loss of fluids or after exhausting illness 

Dulcam. After taking cold : and suppressed eruptions; paralysis of the 
upper and lower extremities, and the tongue; the paralyzed arm feels icy 
cold. 

Ferrum. After great loss of vital fluids. 

Gelsem. Loss of motion, but not sensation; paralysis of the organs of 
deglutition, and in aphonia, fallowing diphtheria; locomotor ataxy; para- 
plegia. 

Grapliit. Rheumatic, peripheric paralysis of the face. 

Hepar. After mercurial poisoning. 

Hyosc. After spasms. 

Ignat. After great mental emotions and night-watching in the sick- 
chamber; hysterical paraplegia. 

Kali carb. Trembling; paralytic weakness, with cramps in fingers and 
hands; also paralytic weakness in the hip-joint. 

Kali, phosph: After exhaustion of nerve power, after hysteria. 



THERAPEUTIC HINTS TO PARALYSIS; AKINESIS. 833 

Laches. Especially left side; awkward, stumbling gait; gressus galli- 
riaceus; after apoplexy. 

Mercur. Rigidity and immobility of all the limbs, although they can 
be easil3 T moved by others; indescribable malaise of body and soul; trembling 
of limbs and bod}-; paralysis agitans. 

Natr. mur. Paralytic condition of the lower limbs; painful contraction 
of the ham-strings; after intermittent fevers, diphtheria, sexual excesses and 
violent fits of passion. 

Nax vom. Incomplete paralysis of the face, arms legs, with vertigo; 
weak memory; darkness before the eyes; ringing in the ears; loss of appetite; 
burning in the stomach; flatulence; vomiting after eating and drinking; con- 
stipation; especially in drunkards; after apoplexy, mental overexertion. 

Oleand. Painless stiffness and paralysis of the limbs; insensibility of 
the whole body; or hyperesthesia, skin sore from the ordinary friction of the 
clothing; trembling of the knees when standing, and of the hands when 
writing; preceded by spells of vertigo a long time before paralysis develops 
itself. 

Opium. Paralysis and insensibility after apoplexy; in drunkards; in 
old people; retention of stool and urine. 

Ox. ac. Paralysis from inflammation of spinal cord; limbs stiff; par- 
oxysms of dyspnoea. 

Phosphor. Paralysis in consequence of spinal affections; after sexual 
excesses; after confinement; tingling and tearing pain from the back down 
into the limbs; gressus vaccinus. 

Picric ac. After tonic and clonic spasms; on standing keeps legs wide 
apart, looks steadily at objects as if unable to make them out; limbs feel as 
if in an elastic bandage, particularly the legs; wasting palsy; progressive 
locomotor ataxy. 

Plumbum. Paralysis complete with atrophy of the affected parts, pre- 
ceded by trembling; mental derangement. 

Psorin. After debilitating acute diseases. 

Rhus tox. Rheumatic paralytic affections after getting wet, and after 
great or unwonted muscular exertions, strainings, etc. ; in consequence of 
typhoid processes; with painful stiffness, tearing, drawing and aching of 
the whole body; sometimes with tingling and numbness of the parts, or con- 
tinued cold feet for a long time; worse during rest, and when commencing to 
move, from washing in cold water, with every change of the weather; better 
from dry heat near the stove, from continued gentle moving about, and flex- 
ion of the limbs. 

Ruta. Facial paralysis after catching cold. 

Secale. Paralysis after spasms and apoplexy, with rapid emaciation of 
the affected parts, and involuntary discharges from bowels and bladder. 

Silic. Paralysis of the left hand, with atrophy and numbness in the 
fingers; paralysis of the legs, always worse in the morning, with heaviness 
of the head and ringing in the ears. 
53 



834 THERAPEUTIC HINTS TO PARALYSIS; AKIXESIS. 

Stannum. Hemiplegia, especially on the left side, with a feeling of a 
heavy load of the affected arm and corresponding side of the chest, and fre- 
quent night-sweats. 

Stramon. After convulsions; also paralysis of the one and spasms of 
the other side. 

Sulphur. After typhus, exanthematic fevers, suppressed itch or chronic 
eruptions and spasms; also when other remedies seem to fail. 

Tarant. Numbness and formication and loss of motor power. 

Terebhith. Paralysis of right arm and left leg. (Berridge. ) 

Zincum. Worse after drinking wine; great restlessness of feet; after 
suppressed foot-sweat. 

Besides, compare the following, which are partly taken from Jahr- 
for— 

Paralysis of the eyelids: Aniica, Arg. nitr.^ Bellad., Canthar., Coccul., 
Cupr. ac, Luphorb., Gclsem., Hyosc, Nitr. ac, Opium, PI lanbum, Rhus tox . , 
Sepia, Spigel., Stramon., Veratr., Ziyicum. 

Paralysis of the face: Bellad., Caustic, Coccul., Graphit., Nux vom., 
Opium. 

Paralysis of the tongue and organs of speech: Aeon., Arnica, Arse?i., 
Bar. card., Bellad., Caustic, Coccul., Cuprum., Dulcam., Hepar., Hydr. ac, 
Hyosc, Laches., Mur. ac, Opium, Plumbum, Stramon. 

Paralysis of the organs of deglutition ; Bellad., Canthar., Caustic, Coccul., 
Cup?'um, Gclsem., Laches., Silic, Stramon. 

Paralysis of the bladder: Arsen., Bellad., Canthar., Dulca?n., Gelsem., 
Hyosc, Laches., Lycop., Natr. mur., Opium. 

Paralysis of the rectum and sphincter ani : Caustic , Coloc , Hyosc. , Ly- 
cop., Opium, Phosphor., Ruta, Zinc sulph. 

Paralysis of all the limbs : Arnica, Arsen., Colchic, Dulcam., Gelsem., 
Meratr., Nux vom., Rhus tox., Sanguin. 

Paralysis of the upper extremities: Aeon., Alsc. hipp., Arnica, Bellad., 
Calc carb., Caustic, China, Coccul., Colchic, Dulcam., Lycop., Mercur., 
Nitrum, Nux vom., RJuis tox., Sepia, Tart, emet., Veratr. 

Paralysis of the right arm and left leg: Terebinith. 

Paralysis of the hands: Ambrd, Arsen., Caustic, Cuprum, Ferrum, 
Natr. mur., Rhus tox., Ruta, Silic 

Paralysis of the fingers: Ambra, Calc. carb.. Cuprum, Natr. mur., Se- 
cale, Silic 

Paralysis of the lower extremities: Alum., Arnica, Bellad., Bryon., 
China, Coccul., Colchic, Dulcam., Kali carb., Mercur., Nux vom., Phosphor., 
Plumbum, Rhus tox., Secale, Sulphur, Veratr. 

Paralysis of the feet: Arsen., China, Oleand., Plumbum. 

Hemiplegia: Alum., Anac, Arg. nitr., Arnica, Bellad., Caustic, China, 
Coccul., Dulcum., Graph it., Hyosc, Kali carb., Laches., Meratr. , Phosph. ac, 
Plumbum., Rhus tox.. Sepia, Stannum, Staphis., Stramon. 



THERAPEUTIC HINTS TO PARALYSIS; AKINESIS. 835 

Left-sided hemiplegia: Arnica, A rse?i., Bellad., Caustic., Laches., Rhus 
tox. 

Right-sided hemiplegia: Arnica, Bellad., Caustic, Rhus tox. 

Paralysis of one and spasms of the other side : Bellad., Laches., Stramon. 

Paraplegia: Coccul., Lauroc, Nux vom., Secale and others. 

Paralysis in consequence of — 

Mental emotions: Arnica, Ig?iat., Natr. mur., Stannum. 

Bodily exertions : Arsen. , Arnica, Rhus tox. 

Spasms: Arsen., Caustic, Coccul., Cuprum, Hyosc, Lauroc, Nux vom., 
Plumbum, Rhus tox., Secale, Silic, Stannum, Stramon., Sulphur. 

Apoplexy: Arnica, Anac, Bar. carb., Caustic, Cuprum, Laches., Nux 
vom., Plumbum, Secale, Stannum, Stramon., Zincum. 

Taking cold: Arnica, Caustic, Colchic, Dulcam., Mercur., Rhus tox. 

Getting wet: Caustic, Nux vom., Rhus tox. 

Suppression of sweat : Colchic 

Onanism, sexual excesses: China, Coccul., Ferrum, Natr. mur., Nux vom., 
Sulphur. e 

Rheumatism: Arnica, Bar. carb., Bryon., Canthar., Caustic, China, 
Coccul., Ferrum., Gelsem., Lycop., Ruta, Sulphur, Tart. emet. 

Intermittent fevers: Arnica, Arsen., Laches., Natr. mur., Nux vom., 
Rhus tox. 

Typhus fever: Coccul., Cuprum, Nux vom., Rhus tox., Sulphur. 

Diphtheria: Arsen., Gelsem., Laches., Natr. mur. 

Cholera: Cuprum, Secale, Sulphur, Veratr. 

Suppressed eruptions: Caustic, Dulcam., Hepar, Sulphur. 

Poisoning by arsenicum : China, Ferrum, Graphit., Hepar, Nux vom. 

Poisoning by lead : Cuprum, Opium, Platina. 

Poisoning by mere: Hepar, Nitr. ac, Staphis., Stramon., Sulphur. 



THE BLOOD. 



The blood being the fluid which nourishes all parts of the system, which 
sustains respiration, which, in short, is the life of the body, must necessarily 
cause great disturbances of the body when it becomes in any way abnormally 
changed. The blood consists of corpuscles and serum. The corpuscles are 
of two kinds — red, and colorless or white. The serum contains water, fibrin, 
albumen, salts, fatty substances and extractive matters. 

Any of these constituents may be abnormally increased, decreased, or 
altered, causing an abnormal condition in the quality of the blood. 

The whole mass of the blood may be increased or decreased, causing an 
abnormal quantity. Obnoxious substances, like sugar, uric acid, oxalic acid, 
ammonia, sulphuretted hydrogen, urates, gall, pus, may be mixed with, and 
thus deteriorate the blood, causing a poisoned state of the whole fluid. 

Cyanosis. 

The blood-corpuscles absorb the oxygen, with which they come in con- 
tact during their course through the lungs. Any cause which prevents this 
absorption of oxygen by the blood-corpuscles hinders the transformation of 
the venous into arterial blood. This is the nature of cyanosis. It consists in 
a decreased absorption of oxygen by the blood corpuscles. Its Causes are 
numerous, and may be arranged under the following heads: 

i. Imperfect respiration, in consequence of spasms, or oedema, or croup- 
ous inflammation of the glottis and larynx; or in consequence of obstructions 
within the trachea and bronchial tubes, caused by spasms, mucus, blood, 
foreign bodies, false membranes; or in consequence of obstacles which pre- 
vent the air from entering the air-cells of the lungs, caused by infiltration, 
hepatization, exudation (emphysema, hydrothorax, pneumothorax); or in 
consequence of paralytic affections of the respiratory muscles and diseases of 
the abdomen, by which the lungs become compressed; enlargement of the 
abdominal organs, tympanites, ascites, etc. 

2. Imperfect circulation, in consequence of heart disease, obstructions 
within the pulmonary vessels, obliteration of the pulmonary tissue and blood- 
vessels, immediate transmission of the venous blood into the left ventrical, 
in consequence of the non-closure at birth of the foramen ovale. 

3. Inhalation of air, which contains too little oxygen, and is impreg- 
nated with irrespirable gases, like carbonic acid gas, etc. 

4. Inability of the blood-corpuscles to absorb oxygen. This has been 
observed in some severe illnesses, such as typhus, pyaemia, and in the last 
stage of pulmonary tuberculosis; cholera. 



DISSOLUTION OF THE RKD BLOOD-CORPUSCLKS. 837 

Symptoms. — Bluishness of the surface of the body, especially of the 
face and lips; coldness of the extremities and depression of the muscular 
and nervous system; sopor; in a still higher degree, asphyxia. 

Cyanosis is, therefore, not a disease in itself, but a mere consequence 
and symptom of other derangements; still as a symptom it has, nevertheless, 
some therapeutic value, suggesting Aeon., Amm. carb., Arnica, Arsen., 
Camphora, Carb. veg., Conium, Cuprum, Digit., Laches., Opium, Pulsat., Rhus 
tox., Sambuc, Secale, Veratr. 

In newborn children, where the foramen ovale has not closed, Laches. 
In consequence of persistence of the ductus Botalli, Lauroc 

Dissolution of the Red Blood-Corpuscles. 

Each blood-corpuscle lives a certain period of times, and after that it 
disintegrates and disappears and new ones form in its place. Thus a constant 
rotation between life and death goes on in these minute bodies in order to 
sustain the life of the whole body. In disease, however, this equilibrium is 
sometimes destroyed; more corpuscles die than are generated, and this causes 
a state of the blood which is called Oligocythemia. It is characterized by 
weakness of the muscular system, tired feeling all over; nervousness, palpi- 
tation of the heart, bellows-sounds of the heart and large arteries; murmur 
in the jugular veins. 

In still other cases the dissolution of the blood- corpuscles goes on so 
rapidly and to such an extent that the blood-serum becomes overloaded with 
the constituents of the destroyed corpuscles, and is thus discolored. Even 
the excretions of the body assume a bloody or dark appearance; and the 
exudations are of a brownish, or still darker hue. The skin and mucous 
membranes become tinctured with haematin (the coloring matter of the 
blood), and color it yellowish, which may be mistaken for jaundice. 

If such a profuse dissolution of blood-corpuscles is confined to a certain 
portion of the circulation, it constitutes an essential part in what is called 
Local Gangrene. A general septic dissolution through the whole system is 
General Gangrene, Septicaemia. We find such states of general dissolution 
in some forms of typhus, scurvy, puerperal fever, yellow fever, and various 
other forms of tropical and infectious fevers. 

Compare Alum, Arsen., Carb. veg., China, Kali phos., Laches., Nitr. 
ac, Secale. 

Leucocythaemia, Leukaemia. 

' ' The number of the colorless cells is so much increased that the blood 
has a whitish color," that is, under the microscope. Virchow thought, by 
finding this state of the blood in some cases, he had discovered a new disease. 
And as, according to his observations, the predominance of the white cor- 
puscles appeared in connection with enlargement of the spleen and tumors 
of the lymphatic glands, he distinguished two forms of leukaemia, the splenic 
and the lymphatic. To this has recently been added a third form, Neumann's 



838 HYDREMIA. 

myelogenous leukaemia, which is presumed to have its starting point in the 
bony marrow. 

The patients complain, long before any increase of the white cells in the 
blood can be discovered, of prostration, dislike to work, dull pains in the 
splenic region, headache, dizziness, ringing in ears, palpitation, shortness of 
breath, enlargement of the lymphatic glands in various parts of the body, 
but especially in the cervical, jugular, axillary and inguinal regions. How- 
ever, there are cases of considerable tumors of the spleen and lymphatic 
glands without leukaemia. 

This • ' new ' ' disease of Virchow has been well known and studied in 
all its features (except the accumulation of the white blood-corpuscles), by 
the older physicians, under the name of Sycosis, who considered it as the ef- 
fect of a contamination with gonorrhceal poison, while Virchow and his fol- 
lowers saw the cause in the surplus of white cells — without explaining the 
cause of this accumulation, which, as stated before, is often not present until 
a late period of the disease. Thus, instead of having discovered a new dis- 
ease, Virchow has found merely a new symptom of an old disease. Com- 
pare Von Grauvogl upon this subject in his great work, "Lehrbuch der Horn- 
ccopathie." 

Therapeutic Hints. 

Grauvogl recommends Natr. sulph. and Thuja as the main remedies. 

Other remedies, however, especially those of the hydrogenoid order, may 
likewise be indicated by special symptoms; such remedies are: Natr. nitr., 
A T atr. carb., Natr. acet., Kali, nitr., Calc. carb., Magn. carb. and phosph. y 
Silic.,Iodium, Broniium, Chlor., Nitr. ac, Natr. mur., Borax, Antimon., 
Alum., Carb. veg., Arnica, Aranea diad., Pulsat., Nux vom., Ipcc, Arsen. y 
Conium, Apis, Spigel., and animal food. 

Hydrsemia 

Consists in a decrease of albumen and an increase of water in the serum san- 
guinis. In consequence of this the serum is much more prone to exudation 
than in its normal state, and we therefore find this state of the blood fre- 
quently associated with dropsical effusions. 
Its CAUSES may be: — 

1. Long-continued pathological secretions of clear albumen, or albumi- 
nous substances (mucus, milk, etc.); in consequence of albuminuria, serous 
diarrhoea, pus-formation, exudation, loss of blood, mucous discharges, too 
copious flow of milk, too long- continued nursing. 

2. Insufficient supply of nutriment or disturbed nutrition, so that the re- 
ceived nourishment is not converted into albumen and assimilated. Hydre- 
mia is therefore found in connection with the most different morbid processes. 
We find it in combination with disease of the heart and lungs, especially 
tuberculosis, chronic indigestion, protracted intermitting fevers, Bright's 
disease, etc. 



plethora. 839 

Therapeutic Hints 
Must be sought for under the above-named morbid conditions. 

Plethora. 

The quantity of the blood must always be estimated as a relative mass. 
We cannot say, so much is just enough, one ounce more is too much. And 
in fact during life we have no means for such estimation. The whole ple- 
thoric theory therefore rests upon a rather weak foundation. On the other 
hand, if we observe different individuals, it seems clear enough that some are 
richer in this vital fluid than others. And as objective signs, which indicate 
such repletion, are stated: 1. A higher degree of redness of the body — such 
higher color, however, may be often very fallacious; it is of any account only 
when it is perpetually so; and, 2. The greater fullness and repletion of the 
circulatory vessels, arteries and veins. This is plethora of olden times. More 
recent observers have split this theory into three branches. 

They divide plethora of old into — 

1. Plethora vera, true plethora, which is said to characterize itself by 
fullness of the arteries and veins, repletion of single organs, florid complex- 
ion and increased temperature of the body. 

2. Serous plethora, an increase of blood-serum, and decrease of cor- 
puscles, which characterizes itself by the fullness of the arteries and veins, 
paleness, or else quick change of color; and, 

3. Plethora ad vasa, or false plethora, which is not too much blood in 
general, but too great an afflux of blood into the blood-vessels, as in fevers, 
in consequence of bodily and mental exertions, spirituous, irritating drugs, 
etc. 

All these distinctions are of little use for Homoeopathic practice, as the 
Homoeopathic physician will scarcely have occasion to trouble his brain with 
the question : Shall I bleed ? or shall I not ? 

Symptomatic Anaemia, Oligsemia. 

The first denotes a want, the latter a poorness of the blood; the exact 
pathological meaning is a diminution of plasmatic albuminates, of red cor- 
puscles and of water in the blood; changes in quality and quantity of other 
blood-constituents are of minor consideration. 

A sudden loss of blood by haemorrhage (internal or from wounds), al- 
though producing a state of anaemia, and in consequence thereof, perhaps 
general epileptiform convulsions, loss of consciousness, delirium, hiccough, 
retching, vomiting and death, does not exactly belong here. We here 
consider the subacute and chronic forms of anaemia, the Causes of which are 
exceedingly various. They may consist of: deficient supply of food, a want 
of light and air, too little or too much exercise, too high or too low tempera- 
ture, excessive losses of semen, too long-continued lactation, profuse men- 
struation, great care, or grief, or mental overwork, albuminuria, blennor- 



840 PROGRESSIVE PERNICIOUS ANEMIA. 

rhoeas of the different mucous membranes, diarrhoea and dysentery, extensive 
suppuration, large effusions in the pericardial, pleural or peritoneal cavities, 
infiltration into the lung tissue, malignant growths, malarial infections, 
mineral poisonings (acids, phosphorus, etc.), animal parasites, especially the 
anchylostomum duodenale (compare the chapter on Intestinal Worms), in- 
digestion, diseases of the spleen, lymphatic glands, etc., and fever. 

The Symptoms of anaemia are: paleness of the skin and mucous mem- 
branes, dropsical effusions in consequence of the diminished albumen in the 
blood, emaciation, marasmus or general atrophy of the tissues, a tendency to 
degenerative processes and haemorrhages, and a decrease of the normal tem- 
perature, even down to 95 ° F. , and lower; muscular exhaustion, irritable weak- 
ness, anaemic murmurs over the region of the heart, and the " Nonnen- 
gerausch," or "bruit de diable," a continous humming sound over the 
internal jugular veins; dyspnoea. v 

The Duration and Prognosis of anaemia depends altogether upon the 
causes to which it owes its origin. 

Progressive Pernicious Anaemia, Idiopathic Anaemia, 

Also known under the names of essential malignant and essential febrile 
anaemia, includes those cases of extreme anaemia which tend uninterruptedly 
towards a fatal issue, and of which no adequate cause can be discovered, 
either in the patients' circumstances or in the previous state of their constitu- 
tion. Its parholog}* and causes are shrouded in utter obscurity. It attacks 
most frequently women from the age of twenty to that of forty, and the cases 
described and classed under this new term by Biermer and Gusserow have 
principally been observed in Switzerland. Most cases were those of preg- 
nant women. 

The Symptoms begin insidiously with a gradual paling of the skin and 
mucous membrane, increasing to a degree as found in acute anaemia from 
haemorrhage. A wasting of the tissues (marasmus) is usually not observed 
until fever sets in, but other symptoms of anaemia associate early w T ith the 
increasing paleness. Such are: Palpitation of the heart; a loud blowing, 
systolic murmur and purring tremor over the heart, and the venous hum in the 
jugular veins, characterized by great constancy and intensity; irritable weak- 
ness and great prostration with severe fainting fits from slightest exertion; 
dyspnoea, is hardly able to speak above her breath; effusion into the pericar- 
dium and pleura, and puffiness of the legs; haemorrhages from different parts 
of the body; the nose, gums, genital organs in women, and the skin in the 
form of petechiae and occasionally as large patches of ecchyinosis; haemor- 
rhages in the retina and other internal parts. The fever is of an irregular 
type, w T ith temporary exacerbations, when the temperature may run up to 
104 F. As the end approaches it is prone to fall suddenly as low as 95 ° or 
even 93. 2 ° F. When occurring during pregnancy, it usually induces pre- 
mature labor, and this is the forerunner of death. 

With all these severe symptoms, Physical Examination shows no 



CHLOROSIS. 84I 

organic disease of the heart, nor of the kidneys (no albuminuria), nor of the 
spleen, liver or Emphatic glands, and microscopic examination reveals no 
disproportion in the relative number of red corpuscles and leucocytes, thus 
distinguishing this disease thoroughly from leukaemia. From chlorosis it 
differs by its dropsical symptoms and its haemorrhagic diathesis, and from 
other forms of anaemia by its fever. 

The duration of this disease is seldom less than six or eight weeks, and 
seldom more than the same number of months. - - Our present experience 
justifies us in regarding every case as tending inevitably to a lethal issue." 
(Immermann.) 

Therapeutic Hints. 

In any case of anaemia we must, above all things, determine its cause or 
causes, and remove such if possible. Nutritious diet, pure air, and rest, are 
important in the treatment of anaemia. As a mere symptom anaemia may 
hint to the one or the other of the following remedies: Arsen., Calc. carb., 
Card, veg., China, Cuprum, Ferrum, Helon., Hydrast., Kali carb., Natr. 
mur., Nux vom., Sulphur, Veratr. and many more. 

Chlorosis, Green Sickness. 

Chlorosis is a form of primary anaemia characterized by a marked 
diminution in the amount of haemoglobin in the blood, and a slight decrease 
in the number of red-corpuscles. In severe persistent cases there is often 
observed an imperfect development of the organs of circulation and reproduc- 
tion. The albuminates and leucocytes seem not to be affected, and this is 
an important pathological distinction between it and anaemia, in which latter 
there is always a decrease of the plasmatic albuminates. 

The disease is almost entirely limited to the female sex, between the 
fourteenth and twenty-fourth years of life; it is especially, therefore, a dis- 
ease of the age of female puberty, seems often to grow upon a hereditary 
disposition, a peculiar constitutional habit of the body, and may be excited 
by conditions incidental to modern social life, or atmospheric and telluric 
influences, or by emotional disturbances, such as terror, anxiety, disappointed 
love, homesickness and the like. 

Its Symptoms are manifold: 

1. Color of the skin. A conspicuous paleness, sometimes clear, some- 
times yellowish, greenish, waxy. Even the lips and other mucous mem- 
branes appear pale; dark rings around the eyes. In some cases there is 
oedema of the feet, face and eyelids; temperature decreased; breath cool; 
lips, nose, ears, hands and feet cold. The patient is sensitive to cold, seeks 
a warm room. 

2. Circulation. The pulse is usually small and compressible, varying 
in frequency, easily excited by any trifling cause. The heart's impulse varies 
likewise in frequency and intensity, amounting often to strong palpitations. 



842 THERAPEUTIC HINTS TO CHLOROSIS. 

Sometimes the palpitation of the heart becomes habitual, and is one of the 
most prominent, and, at the same time, most annoying symptoms. Physical 
signs are those of anaemia: systolic murmurs over the apex of the heart, and 
humming sounds over the jugular veins. The latter are the most constant. 

3. "Respiration is frequently dyspnceic, especially after any exertion; the 
patients sigh and cough occasionally 

4. Muscular system. Great weakness; easily tired and exhausted. 

5. Nervous system. Dizziness; headache; noise in the ears, especially 
in the right ear; pains in different parts of the body, especially in the stomach 
and back; even hysterical spasms; sadness; want of energy; frightful 
dreams; nightmare, melancholy, and even mania, and inclination to self-de- 
struction. 

6. Digestion. Want of appetite; digestion slow; sour and foul eructa- 
tions; desire for sour things; morbid desire for chalk, paper, ashes, coals, 
even excrements. Often the most indigestible things — pork, beans, pastry, 
etc. — suit better than light soups, meat, etc. However, these digestive 
symptoms are, in some chlorotic persons, entirely wanting. 

7. Genital sphere. There is generally amenorrhcea or irregular men- 
struation with pain; thin, watery leucorrhcea in place of the menses, or in 
some cases menorrhagia. 

Chlorosis is often combined with hysteria and chronic paroxysms; also 
Basedow's or Graves' disease stands in undoubted connection with it; and 
other neuroses, such as cardialgia, headache, toothache, backache, etc., are 
found as frequently in chlorosis as in anaemia. 

Its Duration is variable ; under proper treatment it may }deld in a com- 
paratively short time; otherwise it may last for years. Marriage sometimes 
relieves at once. Complications, such as acute febrile disease, phthisis, 
endocarditis, gastric ulcer, etc., of course, change its favorable prognosis. 

Therapeutic Hints. 

A?it. cnid. Menses commence at an early period, are profuse and cease 
afterwards; great deal of headache; peevishness; loss of appetite; irregular 
stool; excessive laziness and weakness, must lie down for hours; deep and 
unrefreshing sleep at night. 

Arsen. Trembling; frequent fainting; excessive debility; pernicious 
anaemia. 

Bellad. Laziness and indisposition to work or stir, great general de- 
bility, with 'weariness and a desire to sleep in the afternoon; shortness of 
breath; extreme paleness of the face changes instantaneously to redness, 
with cold cheeks and hot forehead. 

Bryon. All the symptoms worse from the slightest motion. 

Calc. card. Scrofulous diathesis; disposition to colds and diarrhoea; 
great weakness or curvature of the spine; vertigo, especially on going up 
stairs; disgust for meat; craving for sour and even indigestible things (chalk, 
coal, etc.); after eating, swelling of the stomach and palpitation of the heart; 



THERAPEUTIC HINTS TO CHEOROSIS. 843 

menses sometimes too often and too profuse, or wanting; leucorrhoea; great 
weakness of breath; great weakness of the muscles; walking wearies and 
makes the heart palpitate; sitting causes severe backache and headache; 
therefore constant inclination to lie down; hands and feet are cold; the fingers 
sometimes appear dead. The mind is generally full of concern about 
imaginary things that might happen to her. 

Card. veg. When complicated with itch and fluor albus; the gums are 
swollen, scorbutic and receding from the teeth; the teeth are loose; feels 
wretched all over; can scarcely walk. 

China. In such cases as result from loss of vital fluids, menstrual or 
vicarious bleeding, suppurations, etc. ; or which set in after severe and pro- 
tracted illness, such as intermittent fevers, typhus, cholera, etc. ; showing in 
either case a tendency to dropsical effusions and oedematous swellings. Be- 
sides we observe sour belching, poor digestion, bloated abdomen. 

Cina. On drinking wine she shudders as though it were vinegar; spas- 
modic yawning; headache, pain in the chest and back, caused by fixing the 
eyes steadily upon some object, as, for example, when sewing; all these pains 
are aggravated by external pressure; spells of intermittent fever every after- 
noon at four o'clock, w T ith thirst and coldness of the hands and feet; colic 
and vomiting of ingesta; afterwards heat and sweat, followed by deep sleep. 

Conium. Menses wanting; genitals very sensitive; constant dry heat 
all over, without thirst; stitching pain in the region of the liver, and heavi- 
ness in the limbs; weeping mood; restlessness; great concern about any little 
thing that may happen; anxious dreams. 

Cuprum. Disposition to laryngeal and tracheal affections, to vomiting 
and purging; sweating of feet; torpid cases. (Von Grauvogl.) 

Cyclam. Suppressed menses; or scanty, painful menstruation; head- 
ache; vertigo; swollen eyelids; pale face, lips and gums; loss of appetite; no 
thirst; constipation; palpitation of the heart; constant chilliness; dread of 
fresh air; disinclination to move and to work; constant drowsiness; wants to 
be alone, and weeping does her good. Is very similiar to Pulsat. differing, 
however, from it, by its dread and disinclination for tresh air. 

Ferrum. Anaemia, characterized by great paleness of all the mucous 
membranes, especially that of the cavity of the mouth, by the bellows-sound 
of the heart and anaemic murmur of the arteries and veins; by great paleness 
of the face, which, however, is very apt to suddenly become fiery red, with 
vertigo; ringing in the ears; great palpitation of the heart and dyspnoea; 
thus showing a disposition to congestion and fluxion of the blood to these 
parts of the body. All the muscles are feeble and easily exhausted from 
slight exertion ; there is frequent vomiting of ingesta, especially after eating 
and frommotiom; cardialgia; the menses are either suppressed or watery; we 
observe general emaciation; oedematous swelling of the body; cool skin: 
constant chilliness and evening fever, simulating very closely hectic fever. — 
Florid cases, with disposition to phthisis, haemoptysis, menorrhoea, scrofulous 
inflammation of eyes, diarrhoea, ascarides, etc. (Von Grauvogl.) 



844 THERAPEUTIC HINTS TO CHLOROSIS. 

Graphit. Scanty, pale, delaying menses, or they do not appear at all; 
cold vagina; aversion to coitus; oedema of the eyelids, external genital or- 
gans and abdominal parietes, leaving on pressure the imprint of the finger; 
face pale and yellowish. 

Ignat. Sensitive, nervous, hysteric women, who are inclined to spas- 
modic and intermitting complaints, and where the trouble is induced by 
mental emotions, such as fright, grief, disappointed love, etc. 

Ipcc. Headache, as though the brain were mashed, with nausea and 
vomiting; miliary eruptions on the forehead and cheeks by spells; pale face 
and pale mucous membranes; weak pulse; cold hands; morose, enjoys noth- 
ing. 

Natr. mur. In chronic cases and cachectic individuals, with dead, 
dirty, withered skin; frequent palpitation and fluttering of the heart; sup- 
pressed menstruation; leucorrhoea; diminished sexual desire; oppression and 
anxiety of the chest; sadness. 

Nux vom. Especially in those cases in which the functions of the 
stomach, intestines and liver are principally affected, and we may observe a 
train of symptoms like the following: irritable, angry disposition; great 
anxious concern about little things; headach, with bilious or sour vomiting, 
worse in the morning; pale, earthy face; feeling badly after eating bread or 
sour things; sour taste in the mouth; craving for chalk ; nausea and vomit- 
ing in the morning or after eating; cardialgia, with wind in the stomach, 
better from drinking something hot; obstinate constipation; running of the 
nose through the day, and stoppage of it at night; sore feeling all over in 
bed in the morning; dreads motion and fresh air; gets awake earty in the 
morning, then dozes again and wakes up finally, feeling much worse than 
at any other time. 

Phosphor. In deep-seated, chronic cases, with tubercular diathesis; 
brought on by depressing mental influences, such as grief, worriment, disap- 
pointed love, or by exhausting bodily causes, such as night- watching, loss of 
blood, diarrhoea, night-sweats, onanism, etc. We observe, in such cases, 
puffiness around the eyes, dry, hacking cough, great weakness in the sexual 
organs, consequent upon previous irritation of these parts; leucorrhoea of a 
whitish, watery, slime, especially profuse during the time of the menses, 
sometimes acrid and corroding; a total loss of energy in all the organic func- 
tions of the body. 

Plumbum. Want of breath and great oppression of the chest from 
motion; palpitation of the heart; obstinate constipation; oedema of the feet 
and anasarca; great muscular weakness. 

Pulsat. Great weakness and sluggishness in the circulation, manifest- 
ing itself in constant chilliness, coldness and paleness of the skin and face, 
with hot flashes and transitory redness of cheeks; soft, irregular pulse and 
palpitation of the heart, oppression of the chest and shortness of breath; 
disinclination to move and a sad and tearful disposition; the appetite is 
generally absent, and there is no thirst; the whole digestion is disturbed, 



DIGEST TO CHLOROSIS. 



845 



and consequently the assimilation of nutriments for the blood does not take 
place properly. We observe, therefore, signs of anaemia, such as dizziness 
especially when rising, and amenorrhcea, or scanty, slimy menses, which 
appear too late; in general the patient feels better in the open air. This 
distinguishes Pulsat. from Cyclam. It is frequently indicated after Calc. 
card. , Ignat. , Septa or Sulphur, and is followed well by Ferrum. Disposition 
to intermittents, melancholia, hysteria, heart and kidney diseases, discharge 
from ears, (von Grauvogl.) 

Sabina. Amenorrhcea; frontal headache, pressing down upon eyes, 
worse in morning on rising, better in fresh air; blue rings around eyes; 
nausea and qualmishness when in a crowd; burning in pit of stomach, with 
twisting and gurgling in bowels; bearing down; drawing pain in extremities; 
worse at night; lassitude and sleepiness. (Watzke.) 

Sepia. Bearing down as if everything would issue out of the genitals; 
prolapsus uteri and vagina; brown-reddish color of the vagina; diphtheritic 
ulcers in the vagina and on the labia; leucorrhcea, yellowish and passing 
away in starts; swelling of the external genital organs, with itching, burning 
and soreness; stitching pains in the ovarian region; palpitation of the heart, 
intermitting pulsation; occasionally a hard thump of the heart; frequent 
sickness at the stomach ; brought on even by the smell of cooking. Uneasi- 
ness in the presence of strangers; sudden flushes, starting at trifles; tongue 
coated most at root, clearing off in patches, leaving red surface; no 
menstruation. 

Sulphur. Heat of the head with cold feet; inclination to religious reve- 
ries; inflammation of the eyelids; frequent, unsuccessful desire for stool; 
leucorrhcea; oppression of the chest with palpitation of the heart; exhaustion 
even from talking; feels worse while standing; cutaneous eruptions; sleepy 
in the daytime, restless at night; perspires easily; feels faint before dinner. 
Is often necessary as 4 a foundation for the better action of other remedies. 

Besides compare: Alet. far., Alum., Helon., Senedo aur. 



Digest to Chlorosis. 



Inclination to religious reveries: Sul- 
phur. 

Wants to be alone: Cyclam. 

Inclination to lie down: Calc. carb. 

Indisposition to work or stir: Bellad., 
Calc. carb. 

to move: Pulsat. 

, and general debility: Bellad. 

Laziness: Ant. crud., Bellad. 

Uneasy in the presence of strangers: 
Sepia. 

Anxious about little things: Conium, 
Nux vorn. 

imaginary things : Calc. carb. 

Sadness: Natr. mur. 

Sad, tearful disposition: Pulsat. 



I Weeping mood and restlessness: Co- 
nium. 
Melancholy, hysterics: Pulsat. 
Irritable, angry: Nux vom. 
Morose, enjoys nothing: Ipec. 
Peevish: Ant. crud. 
Starting at trifles: Sepia. 



Vertigo: Cyclam. 

when rising: Pulsat. 

on going up stairs: Calc. carb. 

, with sudden redness of face: Fer- 
rum. 

Headache: Ant. crud., Cyclatn. 

, as though the brain were mashed, 

with nausea and vomiting: Ipcc. 



846 



DIGEST TO CHLOROSIS. 



, with bilious or sour vomiting, worse 

in the morning: Nux vom. 

, frontal, pressing down upon the 

eyes, worse in morning on rising, better 
in fresh air: Sabina. 

and pain in chest and back, caused 

by fixing the eyes steadily upon some 
object, when sewing; worse from exter- 
nal pressure: Cina. 

and backache from sitting: Calc. 

card. 

Heat of head, with cold feet: Sulphur. 



Disgust for meat: Calc. curb. 
No thirst: Cyclam. x Pulsat. 



Eyelids inflamed: Sulphur. 

swollen: Cyclam. 

cedematously: Graph it. 

Around the eyes, puffmess: Phosphor. 

, blue rings: Sabina. 

Ears, ringing in: Ferrum. 
, discharge from: Pulsat. 



Nose, running through day, stoppage at 
night: Nux vom. 

Face pale and earthy: Nux vom. 

and yellowish: Graphit. 

, and pale lips and gums: Cy- 
clam. 

, and pale mucous membranes: 

Ipec. 

, changing suddenly to fiery red, 

with vertigo: Ferrum. 

, , with cold cheeks and 

hot forehead: Bellad. 

, miliary eruptions on forehead and 

cheeks by spells: Ipec. 



Mucous membrane of mouth pale: 

Ferrum. 
Teeth loose, gums swollen, scorbutic and 

receding from teeth: Carb. veg. 
Tongue coated at root, clearing off in 

patches, leaving red surface: Sepia. 
Before dinner, feels faint: Sulphur. 
After eating, swelling of stomach and 

palpitation of heart: Calc. carb. 
bread or sour things, feels badly: 

Nux vom. 
On drinking wine she shudders as though 

it were vinegar: Cina. 
No appetite: Ant. crud., Cyclam., Pul- 
sat. 
Craving for chalk: Nux vom. 
for sour things and indigestible 

things (chalk, coal, etc.): Calc. carb. 



Belching: China. 

Nausea when in a crowd: Sabina. 

from the smell of cooking: Sepia. 

and vomiting after eating and from 

motion: Ferrum. 

, and in the morning: Nux 

vom . 

Vomiting of ingesta and colic: Cina. 

Burning in pit of stomach, with twisting 
and gurgling in bowels: Sabina. 

Cardialgia, with wind in stomach, worse 
from drinking something hot: Nux 
vom. 

Indigestion: Pulsat. 

and bloated abdomen: China. 

Stitching pain in liver region: Carb. 
veg. 

Constipation: Cyclam., Nux vom'., 
Plumbum. 

Irregular stool: Ant. crud. 

Frequent, unsuccessful urging: Sulphur. 

(Edema of abdominal parietes: Graphit. 

Ovarion region, stitching pain in the: 
Sepia. 

Prolapsus uteri and vaginae: Sepia. 

Bearing down: Sabina, Sepia. 

Sexual desire diminished: Natr. mur. 

Aversion to coitus: Graphit. 

Weakness of sexual organs after pre- 
vious irritation: Phosphor. 

Menses too early and too profuse: Calc. 
carb. 

commence at an early period, pro- 
fuse, but cease afterwards: Ant. crud. 

wanting or suppressed: Ant. crud., 

Calc. carb., Conium, Cyclam., Ferrum, 
Graphit,, Natr. mur., Pulsat., Sabina, 
Sepia. 

scanty, painful; Cyclam. 

, pale, delaying: Graphit. 

, slimy, too late: Pulsat. 

watery: Ferrum. 

Instead of the menses, whitish, watery, 
slimy, profuse, sometimes acrid and cor- 
roding leucorrhcea: Phosphor. 

Leucorrhcea: Calc. carb., Carb. veg., 
Natr. mur., Sulphur. 

yellowish and passing away in 

starts: Sepia. 

Vagina cold: Graphit. 

of a brown reddish color: Sepia. 



DIGEST TO CHLOROSIS. 



8 47 



, diphtheritic ulcers in: Sepia. 

External organs oedematously swollen: 
Graphit. 

, with itching, burning and sore- 
ness: Sepia. 

Genitals very sensitive: Conium. 

Dry, hacking cough: Phosphor. 
Oppression of chest and shortness of 
breath: Bel lad., Calc. carb., Pulsat. 

and want of breath from motion: 

Plumbum . 

and anxiety of chest: Natr. mur. 

and palpitation of heart: Ferritin, 

Sulphur. 

Palpitation of heart: Cyclam., Plum- 
bum, Pulsat., Sepia. 

and fluttering: Natr. mur. 

from walking: Calc. carb. 

Hard thump of heart, occasionally, and 
intermitting pulsation: Sepia. 

Bell0WS-S0nnd in heart and anaemic 
murmurs in arteries and veins: Fer- 
?'um. 

Soft, irregular pulse : Pulsat. 

Weak pulse: Ipec. 



Curvature of spine: Calc. carb. 



Spasmodic yawning: Cina . 

Constant drowsiness: Cyclam. 

Sleepy and lassitude: Sabina. 

and weary in afternoon: Bellad. 

in daytime, restless at night: Sul- 
phur. 

Deep and unrefreshing sleep at night: 
Ant. crud. 

Wakes early in the morning, dozes again 
and feels worse afterwards: Nux vom. 

Anxious dreams: Conium. 



Cold hands: Ipec. 

, fingers sometimes appear dead: Calc. 

carb. 

and feet; feet damp: Calc. carb. 

Cool skin: Ipec. 

Constant chilliness: Cyclam. 

and evening fever, similar to hectic 

fever: Ferrum. 
Intermittent fever at 4 p. m., with thirst 

and coldness of hands and feet: Cina. 
Chilliness, coldness and paleness of skin 

and face, with hot flashes and transitory 

redness of cheeks: Pulsat. 



Sudden flushes: Sepia. 

Heat and sweat, followed by deep sleep : 
Cina. 

Dry heat all over, without thirst: Co- 
nium. 

Perspires easily: Sulphur. 



Drawing pain in extremities, worse at 
night: Sabina. 

Heaviness in limbs: Conium. 

Wretched all over, can scarcely walk: 
Carb. veg. 

Must lie down for hours: Ant. crud. 

Muscular weakness: Calc. carb., Plum- 
bum. 

, easily exhausted from slight exer- 
tion: Ferrum. 

Debility, trembling, fainting: Arsen. 

Exhausted from talking: Sulphur. 



Sulphur. 

and cedematous 



Cutaneous eruptions 
Dropsical effusions 

swellings: China. 
(Edematous swelling of body: Ferrum 
of feet and anasarca: Plumbum. 



Better in open air: Pulsat. 

from weeping: Cyclam. 

Worse from motion: Bryon. 

while standing: Sulphur. 

Dreads fresh air: Cyclam. 
and motion: Nux vom. 



Caused by mental emotions, fright, 
grief, disappointed love: Ig?iat., Phos- 
phor. 

loss of vital fluids: China. 

, night- watching: Phosphor. 

protracted illness: China. 

COMPLICATED WITH: 

A disposition to heart and kidney dis- 
eases: Pulsat. 

stomach, liver and intestinal affec- 
tions: Nux vom. 

laryngeal, tracheal and intestinal 

affections: Cuprum. 

phthisis, haemoptysis, menorrhcea, 

scrofulous inflammation of eyes, diar- 
rhoea, ascarides, etc.: Ferrum. 

tubercular diathesis: Phosphor. 

cold and diarrhoea: Calc. carb. 

itch and fluor albus: Carb. veg. 



848 SCURVY, SCORBUTUS. 



intermittent affections: Ignat., Pul- 
sat. 

dead, dirty, withered skin: Natr. 

mur. 

sweating of feet: Cuprum. 

Total loss of energy in all the functions 
of the body: Phosphor. 

Pernicious anaemia: Arsen. 



Cyclam. is similar to Pulsat. , but distin- 
guished by its dread to fresh air. 

Pulsat. is frequently indicated after Calc. 
card., Ignat., Sepia, or Sulphur, and is 
followed well by Ferrum. 

Sulphur is often necessary as a founda- 
tion for the better action of other 
remedies. 



Scurvy, Scorbutus. 

This disease belongs to the general disorders of nutrition, and is charac- 
terized by an intense general cachexia in connection with various local erup- 
tions, and disorders of a hemorrhagic and haemorrhagico-inflammatory char- 
acter, most constantly observed in the gums. 

The occurrence of scurvy so extraordinarily frequent in the middle ages, 
has become much less frequent in our times; but it is still occasionally ob- 
served on the land in times of famine, in places undergoing siege, in poorly 
ventilated dwellings, and in cold and damp regions and seasons; on the sea 
during long voyages upon sailing vessels, and especially when a gloomy and 
anxious state of mind and poor food enter this combination of circumstances. 
As regards food there is no doubt, that a deficiency of fresh meat and vege- 
tables, especially potatoes and greens, induces the disease in many cases. 
And because these articles of diet contain a greater percentage of potash, 
than salt meat, dried beans and the like, some authors have unreservedly laid 
the cause of scurvy in a deficiency of potash in the food. This, however, is 
obviously wrong, since many outbreaks of scurvy are recorded where there 
was no lack of these articles. Hence, it can also be seen that a mere dietetic 
treatment will not always suffice for a cure. But there are still other con- 
ditions mentioned under which scurvy has been seen to develop, namely: 
convalescence from typhus and acute exanthemata, surgical diseases, especi- 
ally in military hospitals, and the dwelling together of old people in bene- 
ficiary hospitals. Its onset is usually insidious and its course lingering. We ob- 
serve at first a general debility, lassitude, sleepiness and depression of spirits; 
a sad-looking, pale, cachectic face, with blue rings around the eyes; loss of 
appetite, except perhaps in some cases a craving for fresh green or sour 
things; the stool is slow, the urine scanty and the skin dry. With all this 
there are aching pains, especially in the popliteal space, with circumscribed 
hardness and a light bluish color. After a few days the gums become 
swollen, spongy and bluish; they bleed at the slightest touch. There is a 
bad taste in the mouth and a fetid breath. The general debilit}' increases; 
ecchymosed spots appear on the skin; first on the legs, later all over the 
body from the size of a lentil to that of a half dollar and larger, at first 
looking purple, in severe cases black, later changing into all the different 
hues which extra vasted blood undergoes; frequent nosebleed. All these 
symptoms may reach a still higher degree; the weakness may augment to 
prostration, so that even the slightest exertion or motion causes fainting; the 



THEPAPEUTIC HINTS TO SCURVY, SCORBUTUS. 849 

gums may issue a fetid, ichorous, bloody fluid; the ecchymosed spots may 
change into blisters, rilled with ichorous fluid and forming ulcers. 

The pain in the extremities may grow still more severe, and the joints 
and bones may swell; effusions of fibrin beneath the skin may harden the legs 
like boards. The hard stools may change into a thin, ichorous and bloody 
diarrhoea, with colicky pains. The spleen is usually enlarged. Epistaxis in- 
creases, and there are even bloody secretions from the conjunctiva, respira- 
tory organs, stomach (by vomiting), and from the urinary organs, in the 
form of blood}^ urine. 

If to all these symptoms be added extravasation of bloody serum into 
the pleura, the pericardium, the lungs, the brain or its membranes, the pa- 
tient generally dies, either suddenly or gradually in consequence of increas- 
ing prostration and hectic fever. Of course, all cases do not terminate thus. 
Its duration, however, is long, lasting months, and convalescence is very 
slow, if left to nature. 

Therapeutic Hints. 

The special cases which have been brought on by a deficiency of certain 
articles of food should certainly be supplied with these articles, as a matter 
of course, where it can be done. In other cases which owe their origin to 
other causes, the mere feeding with greens and acids will certainly be of no 
avail. We shall have to look again for help in the law of similars. 

Agave America?ia. Countenance pale and dejected; gums swollen and 
bleeding; left leg, from ankle to groin, covered with dark purple blotches; 
leg swollen, painful and of stony hardness; pulse small and feeble; appetite 
poor; bowels constipated. 

Amm. carb. Hectic fever, profuse haemorrhages from the intestines, 
nose and gums; falling out of the teeth; muscles soft and flabby; emaciation. 

Arsen. The gums bleed readily; fetid smell from the mouth; violent 
thirst, which obliges him to drink frequently, although but little at a time; 
offensive diarrhoea; excessive debility; stiffness and immobility of the knees 
and feet, with violent tearing pains, worse about midnight, better from ex- 
ternal warm applications; great despondency and restlessness. 

Canthar. Pains in the gums; coagulated blood in the mouth; early in 
the morning, in bed; bloody urine. 

Carb. veg. Swelling, receding, and bleeding of the gums; nosebleed; 
readily bleeding ulcers; general physical depression; attacks of sudden weak- 
ness, like fainting; after too much salty food. 

Cki?ia. Inertia; excessive debility ; haemorrhage from the mouth, nose 
and intestines; great desire for sour things; diarrhoea. 

Hydrast. Physical prostration; fainty, weak feeling; ulcers on the 
legs. 

Kali phosph. Easily bleeding gums; putrid decomposition; prostration. 

Mercur. Spongy, bleeding gums, of a sickly appearance; they look 
white along the upper border and recede from the teeth; bluish color of the 
54 



850 PURPURA HEMORRHAGICA. 

inner cheeks; fetid smell from the mouth. Sinking with an indescribable 
malaise of body and soul, obliging him to lie down; fetid ulcers on the legs, 
which speedidly become putrid; spongy, bluish, readily bleeding ulcers. 

Mur. ac. Swelling of the gums; scorbutic gums. 

Natr. mur. Scorbutic, putrid inflammation of the gums; bloody saliva; 
difficulty of talking, as if the organs of speech were weak. 

Nitr. ac. Swelling and bleeding of the gums; the teeth are loose; 
bloody saliva; putrid smell from the mouth; after abuse of Mercury. 

Nux vom. Putrid bleeding; swelling of the gums; putrid ulcers in the 
mouth; cadaverous smell from the mouth; bloody saliva; spitting of blackish, 
coagulated blood, and blowing blood from the nose; pain in the limbs; great 
weariness and languor. 

Phosphor. The gums bleed easily and stand off from the teeth; sore, 
excoriated spots on the skin; ecchymosed spots. 

Staphis. The gums are painful to touch and bleed easily on being 
touched; scrobutic ulcers. 

Sulphur. Swelling of the gums, with throbbing pain in them; bleeding; 
fetid smell from the mouth; sleeplessness at night; desire for brandy. 

Besides, compare Cistus can., Crotal., Hepar, Kreos., Sepia, Sulph. ac. y 
Terebinth. 

Purpura Haemorrhagica, Morbus Maculosus Werlhofii. 

This is a transitory haeaiorrhagic diathesis of sporadic occurrence and a 
relatively brief duration, the etiology of which is entirely unknown; its de- 
velopment appears spontaneous. 

In this apparent spontaneity of its occurrence, without regard to age, 
previous health, or inherited predisposition of the individual attacked, it dif- 
fers from haemophilia, scurvy, and symptomatic tendency to bleeding, which 
is frequently observed as a consecutive or accompanying symptom of certain 
severe and acute or chronic diseases, such as variola, typhus exanthematicus, 
phosphorus-rJoisoning, leukaemia, pernicious anaemia, protracted icterus, etc. 

It often begins suddenly, without prodromal warnings, with petechiae 
upon the skin or epistaxis; at other times its outbreak is preceded, for sev- 
eral days, by languor, headache, loss of appetite and even moderate fever. 
In still other cases it commences with rheumatic pains in the lower extremi- 
ties especially the knees and ankles, when it has been called Purpura rheu- 
matica or Peliosis rheumatica. (Schoenlein.) 

The haemorrhagic exanthem may extend over the entire body, and the 
individual spots vary greatly in size, from that of a pinhead to that of a len- 
til, a pea or a bean. The larger ecchymoses are rare, and assume every pos- 
sible shape. These maculae are often interspersed with more or less numerous 
vesicles, which are evidently produced by circumscribed haemorrhages into 
the rete Malpighi from capillary loops of the papillae of the skin. The color 
of the maculae, when fresh, is dark bluish-red; later it changes successively 
to greenish-blue, brown and yellow. Pressure does not alter the appearance. 



H^MOPHIUA. 851 

It is exceedingly common for fresh crops to appear at varying intervals dur- 
ing the disease, which brings ab|^ut the various colors of the different ages of 
these maculae. 

As long as the disease manifests itself as a mere cutaneous eruption, it 
is called Purpura simplex ; when, however, it is attended by haemorrhages 
in other parts, it is called Purpura hemorrhagica. Such haemorrhages may 
ake place from the mucous membrane of the nose, mouth, stomach, intes- 
tines, urinary passages, genitals in women, and bronchi; they are much more 
common in morbus maculosus than even in severe cases of scurvy; but th 
bluish-red discoloration, the softening, swelling and spongy character of the 
gums, and the excessive sensitiveness of these parts, which is characteristic 
of scurvy, are entirely wanting. Haemorrhages occur exceptionally also 
within the serous cavities, in the meninges and in the substance of the brain. 
Simple cases pass over in a week or two; repeated and profuse haemorrhages 
may induce anaemic pallor, dropsical swellings, extreme weakness, fainting 
fits, etc. 

Therapeutic Hints. 

Compare, as the most important remedies, Crotal., Phosphor., Ledum, 
Bryon., Hamam., Secale, Arnica, Arsen., Ferr. p/wsp/i., Laches., Sidph. ac; 
and in cases of Epistaxis, Haematemesis, or Haematuria, the corresponding 
chapters. 

Heemophilia, Haemorrhophilia. 

By this name is meant a congenital haemorrhagic diathesis, in conse- 
quence of which even the slightest wounds, no matter where, always bleed 
very profusely. The cause is unexplainable; we only know that this ten- 
dency to bleed exists in certain families, and is propagated^ to three or four 
generations; sometimes leaping over one link and appearing again in the 
following. The female members of such families are generally, although 
not always, exempt, but they are very apt to propagate this tendency to their 
male children. 

There are no objective signs by which this diathesis could be recognized 
before the bleeding sets in. Such persons, however, are described as having 
blonde or reddish hair, a very fair skin, with tlie blood-vessels shining 
through, and blue eyes. In some cases it shows itself immediately after 
birth, as an uncontrollable bleeding of the navel; oftener during the first or 
second dentition, and in other cases still later. Then the blood oozes unin- 
terruptedly from the slightest wound, as out of a sponge, until the patient 
becomes exhausted from loss of blood. Mere bruises cause large effusions of 
blood into the cutaneous and subcutaneous tissues. Spontaneous bleedings 
from the nose, which are by far the most frequent, or from the lungs, 
stomach, intestines, or kidneys, do not take place until after several bleedings 
from external wounds. Such spontaneous internal haemorrhages are mostly 



852 SCROFULOSIS. 

preceded by palpitation of the heart, oppression, congestion to the head, pain 
in the limbs, and, in some cases, by painful swellings of the knee and ankle- 
joints. Bleeders seldom reach an old age; in some cases, however, this ten- 
dency to bleed gradually diminishes with the advancing years, and ceases en- 
tirely at last. 

Therapeutic Hints. 

It seems that Phosphor, must be the main remedy. Compare likewise 
Secale, and for internal bleeding those chapters which treat of the correspond- 
ing haemorrhages. Eriger. is said to be very efficacious; also: Natr. sulph., 
Crocus. China, Arsen., Hamam. 

Scrofulosis. 

• 

We understand by this term a^ cachexia which manifests itself as a 
nutritive disturbance in the external skin, the mucous membranes, joints, 
bones, organs of sense, and, above all, in the lymphatic glands, insuch a 
manner that individuals thus affected betray the internal disorders by a 
peculiar habitus. According as the faulty nutrition leads either to an accu- 
mulation of fatty deposits in certain parts of the body, or to a deficiency in 
fat on account of too rapid growth, scrofulosis has been divided into a torpid 
and an erethic form. The habitus of the first Canstatt portraits in the fol- 
lowing manner: ' ' uncommonly large head; coarse features; thick, swollen 
nose and upper lip; broad cheek-bones; large belly; swollen glands on the 
neck; soft, nappy muscles." The erethic form he characterizes as follows: 
'*' conspicious white skin, which reddens easily, and through which the blood- 
vessels shine forth; red lips and cheeks; bluish color of the sclerotica, which 
gives to the eyes an expression of languor; the muscles of such individuals are 
thin and flabby; the w r eight of the body does not correspond with their size, 
showing a want of solidity of the bones; their teeth are fair, bluish, glisten- 
ing, long and narrow, and their hair is soft." The majority of cases, how- 
ever, lie between these two extremes, or represent a mixture of the charac- 
ters of both, as it happens with all such classifications. 

The special changes in the skin are eruptions, which usually have their 
seat in the face and on the scalp, and the} T consist of a superficial dermatitis, 
with exudation of lymph upon the free surface, constituting eczema or im- 
petigo, or as they are likewise called, tinea or porrigo, etc. Destructive 
processes, like forms of lupus, do not take place until sometimes at a much 
later period. 

The scrofulous affections of the mucous membranes involve most gen- 
erally by their secretion the adjacent parts of the exteral skin; thus we find 
that a scrofulous conjunctivitis, otitis or coryza is generally attended by an 
eczema either on the cheeks or about the entrance to the ear or on the upper 
lip. Bronchial and intestinal catarrhs, or catarrhal affections of the urinary 
or sexual organs of scrofulous individuals, are generally of an obstinate char- 
acter. 



SCROFULOSIS. • 853 

The scrofulous affections of the joints manifest themselves either as 
dropsical effusions, or as the so-called white swellings, or even as suppurat- 
ing processes, constituting caries of the bone-ends and destruction of the 
capsular ligaments, as found in coxitis, gonarthrocace, etc. 

The bones themselves are attacked by inflammation of their texture or 
lining, constituting either osteitis or periostitis, or caries, or necrosis, or all 
combined. 

Scrofulous affections of the organs of sense manifest themselves in the 
eyes, either as inflammation of the Meibomian glands, or as conjunctivitis or 
corneitis, which latter not unfrequentfy leaves behind spots and cicatrices 
upon that organ; in the nose, as obstinate coryza, or, although only in quite 
rare cases, as lupus; in the ears, as otitis, which may terminate even in de- 
struction of the petrous portion of the temporal bone. 

The greatest nutritive disturbances are sustained by the lymphatic glands 
of scrofulous individuals. Everywhere, where there is an inflammatory pro- 
cess of the skin or in the mucous membranes, we find the adjacent lymphatic 
vessels and glands participating in that process. The glands swell and in- 
flame, and the inflammation spreads from the parenchyma of the glands to the 
surrounding cellular tissue, causing suppuration and abscesses, which are of 
slow growth and great obstinacy, leaving on healing almost always ugly 
cicatrices. We find these glandular abscesses most frequently in the cervical 
region. But the lymphatic glands of scrofulous individuals swell also with- 
out any inflammation of neighboring organs. 

This is almost a pathognomonic sign of scrofulosis. We sometimes find 
whole convolutes of these glands enormously enlarged. 

The Exciting Cause of these pathological changes in the lymphatic 
glands is now generally conceded to be the bacillus tuberculosis of Koch , 
and, in fact, scrofulosis has been called chronic tuberculosis of the lymphatics, 
When the}- inflame and suppurate, they form, as above stated, abscesses, 
which break; in other cases, the puriform matter becomes desiccated into a 
cheesy mass, and may be finally transformed into chalky substance, when it 
appears under the skin as a hard, uneven protuberance. Such chanVy masses 
not unfrequently irritate the adjacent parts, and give rise to troublesome 
inflammation and suppuration of the glands. The main seat of these glandu- 
lar swellings is the cervical region, especially behind the ears and under the 
lower jaws, extending sometimes as far down as the shoulders. But the 
bronchial and mesenteric glands also are not unfrequently the seat of this nu- 
tritive derangement. 

The scrofulous diathesis can be inherited from scrofulous or tuberculous 
parents, although children from such parents may be entirely free from any 
scrofulous taint. It has also been attributed to parental tertiary syphilis, 
carcinoma, advanced age, or when parents have been near relatives. Acquired 
it may be by podr or faulty diet, or by the want of exercise and fresh air; 
frequently by the joint action of different unhealthy influences. 

Its course is always chronic; sometimes periodically improving, and then 



854 THERAPEUTIC HINTS TO SCROFULOSIS. 

growing worse again. Its worst feature is its tendency to make children 
prone to the worst forms of illness of childhood, such as croup, hydrocephalus 
and tuberculosis, with which they combine and which they aggravate. 
Statistics show that most of the victims of these diseases are scrofulous chil- 
dren. 

Therapeutic Hints. 

Compare in general, as the most important remedies, Aln. rub., Asa/., 
Aurum, Badiaga, Baryt. card., Bellad., Calc. card., Calc. phosph., Cistus, 
Conium, Hepar, Iodium, Lycop., Mercur., Natr. mur., Rims tox., Sepia, 
Silic, Sulphur. Theridion "I always interpolate, when the best chosen 
remedies fail, and allow it to act for at least eight days." (Baruch.) 

For special hints, reference is made to the special ailments under their 
respective heads, and to Goullon's Scrofulous Affections, translated by E. 
Tietze, M. D. 



ACUTE INFECTIOUS DISEASES. 



The acute infectious diseases form a group which are caused by specific 
pathogenic micro-organisms, be they bacteria as in typhoid fever, protozoa as 
in malaria, or fungi as in actinomycosis. 

Many are epidemic and contagious. 

Infectious is now applied to those diseases caused by specific pathogenic 
micro-organisms, -the term contagious on the other hand is applied in refer- 
ence to the manner of transmission of a disease, and not in reference to its 
causative agent. 

Fever. 

Fever is characterized by an increase of temperature of the body, and a 
rapid consumption of the tissues. # 

Without an increase in the natural heat of the body, there is no fever. 
It is necessary, therefore, to know something about — 

Clinical Thermometry. 

The normal temperature in the axilla of a healthy person ranges between 
97.25 and 99. 5 F.; the mean is 98.6° F. or 37 ° C. This temperature is 
nearly the same in all climates and keeps its standard alike in summer and 
winter. Its daily oscillations are most marked after meal-times, when there 
is a slight rise The mean temperature we find a short time before the main 
meal, its maximum about four hours after the main meal, and its minimum 
in the night hours. 

In order to ascertain the degree of temperature of a person it is sufficient 
that the bulb of the instrument be held for five or ten minutes firmly in the 
hand, or, what is much more preferable with patients, to insert the bulb into 
the axilla, taking care that it be entirely surrounded by the adjacent parts. 
This is easily secured by slightly pressing the upper arm against the chest. 

In this way the instrument is kept in a firm position, and after the lapse 
of five or ten minutes the quicksilver partakes of the same degree of warmth 
as the surrounding parts, and its expansion can easily be read on the scale of 
the instrument. However the self-registering clinical thermometer for use 
in the mouth or rectum is the most satisfactory for general use. 

"A normal temperature does not necessarily indicate health; but all 
those whose temperature either exceeds or falls short of the normal range 
are unhealthy." 

"The range of temperature in severe diseases is between 95 ° F. and 



856 CLINICAL THERMOMETRY. 

108. 5 F., and very seldom falls below 91. 4 F., or rises to 109. 4 F., though 
in rare cases it has reached 112.55 F." " Alterations of temperature may 
be confined to special regions, whilst the rest of the body remains almost 
normal; they seldom exceed i.8° to 2 F." "A rapid increase in the heat 
of the body, and decrease of the heat of the extremities, is associated with 
1 cold shivers, rigors, fever-frost.' " 

' ' A protracted temperature of 101.3 F. , or more, is usually accompanied 
with heat, lassitude, thirst, headache, frequency of pulse; if persisting, with 
diminution of body- weight, ' pyrexia,' fever, fever-heat." ''Any consider- 
able diminution of warmth in the extremities, with very high, or very low 
central temperature, is expressed by a small pulse, sunken features, weak- 
ness, nausea, cold sweating, collapse." 

11 Temperatures much below 96. 8° F. are ' collapse ' temperatures. Below 
92. 13 F. deep, fatal algide collapse. 

92. 3 to 95 F. algide collapse with great danger, still with possibility 
of recovery. 

95 to 96. 8° F., moderate collapse, in itself without danger. 

99. 5 to 1 00. 4 F., sub-febrile temperature. 

100. 4 to 101.12 F., slight febrile action. 

101.3 to 102. 2 F. in morning, rising to 103. i° F. in evening, moderate 
fever. 

103. 1 ° F. in morning and about 104 F. in evening, considerable fever. 

103. 1 ° F. in morning and above 104.09 F. in evening, high fever. 

107. 6° F. and above indicates a fatal termination, except in relapsing 
fever; hyperpyretic temperatures." 

1 ' There is often a contrast between the temperature and the frequency 
of the pulse ; though, as a rule, slight febrile heat coincides with a pulse of 
80 to 90; moderate fever with 90 to 108; considerable fever with 108 to 120; 
extreme heat with 120 and upward per minute." 

' ' A pulse rather slow in proportion to the temperature is favorable as in- 
dicating a tranquil nervous system. A low pulse with high temperature in- 
vites us to look for spinal cause, as pressure on the brain, depressing action 
of drugs, etc." 

' ' A low temperature and frequent pulse points to local complications in 
the thorax or pelvis. Not forgetting, however, that moving accelerates the 
pulse. ' ' 

' ' The number of respirations per minute does not correspond so closely 
to the temperature as the frequency of the pulse. In collapse there is often 
(not always) a frequency of respiration, and in slight fever of childhood also; 
in moderate fever the respirations amount to 20 or so per minute; in children 
to 40 or 50. In considerable or extreme degrees of fever they are higher yet, 
60 in many cases; movement also increases their frequency. In other cases 
a quickened respiration indicates local causes." {Medical Thermometry and 
Hu7)ian Temperature, by Wunderlich and Seguin.) 



CRISIS AND CRITICAL DAYS. 857 

The temperature in special diseases is stated in the corresponding 
chapters. 

Crisis and Critical Days. 

Already Hippocrates, in the twenty-fourth aphorism of the second book, 
teaches in regard to critical da}^s as follows: " Of seven days, it is the fourth 
that is indicative. With the eighth day begins the second week. The 
eleventh again must be observed, because it is the fourth day of the second 
week. So also must be noticed the seventeenth day, as it is the fourth from 
the fourteenth and the seventh day from the eleventh." And in aphorism 
thirty-six, in the fourth book, he says: "Such sweats which occur in fever- 
patients on the 3d, 5th, 7th, 9th, nth, 14th, 17th, 21st, 27th, 31st or 34th 
day, are salutar}-, because they bring on a favorite turn in the disease. If 
sweats, however, occur on other days, they denote exhaustion, obstinacy and 
relapse of the disease. ' ' 

These remarks are no doubt the result of a large amount of observation 
on fever- patients, which, having been left to nature, afforded a clear basis 
for observation. As such they have been verified up to this day. As the 
most important of these critical days are acknowledged, according to von 
Grauvogl, the 3d, 5th, 7th, 13th and 21st. Why is it that these days should 
have more importance in the course of a disease than others? Is there any 
natural connection between these odd numbers and the diseased states of the 
body? The old school has acknowledged the Hippocratic facts, but has 
never succeeded in solving the perplexed question. Just as many other 
things, which belong to the interior vital workings, could not be solved until 
the higher light of Homoeopathy had been made to shine upon the organism, 
so also had this problem to wait until Dr. von Grauvogl caught the seemingly 
loose and unconnected threads between odd days and certain developments 
in disease, and showed their legitimate connection by nature's own laws. I 
shall try to condense his views on this subject as he has set them forth elab- 
orately in his Lehrbuch der Homceopathie . 

According to physiological experiments it appears that a living organis- 
mus, when it is subjected to a starving process, does not lose its bodily sub- 
stance evenly, but rather periodically, so that its greatest losses always fall 
upon the 5th, 8th and 13th day. Thus the operations in a living organism 
differ essentially from mere mechanical or chemical operation. If you, for 
example, expose a vessel with water to an equally dry atmosphere, it will 
lose its contents by evaporation evenly, just so much an hour. The living 
organism does not. It regulates its expenditures, or its losses, according to 
its own laws, which allows its receipts and expenditures to oscillate between 
a certain boundary, and make its operations to go 011 in regular periods. 
These periodical fluctuations are, therefore, the law of normal life, part and 
portion of all its evolutions in health and disease, and are not peculiar to 
states of disease. When, therefore, in diseases on the 3d, 5th, 7th, 13th, 21st 
and 35th day, a greater amount of losses sets in in the form of excretions, 



858 INTERMITTENT FEVER. 

such as sweat, flow of urine, diarrhoea, etc., which is called the crisis, it is 
nothing more nor less than the same periodic oscillation which is going on 
continually in the living organism, and which becomes only more conspicuous 
in disease, because it is frequently followed by a decided improvement or 
death. 

It necessarily must become more conspicuous, because this periodical 
loss is added to the extra consumption, which is a condition of the acute dis- 
ease. If the physical state of the patient be such as to endure both, he, of 
course, must feel better the next day, when the periodical acme ceases; and 
he dies, if his physical power cannot endure the united action of both. 

Thus the critical days of the disease are nothing more nor less than the 
normal, periodical fluctuations of the living organism, with which they cor- 
respond; and the crisis is that critical day with its normally increased ex- 
cretions, which falls together with the height of the disease. These obser- 
vations are corroborated by the following facts: that the so-callled crisis does 
not appear, when, during the course of a disease, the organism is weakened 
by improper medication, because then the natural periodic fluctuation is dis- 
turbed and destroyed; and it does not appear when, by the application of the 
proper remedy, health is restored; because the periodic fluctuation alone is 
not conspicuous enough to be observed. 

It is, however, never wanting when the disease runs an undisturbed 
c ourse; and, in so far, it is an important means to distinguish between a suc- 
cessful and an unsuccessful treatment. This is the theory of Grauvogl. 

It may be proper to add some further conclusions as to the importance 
of watching the critical days during homoeopathic treatment. 

1. The right remedy cures a disease without a crisis; and thus we have 
an indisputable proof that the selected remedy was the remedy. 

2. Aggravations after a remedy, when they occur on critical days, need 
not be the result of the remedy, as the conjoined action of the disease and 
the periodical oscillation alone will cause them naturally. 

3. When, after the administration of a homoeopathic remedy, a crisis 
takes place notwithstanding, we may be sure that we did not "hit" the 
case, and that the patient got well without our aid. 

4. When no crisis appears, and the patient gets worse and worse, it is 
clear that we did not find the right remedy, and w T e may even have spoiled 
the case by wrong means. 

Lastly, it seems to explain the observation that in most chronic cases 
the well selected remedy develops its action visibly not before the eighth 
day, and that we then ought not to disturb its action, either by repetition or 
change, before the thirty-fifth day. 

Intermittent Fever, Fever and Ague. 

This fever is caused by a poison, which, under certain conditions, origi- 
nates in marshy lands, swamps, in low regions near rivers, in newly settled 
places which just came under the hand of cultivation; in the neighborhood 



INTERMITTENT FEVER. 859 

of canals when first dug; in regions which seemingly lie dry, but contain a 
great deal of underground water; the dryer the surface the greater the 
effluvia from underneath the porous and cracked crust. This poison is called 
swamp-miasma, or malaria. Its nature is entirely unknown, but differs totally 
from typhus, smallpox, scarlatina and measles virus, as it never is propa- 
gated or carried from one person or place to another. Although swamps, 
damp, low regions, etc., are necessary for its development, yet they seem not 
the only conditions under which malaria is generated. Neither does the 
heat of the sun, the decay of vegetable substances, explain fully its presence 
here and its absence there; because there are large tracts of land where all 
these conditions exist without any sign of miasma; whilst, on the other hand, 
we find small, confined districts in which ague prevails every spring and 
summer. Another peculiarity of the poison is, that it seems to spread hori- 
zontally, so that it is often prevented from spreading further by a wall, a 
hedge, unless carried over these obstacles by a blast of wind. In those 
places where the miasma develops itself, ague prevails endemic ; but how 
widely spread epidemics of intermittent fever originate is wholly unexplain- 
able. So, also, have great ague epidemics been the forerunner of the Asiatic 
cholera; in hot climates both are often found together, and still more fre- 
quently go hand-in-hand, typhus fever, dysentery, influenza and ague; all 
which facts we cannot explain. Quite inexplicable is also the occurrence of 
sporadic cases in places where the miasma never prevails, and the attacked 
person had never been in a malarial region. 

Late researches point to the Plasmodium malarise (Hsematozoon of 
Laveran), as the probable micro-organism causing malaria. It is aproto- 
zoon found in the blood particularly during a paroxysm, attached most 
frequently to the red blood corpuscles, which it destroys. It exhibits amoe- 
boid movements. 

The liability to invasion by the miasma is a very general one; no age 
or sex being exempted. Unlike smallpox, scarlatina, etc., the liability to 
repeated attacks increase after the first invasion. Persons thoroughly satu- 
rated with the poison may not suffer any more with acute outbreaks of 
chills and fever, but are more subject to a chronic enlargement of the spleen 
and a malaria cachexia. 

The time of incubation is not known with certainty; in some cases the 
poison seems to develop its consequences at once, and in others it seems to 
linger in the system from six to twenty days, in still others three, six and 
even nine months. Before, however, it produces its own characteristic type 
of paroxysms of chills and fever, with intervals of immunity — apyrexia — it 
often manifests itself for a while only as a general indisposition — a general 
malaise and disturbance of different functions. 

The real paroxysm of an intermittent fever consists of three stages — the 
chill, the heat and the sweat. 

The chilly stage may last from a few minutes to fully three hours. Dur- 
ing this stage the appearance of the patient is remarkably altered; his whole 



86o INTERMITTENT FEVER. 

volume seems to shrink; his face appears sunken, his nose pinched, and the 
rings on his fingers (if he wears any) become quite loose. The arterial blood 
is prevented from reaching the surface, while the venous blood is stagnated 
in the capillaries; this makes the skin pale and the lips and nails blue. The 
whole surface is cold, and covered with the well-known appearance of 
goose-skin (cutis anserina). The internal temperature, however, increases 
rapidly from two to three, even to five and seven degrees above the normal 
standard. The attending symptoms of this stage are numerous and various 
— headache, thirst, colic, cough, oppression, backache, etc., etc.; either one, 
or all, or still others, may exist in a lighter or graver degree or not at all at 
that stage. 

The stage of heat creeps on slowly, still intermingled with chill}'' sensa- 
tions. Finally, the whole body is in a perfect blaze; the temperature rises 
still higher and remains so until near the end of this stage. There have been 
cases observed where the thermometer rose to 108.5 and 109. 4 F. Physical 
examinations may also detect a swelling of the spleen which, having com- 
menced during the chill, reaches its height during this stage. The heat 
generally lasts from a few to eight, or even twelve hours. Here, too, as in 
the chill y stage, the attending sj^mptoms vary in number and character in 
each individual case. 

The third stage, that of sweat, finally closes the paroxysms, and, in most 
cases, greatly relieves the sufferings of the patient. The temperature sinks 
step by step till at last the patient feels more or less completely well again. 
There are, however, enough cases in which this last stage is likewise attended 
by a number of various symptoms, which, indeed, are important, like those 
of the first and second stage, in regard to the selection of the remedy, but 
have no particular bearing on the diagnosis of the case. 

The apyrexia which now follows is very seldom entirely free of all mor- 
bid manifestations, and these are likewise numerous and various, and for 
the observant homoeopathic physician of the highest importance. Just these 
manifestations may present to him the hints which will lead him to the dis- 
co very of the required remedy for the case. 

When an intermittent fever develops its paroxysms in these three stages, 
and in this order, it is called intermittens completa ; when, however, one or 
the other of the stages is wanting, it is called intermittens incompleta ; and 
when the order of its stages is reversed, so that, for example, the paroxysm 
commences with sweat and ends with the chill, it is calle'd intermittens 
inversa. 

The apyrexia is, in different cases, of variable duration. It may last 
only six, eight, or twelve hours, so that the new paroxysm sets in after 
twenty-four hours from the one preceding, then it is called a daily or quo- 
tidian fever ; if twice twenty-four hours elapse between the paroxysms, it is 
called a tertian fever; and if three times twenty-four hours intervene, it is 
called a quartan fever. Sometimes it recurs only ever) 7 seventh day — inter- 
mittens septiana. 



THERAPEUTIC HINTS TO INTERMITTENT FEVER. 86 1 

The most frequent forms are the quotidian and tertian. Sometimes it 
happens that the paroxysms keep no regular time; they either set in each 
time earlier (anticipating), or later (postponing). In such cases it may 
come to pass that the original type is altogether changed into another; for 
example, a quotidian by postponing into a tertian, or tertian by anteponing 
into a quotidian. When a fever-paroxysm lasts so long that its end reaches 
to the beginning of a new paroxysm, it is called a febris intermittens sub- 
intrans. When, however, the intervals of a quotidian, tertian, or quartan 
fever are again interrupted by another paroxysm, then it is called a febris 
intermittens duplicata. The double quotidian consists of two paroxysms 
within twenty-four hours, the intervening being generally lighter than the 
original. The double tertian has one paroxysm every day, mostly at differ- 
ent hours, and again the intervening lighter than the original; while the 
double quartan has two paroxysms in three days, and in this way, that two 
successive days are fever days, and the third day is free. 

Masked intermittents show themselves usually as typical neuralgias, in 
the course of one or another nerve-trunk, which, however, cannot be dis- 
tinguished from other neuralgias, except by their typical recurrence; they 
manifest themselves also in the form of intermittent hyperemia, haemorrhage, 
oedema, coryza, bronchial catarrh, etc., as typical skin affections, such as 
erysipelas, purpura, urticaria, pemphigus, and in many other typical forms 
of disease. 

A long-continued, oftentimes suppressed intermittent fever frequently 
terminates in dropsy in consequence of existing functional disturbances of 
the spleen, which gradually become an organic lesion, or in chronic paren- 
chymatous nephritis, or scorbutic affections and general ague cachexia. 

Therapeutic Hints. 

Aeon. In recent cases of young individuals of a full habit; all the 
stages must be sharply marked, with a prominent congested state of the head 
and chest. The pulse is full, hard and frequent. During the chill internal 
heat, with great anxiety, sensitiveness and restlessness; the pupils are con- 
tracted. The heat is confined mostly to the head and face; great thirst for 
cold water and inclination to uncover. The sweat is most prominent on the 
parts covered, and is attended with earache and profuse micturition. 

Ant. crud. Predominant gastric symptoms: thick-coated tongue; bitter 
taste; nausea; belching; vomiting; loss of appetite; little or no thirst; pain 
in the bowels, diarrhoea or constipation. Sweat breaks out after the chill 
with the heat but soon disappears, dry heat continuing. 

Apis. According to Wolf, is one of the most important remedies in all 
kinds of intermittent fevers, and indeed has been used everywhere with great 
success. Chill with thirst about three or four o'clock p.m. ; worse in a warm 
room or near the stove; renewed chilliness from slightest motion, with heat 
of the face and hands. Heat, especially in the chest, pit of the stomach, 
bowels, female organs and hands, with muttering and unconsciousness; 



862 THERAPEUTIC HINTS TO INTERMITTENT FEVER. 

diarrhoea; shortness of breath; drowsiness or sleeplessness; rarely thirst. 
Sweat alternates with dryness of the skin; no thirst. Nettle-rash during 
sweat or apyrexia. During the a pyrexia, pain under the short ribs, worse on 
the left side; great soreness of all the limbs and joints, great debility; en- 
largement of the abdomen; swollen feet and scanty urine. Apis is therefore 
indicated not only in recent but also in protracted and badly-treated cases. 
After it Natr. mar. follows well. 

Ar?iica. Before and during the chill great thirst; drinks a great deal, 
and vomits afterwards; yawning and stretching; pain in all the bones; bed 
and sofa feel too hard; the chill is felt worst in the pit of the stomach; cold 
hands and feet, with heat in the head and face, and redness of one cheek; 
heat, with indifference, stupor; drinks less; the sweat smells sour; during the 
apyrexia stitching pain in the region of the spleen; soreness of the spleen on 
pressure; aching in all the limbs as though beaten. 

A?'se?i. Intermittens incompleta. Before the attack: vertigo; head- 
ache; yawning; stretching; general discomfort; weakness; pain in the pit 
of the stomach and empty eructations; cutting pain in the bowels. The chill 
is frequently intermixed with heat; or heat and chilliness follow each other 
in rapid succession; or the patient feels cold inside and burning hot outside. 
During the chill: generally no thinst; if there be any, drinking increases 
the chill and causes vomiting; oppression and spasms in the chest, with hack- 
ing cough; bloating of the pit of the stomach; pain in the pit of the stomach; 
anxiety, restlessness; blue nails. The heat is either wanting, or mixed up 
with the chill, or is very great, with delirium, unconsciousness and headache; 
restlessness; anxiety, pulsation through the whole body; tension and press- 
ure in the left rrypochondrium ; burning in the stomach; generally great 
thirst, but drinking little at a time; also drinking a great deal at a time; 
oppression and short breathing; palpitation of the heart. The sweat sets in 
some time after the heat, or does not appear at all; during the sweat the 
thirst is often the greatest, and the patient drinks large quantities of water; 
the symptoms of the former stages become ameliorated. The apyrexia is 
never clear. The face is pale, sunken, earthy, sallow, bloated; the lips are 
pale, cracked, swollen and crusty; the tongue is white and dry, or coated 
yellowish; the taste is gone, without bad taste, only after eating, bitter taste; 
the appetite is sometimes increased for a while, satisfying it causes heat and 
nausea, and not satisfying it causes an unpleasant sensation of discomfort; 
the hypochondriac regions are swollen, especially the left, the abdomen is 
bloated; the stools are diarrhceic, fetid; the urine is rather scanty and turbid; 
the feet are cedematous; the skin is pale, often covered with cold perspiration; 
there is sleeplessness, especially the night before a new paroxysm, and great 
sinking of general strength. 

Bellad. The heat predominates, with vertigo, hallucinations, delirium, 
restlessness, anxiety; drowsiness with inabilily to go to sleep, or sopor; head- 
ache, throbbing in right temple, injected eyes, and sensitiveness to light; red 
cheeks; throbbing of the carotid arteries; choking sensation in the throat; 



THERAPEUTIC HINTS TO INTERMITTENT FEVER. 863 

great thirst and dryness of the mouth and throat; palpitation of the heart; 
painful swelling of the spleen; constipation; great irritability of temper, or 
else tearful mood. 

Bryon. The chill predominates, only exceptionally the heat; great 
thirst during the chill, still greater during the heat; the sweat lasts long. 
There are, as the most important leading symptoms: stitching pains in the 
sides of the chest, with hard cough; stitching pain in the hypochondriac 
regions and in the abdomen; rheumatic pains in the limbs; all worse from 
motion. 

Cad. grand. Regular paroxysms at 1 1 o'clock a. m, or p. m. ; first chill, 
then burning heat, with headache, coma, stupefaction, insensibility; thirst, 
shortness of breath, inability to remain lying. The sweat is profuse and at- 
tended with inextinguishable thirst. The apyrexia is complete. 

Calc. carb. Chronic cases; chill commences in pit of stomach; thirst 
during the chill. General indications: hardness of hearing; pot-belliedness; 
hard, bloated stomach, enlarged spleen ; diarrhoea white; undigested; monthly 
period too early and too profuse; glandular swellings about the neck; alto- 
gether scrofulous diathesis. 

Capsic. Chill, mostly with thirst, and worse after drinking; the chill 
commences in the back and spreads all over, and is relieved by hot irons or 
jugs of hot water; after the chill sweat ; or heat, with sweat and thirst at the 
same time. During the chill: giddiness and excruciating, tearing pains in 
the back and limbs, extorting cries and causing the patient to bend together 
like a hedgehog. During the heat: cutting pains in the bowels, and slimy, 
burning stools, with much pressing and bearing down; headache. 

Carb. veg. Irregular paroxysms, sometimes commencing with sweat, 
followed \>y chill. Before the attack toothache, headache and pain in the 
limbs. During the chill great thirst. Heat and sweat frequently mixed 
together, with evening hoarseness, dizziness, red face, nausea, but no thirst. 
The sweat is sour and sometimes very profuse. Afterwards long-continued 
headache; heat and burning in the eyes; yellow complexion; liver-spots in 
the face; belching; bad smell from the mouth; stomach bloated; spleen 
swollen and painful; abuse of quinine. 

Cedron. Chill at 3 A. m. or 3 p. m., is preceded by mental depression, or 
excitement; during chill no thirst; chill predominates; during heat thirst 
for warm drinks; numb, dead feeling in legs; sweat profuse, with thirst and 
tearing pains in extremities. During apyrexia general malaise and great 
debility. 

Ckamom. Heat and sweat predominate, and are often together; red 
face, or only one cheek red and the other pale; sweat especially about the 
head, and mostly hot. The tongue is red in the middle and white on the 
sides, or white in the middle and red on the edges; bitter taste; bitter vom- 
iting; great oppression about the heart; diarrhoea. The patient is very irri- 
table, excited, complaining, with great restlessness and anxiety. 

China. The paroxysms come most at irregular hours, with thirst before 



864 THERAPEUTIC HINTS TO INTERMITTENT FEVER. 

(not during) chill or heat and during the sweat; they are mostly preceded 
by palpitation of the heart with anxiety; sneezing; nausea; hunger; pressure 
in the stomach; pain in the bowels and jerking, tearing headache; pain in 
the limbs and great debility. During the fever the veins appear greatly en- 
larged, and there is great congestion to the head, with redness and heat of 
the face, even with chilliness and coldness of other parts of the body. The 
sweat is sometimes only partial and cold, for example, on the forehead; at 
other times it is profuse, and almost always attended with thirst. In general 
the patient sweats easily, especially at night, during sleep; there is swelling 
of the liver and spleen, painful to motion and pressure; a characteristic 
weakness, exhaustion and cachectic appearance, a sallow yellowishness of the 
skin, not only in the face but also on the chest and region of the stomach, 
and different anaemic and dropsical symptoms. The urine is scanty and 
turbid, with a thick yellowish or brick-dust sediment, or a sediment of little 
crystals. The presence of swamp miasma is another indication. 

Chin, sulph. Regular paroxysms at the same hour, and clear intermis- 
sions; real thirst mostly only during the sweat. During the paroxysm pain 
in the dorsal vertebrae on pressure ; pain in the region of the liver and spleen 
on bending, taking a deep breath, coughing; the urine gives a voluminous, 
brick-dust-like or fatty sediment, or contains crystals of urates; ringing in 
the ears, with dizziness and enlarged feeling of the head. 

Cimex. Before the chill thirst and heaviness in the legs. The chill 
commences with clenching of the hands and violent raging; it is attended with 
pains in all the joints; sensation as if the tendons were too short; the knee- 
joints are usually contracted, so that the legs cannot be stretched; the chest 
feels oppressed, obliging one to frequently take a long breath; irresistible 
sleepiness; it ends with a tired feeling in the legs, obliging one to change po- 
sition constantly ; with thirst; drinking, however, causes violent headache; 
continuous dry cough; oppression of breathing; heaviness in the middle of 
the chest; anxiety. Abstaining from drinking ameliorates all this. The 
heat is attended with gagging; the oesophagus feels constricted, and the water 
drank goes down only at intervals; no thirst. The sweat is mostly on the 
head and chest, accompanied by hunger. 

Cina. Thirst only during the chill, or only during the heat. Nausea, 
vomiting, diarrhoea, pain in the stomach and abdomen may set in at any 
time, and soon be followed by a clean tongue and ravenous appetite. The 
face is puffed and pale even during the heat, or glowing red; the pupils are 
much enlarged, and the child picks often at the nose. 

Diadema. Paroxysms every day or every other day at precisely the 
same hour; chill predominating; constant chilly feeling; always worse on 
rainy, cold days; menses too early and too profuse; enlargement of the 
spleen. 

Eupat. per/. Long before the chill great thirst, which continues through 
chill and heat; after drinking, vomiting; the paroxysms usually occur in the 
morning, about seven or nine o'clock; they are attended with intense itching 



THERAPEUTIC HINTS TO INTERMITTENT FEVER. 865 

in the back and limbs, as if the bones were broken, and with a number of 
gastric or so-called bilious symptoms; the sweat is generally not very promi- 
ment, or even wanting, but sometimes drenching, and the intermission is 
sometimes marked by a loose cough. 

Eupat. purp. The paroxysm comes at different times in the day, every 
other day; chill commences in the small of the back and then spreads over 
the body; violent shaking, with comparatively little coldness; thirst during 
chill and heat; vomiting between chill and heat; violent bone-pains during 
chill and heat. 

Ferrum. Similar to Arsen. and China, it will frequently be of service 
in protracted and cases badly-treated by Quinine, which are characterized by 
anaemia and total prostration of the reproductive sphere of the system. We 
observe great paleness of the face, which, however, may flush up from any 
excitement to a fiery redness of short duration; paleness, whiteness of the 
inner surface of the mouth; vomiting of everything that is eaten without be- 
ing digested; swelling and hardness in the hypochondriac regions; great 
weakness and emaciation; dropsical swelling of the feet; frequent conges- 
tion of the lungs; continued shortness of breath; nun's murmur in the 
veins. 

Gelsem. Chill in afternoon or evening, commencing in hands and feet, 
or running up back from sacrum to occiput, without thirst; or only fever at 
10 a.m., without chill and without thirst. The heat is attended with red 
face and sleep, or with nervous restlessness, delirium, mental anxiety or agi- 
tation, vertigo; a curious sensation of falling, sensitiveness to light and sound, 
partial blindness or deafness. Where there is a want of distinctness in its 
several stages; the whole presents an adynamic condition of the system. 

Hepar. Bitter taste in the mouth; bilious vomiting; diarrhoea; itching, 
stinging, nettle-rash before and during the chill; fever-blisters around the 
mouth; tettery eruption on the chest; previous abuse of Mercury. During 
the sweat keeps himself closely covered. 

Ignat. Thirst only during the chill, or in short spells, independent of 
any stage. The chilliness is relieved by the external application of warm' 
things; external heat, or heat in some, and coldness of other parts of the 
body; sometimes with pain in the bowels; afterwards sleep and sweat. The 
paroxysms are sometimes accompanied with spasmodic symptoms; heaviness 
of the head; aching pain in the occiput; vomiting and pressive pain in the 
pit of the stomach; urticaria over the whole body. The paroxysms are apt 
to postpone or antepone. 

Ipec. Predominance of gastric symptoms during the paroxysm as well 
as during the apyrexia. It begins chiefly with yawning, stretching and a 
collection of saliva in the mouth; then follows the chill, aggravated by ex- 
ternal warmth, with or without nausea, vomiting, diarrhoea, or great oppres- 
sion of the chest, with heaving. The three stages may be very strongly 
marked or very light; the thirst is generally quite inconsiderable in all of 
them. The ap}^rexia has the same gastric symptoms, especially a marked 
55 



866 THERAPEUTIC HINTS TO INTERMITTENT FEVER. 

sensation of relaxation of the stomach, as though it were hanging down; 
entire loss of appetite. The spleen is little, if any, swollen. Miasma; after 
the abuse of Quini?ie and Arsenicum; after faults in diet. 

Laches. One of the most important remedies after the abuse of Qui?iine. 
The paroxysms are mostly in the afternoon, with pain in the small of the 
back and limbs; restlessness; oppression of the chest; jerking; headache; red 
face; talkativeness. During the chill wants to lie near the fire, or be held 
tightly to relieve the pain in head and chest, and prevent shaking. 

Lycop. Where there are other chronic symptoms — cough, with thick, 
yellow, salty expectoration; oppression of the chest; pain in the left side; 
palpitation of the heart ; pale face, often with circumscribed redness of the 
cheeks; sour vomiting between chill and fever; bloatedness of the stomach; 
rumbling in the bowels; great debility; the sweat is often sour and profuse, 
sometimes following immediately upon the chill, and at other times not until 
some time after the heat; after the sweat, thirst. Fever paroxysms often 
from 4 to 8 p.m. 

Mangan. Incomplete intermittent, consisting of only heat and sweat, 
with moderate thirst. 

Mejiyanth. Irregular time and type; chill predominating without 
thirst; especially coldness of fingers, toes and legs, not relieved by external 
warmth of abdomen. 

Mezer. Incomplete intermittent, consisting of chill with thirst, and 
sweat with sleep. 

Natr. mtir. One of the most important of all in recent as well as in 
inveterate and badly treated cases. Hard chill very often at ioor n o'clock 
A. m. , with great thirst which continues through all stages. The heat is 
characterized by the most violent headache, relieved by perspiration. There 
soon appears an eruption of hydroa or fever- blisters, which cover the upper 
and lower lip like pearls. During the apyrexia sallow complexion, dry, 
white coated tongue; bitter taste; water tastes bad; loss of appetite; after 
eating, sour belching and vomiting; pressure in the stomach; swollen stom- 
ach; pain in the region of the kidneys; cutting pain in the urethra after 
micturition. 

Nux vom. Is characterized by great prostration and paralytic weak- 
ness from the beginning. Hard chill with bluish face and blue nails; stitch- 
ing pain in the abdomen; spasmodic drawing and stiffness or the lower ex- 
tremities; great thirst; the heat is great, and notwithstanding this the patient 
covers himself all over, because uncovering or the slightest motion makes 
him feel chilly; headache; great thirst, especially for beer. Both chill and 
heat are accompanied by gastric and bilious symptoms. During the sweat 
the painful symptoms gradually subside. During the apyrexia, headache; 
yellowish complexion; belching; loss of appetite; nausea; vomiting; consti- 
pation; liver and spleen swollen; cough; debility; soreness of the spine. 

Opium. Sleep, during chill, heat and sweat; during sweat he still feels 
burning hot; children and old people. 



THERAPEUTIC HINTS TO INTERMITTENT FEVER. 867 

Podoph. Chill at 7 A. m., without thirst; heat with thirst; loquacity 
during chill and heat; sweat with sleep; besides, pain or uncomfortable 
feeling in region of liver which makes him rub and stroke this part; diar- 
rhoea during forenoon, frequently changing in color. 

Pulsat. The several stages are in general not very violent, and mostly 
unattended by thirst: or thirst only during the heat; or the several stages 
are mixed up; one-sided sweat. The paroxysms set in frequently (though 
not always) in the evening, and last through the night. Characteristic feat- 
ures: tearful and peevish; headache during the intermission; face pale or 
greenish-yellow; tongue moist, coated, with bad taste; loss of appetite and 
thirst; nausea; vomiting of slime and bile; spleen enlarged; stools diarrhceic, 
slimy, watery, at night; profuse, watery urine; suppressed or scanty menses; 
pain in the chest and cough, with pain in the head and pit of the stomach; 
frequent palpitation of the heart; murmur in the jugular veins; constant 
chilliness and drowsiness; chlorotic state of the system. 

Rhus fox. Before the chill: stretching of the limbs; yawning with a 
feeling in the maxillary joint as if sprained; thirst; dry, teasing cough, with 
sweetish, foul expectoration. Chill, in some parts, and in others heat; or 
hard chill, with aching in the small of the back, drawing in the limbs and 
formication in the fingers; with restlessness and constant change of position. 
The heat is sometimes before and sometimes after the chill, and often at- 
tended with nettle-rash; pain in the bowels and diarrhoea. The following 
sweat is often profuse and sour. The paroxysms set in most frequently in 
the evening and last through the night; they generally return every day, 
but seem altered every other day. 

Sabad. Intermittens incompleta, consisting of chills only; or intermit- 
tents with predominating chill, and thirst between chill and heat; the 
paroxysms occur precisely at the same hour; sometimes they are accom- 
panied by morbid hunger in alternation with loathing of food; during the 
apyrexia there is constant chilliness; sometimes cough with heavy breathing 
and pain in the chest. 

Sambuc. Profuse, debilitating sweat lasts through the apyrexia, com- 
mences in the face, is worse while the patient is awake, disappears and 
changes to a dry heat when he is falling asleep. 

Sepia. Chronic cases, with one or the other of the following symptoms: 
frequent flushes of heat; paralytic sinking down of one of the upper eyelids; 
yellowishness of the white of the eyes; brownish-yellow saddle across the 
bridge of the nose; yellowishness around the mouth; loathing of meat and 
milk; diarrhoea after drinking milk; pain in the liver on moving; bearing 
down towards the genitals; palpitation of the heart; tettery eruptions; the 
coldness begins in the feet and rises upwards. 

Silic, In scrofulous subjects. 

Stramon. Chill, with icy-cold skin, covered with cold sweat; hands 
and feet livid, head and face hot, vertigo; delirium; epileptiform; convul- 
sions. Wants to be covered during all stages. 



868 DIGEST TO INTERMITTENT FEVER. 

Sulphur. Like Sepia, in chronic cases; especially when rooting in the soil 
of suppressed eczema or other cutaneous eruptions, with one or the other of 
the following symptoms: heat on the top of the head with cold extremities; 
red lips; red tip of the tongue; always worse after eating; sudden attacks of 
faintness, with hunger in the forenoon; costiveness, or else looseness of the 
bowels early in the morning, driving out of bed; hemorrhoidal complaints; 
leucorrhcea; cough when lying down in the evening; feverishness through 
the night: complete sleeplessness; itchiness of the skin. 

Tart. emet. Thirstlessness during chill and fever, shuddering with 
sleepiness; heat with sopor; sweat with sleepiness; fainting; anxiety; and 
pain in the lower extremities. 

Thuja. According to Wolf, if Apis is not sufficient, and the complaint 
originates in a chronic gonorrhceal contamination of the system; only the 
uncovered portions of the body perspire; those which are covered are dry 
and hot. 

Veratr. Chill at 6 a.m.; chill and coldness predominate, with sticky, 
cold perspiration and thirst; heat not so marked; sweat profuse, often cold 
and long-continuing. Attending symptoms: great exhaustion; sinking of 
strength; nausea; vomiting; diarrhoea, or obstinate constipation; cramps in 
the limbs. It is indicated, therefore, in the most pernicious kinds of inter- 
mittent fevers, and those which occur during the prevalence of cholera. 

For still further particulars I refer to H. C. Allen's and T. P. Wilson's 
Treatise on Intermittent Fever, and Wm. A. Allen's Repertory. 

Digest to Intermittent Fever. 

BEFORE CHILL. , general discomfort, weakness 

Mental depression or excitement: Ce- Arsen. 

dron. Itching", stinging nettle-rash: Hepar. 

VertiffO : Arsen. Sleeplessness the night before, and great 
Headache: Arsen., Card, veg., China. sinking of general strength: At sen. 

Toothache and pain in limbs: Card. veg. CHILL BEGINS WITH: 

Bitter taste, bilious vomiting, diarrhoea: Yawning, stretching and a collection of 

Hepar. saliva: Ipec 

Thirst, drinks a great deal and vomits Clenching of hands and violent raging: 

afterwards: Arnica, Eup. perj. Cimex 
, palpitation with anxiety, sneezing, 

nausea; hunger, pressure in stomach, TIME OE OCCURRENCE. 

pain in bowels, pain in limbs, and great Midnight, after: Arsen. 

debility: China. 3 o'clock A. M. or P. M.: Cedron. 
, dry, teasing cough, with sweetish, 6 o'clock A. M.: Veratr. 

foul expectoration: Rhus tox. 7 o'clock A. M.: Podoph. 

, and heaviness in legs: Cimex. 7-9 o'clock A. M.: Eup. per/. 

Yawning and stretching, pain in pit of 10 o'clock A. M.: Stannum. 

stomach and eructations; cutting pain 10-11 o'clock A. M.: Natr. mur., Sulphur. 

in bowels: Arsen. 11 o'clock A. M.: Nux vom. 
, pain in bones; bed or sofa feel or p. M.: Cact. gaand. 

too hard: Arnica. Noon, about: Nux vom. , Sulphur. 
, maxillary joint feels as if 1-2 P. M.: Arsen. 

sprained: Rhus tox. 2-3 P. M.: Laches. 



DIGEST TO INTERMITTENT FEVER. 



869 



3 P.M.: Apis, Bel I ad. 
Afternoon and evening: Gelsem. 
Evening: Nux vom., Pit /sat., Rhus tox. 
Any time: Arsen., China, Eup. per/., 

Eup, pur p., I pee., Natr. mur., Nux 

vom., Pulsat., Sulphur. 
Irregular time: China, Menyanth., 

Sepia. 
At precisely the same hour: Cedron., 

Diad., Sabina. 
Postponing: China, Cina, Ignat., Ipec. 
Anticipating: Arsen., Bryon., China, 

Ignat., Natr. mur., Nux vom. 
Quotidian: Arsen., Card, veg., China, 

Cina, Diad., Gelsem., Ignat., Ipec., 

Natr. mur., Nux vom., Pulsat., Rhus 

tox., Sulphur. 
, double: Ant. crud., Apis, Bellad., 

China, Elater., Stramon., Sulphur. 
Tertain: Arsen., Bellad., Bryon., Card. 

veg., China, Cina, Diad., Eup. per/., 

Ignat., Ipec., Natr. mur.. Nux vom., 

Pulsat., Rhus tox. 
, double: Arsen., China, Eup. purp., 

Lycop., Rhus tox. 
Quartan: Arsen., Card veg., China, 

Menyanth, , Natr. mur., Nux vom., 

Pulsat., Rhus tox., Sabina, Veratr. 
, double: Arsen., China, Eup. purp., 

Rhus tox. 

LOCATION AND DIRECTION. 

Pit of stomach, commences in: Calc. 
carb. 

, is felt most in: Arnica. 

Back, between shoulders, commences in, 
and spreads all over, worse by external 
heat: Bryon., Capsic. 

Small of back, commences in, and 
spreads all over: Eup. purp. 

Hands and feet, commences in, or run- 
ning up back from sacrum to occiput: 
Gelsem. 

, coldness of, with heat in head 

and face, and redness of one cheek: 
Arnica. 

Feet, begins in, and rises upwards: La- 
ches., Sepia. 

Fingers, toes and legs, abdomen, cold- 
ness of, not relieved by external 
warmth: Menyanth. 

In some parts, in others heat: Rhus tox. 

Left hand cold, right one warm: China. 



Icy-COld skin, covered with cold sweat: 
Stramon. 

ACCOMPANIED BY: 

Delirium: Stramon. 
Loquacity: Podoph. 
Anxiety, sensitiveness and restlessness: 

Aeon., Arsen. 
Vertigo: Capsic, Stramon. 
Pupils contracted: Aeon. 
Face bluish and nails bluish: Nux vom. 
and head hot: Stramon. 



Thirst during chill only: Apis, Calc. 
carb., Capsic, Carb. veg., Cimex, Cina, 
Ignat., Mezer., Nux vom., Veratr. 

Thirst during chill and during heat: 
Eup. per/. , Eup. purp. 

and more during heat: Bryon. 

between chill and heat: Sabad. 

during chill and all stages: Natr. 

mur. 

, or in short spells, independent 

of any stage: Ignat. 

, or only during heat: Cina. 

, chill worse after drinking: Arsen., 

Capsic 
, chill with; but drinking causes 

headache, dry cough, oppression of 

breathing, heaviness in middle of chest, 

anxiety: Cimex. 
, without: Arsen., Cedron., Gelsem., 

Menyanth., Podoph. 
, , during chill and fever: Tart. 

emet. 
Morbid hunger or loathing of food; Sa- 
bad. 
Gastric and bilious symptoms: Eup. 

per/., Nux vom. 
With Or without nausea, vomiting and 

diarrhoea: Ipec. 
Vomiting after drinking: Arsen. 

between chill and heat: Eup. purp. 

Bloating and pain in pit of stomach: 

Arsen. 
Stitching pain in abdomen: Nux vom. 

and hypochondriac regions: 

Bryon. 



Chest, oppression of, and heaving: Ipec. 
, , must take long breaths: 

Cimex. 
, , and spasms in chest, with 

hacking cough: Arsen. 



870 



DIGEST TO INTERMITTENT FEVER. 



, stitching pain in sides of, with hard 

cough: Bryon. 

Aching in back and limbs, as if the bones 
were broken: Eup. Perf. 

in small of back, drawing in limbs, 

formication in fingers, with restlessness: 
Rhus tox. 

Tearing pains in back and limbs, ex- 
torting cries and causing the patient to 
bend together like a hedgehog: Capsic. 

Drawing and stiffness in lower extremi- 
ties: Nux vom. 

Pains in all the joints, as if the tendons 
were too short; knee-joints contracted; 
Cimex. 

Rheumatic pains in the limbs, worse 
from motion: Bryon. 

Pain in all the bones, couch feels too hard: 
Arnica. 

Violent bone-pains: Eup. per/., Eup. 
purp. 

Livid feet and hands: Stramon. 

Blue nails: Arsen. 

Chill ends with a tired feeling in legs, 
must change position: Cimex. 



Sleepiness: Cimex. 

, with shuddering: Tart. emet. 

Sleep during chill, heat and sweat: 
Opium. 



Itching, stinging nettle-rash: Hepar. 
Sticky, cold perspiration: Ver. alb. 

CHILL IS AGGRAVATED : 

After drinking: Capsic. 

In a warm room or near the stove, and 

motion: Apis. 
By external warmth: Ipec. 

CHILL IS RELIEVED : 

By external warmth: Ignat. 

and being held tightly: Laches. 

Wants to be covered during all stages: 
Stramon. 



Chill predominates: Bryon., Cedron, 
Diad., Hfenyanth., Sabad. , Ver. alb. 

, only exceptionally the heat 

predominates: Bryon. 



Chill and internal heat: Aeon. 

intermixed with heat, or cold inside 

and burning hot outside: Arsen. 



AFTER CHILL : 

Vomiting: Eup. purp. 
Vomiting, sour: Lycop. 
Sweat: Capsic. 

and heat; sweat soon disappears, dry 

heat continues: Ant. crud. 

HEAT. 

At 10 A. M., without chill or thirst: 
Gelsem. 

From 4-8 P. M.: Lycop. 

Sometimes before the chill: Rhus tox. 

Mixed up with chillness: Aeon., Apis, 
Arnica, A) sen., Bellad., Chamom., 
China, Eup. purp., Gelsem., Laches., 
Nux vom., Podoph., Pulsat., Rhus 
tox., Sulphur. 

with sweat: Capsic, Card veg., Eup. 

perf., Ipec, Opium, Podoph., Pulsat., 
Rhus tox., Sabad., Sepia, Stramon., 
Veratr. 

External heat ; or heat in some, and 
coldness of other parts: Ignat. 

ACCOMPANIED BY: 

Coma, stupefaction, insensibility: Cact. 

grand. 
Unconsciousness: Arsen., Natr. mur. 

, with muttering: Apis. 

Delirium: Arnica, Arsen., Bellad., Chin. 

sulph., Gelsem., Ignat., Laches., Natr. 

mur., Nux vom., Opium, Podoph., 

St ram 07i. 
Loquacity: Podoph. 
Indifference, stupor: Arnica. 
Anxiety, or agitation: Arsen., Bellad., 

Gelsem. 
Vertigo: Arsen., Bellad., Bryon., Carb. 

veg., Gelsem., Ignat., Ipec, Natr. 

mur., Nux vom., Pulsat., Sepia, Stra- 
mon., Veratr. 
, curious sensation of falling: Gelsem. 



Headache: Aeon., Arnica, Arsen., 
Bellad., Bryon., Capsic, Carb. veg., 
China, Eup. perf., Ignat., Laches., 
Natr. mur., Nux vom., Opium, Po- 
doph., Pulsat. , Rhus tox. , Sabad. , Sepia, 
Sulphur. 

, relieved during sweat: Natr. mur. 

Sensitiveness to light and sound, or 
partial blindness and deafness: Gelsem. 

Eyes injected: Bellad. 

Pupils enlarged: Cina. 



DIGEST TO INTERMITTENT FEVER. 



8 7 I 



Ears cold: Ipcc 

Nose cold: Ignat. 

Picks at nose: Cina, 

Face cold: Ipec, Pulsat. 

pale: Arsen., Bryon., Capsic, Cina, 

I pec, Rhus tox., Sepia. 

and red alternately : Aeon., Bel- 
lad., Capsie., Ipec, Nux vom., Opium, 
Pulsat. 

One cheek pale, the other red: Chamom. 

Cheeks puffed: Cina. 

Lips, burning of: China. 

, dryness of: Rhus tox. 

, fever-blisters on: Hepar, Ignat., 

Natr. mur., Nux vom. 

Tongue red in middle and white on 
edges, or white in middle and red on 
edges: Chamom. 

Mouth and throat dry; choking sensa- 
tion in throat: Bel I ad. 

(Esophagus constricted: Cimex. 

Thirst: Aeon., Arsen., Bellad., Bryon., 
Cact. grand., Capsie., Chamom., China, 
Chin, sulph., Eup. purp., Hepar, Ipec., 
Laehes., Natr. mur., Nux vom., 
Podoph., Pulsat., Rhus tox., Sulphur. 

for beer: Nux vom. 

, drinks but small quantities at a 

time: Arsen., China, Pulsat. 

, drinks large quantities: Aeon., Ar- 
sen., Bryon., Natr. mur. 

, drinks less during fever: Arnica. 

- , only during heat: Cina, Pulsat. 

for warm drinks: Cedron. 

for cold water: Aeon. 

When drinking, the water goes down 
only at intervals: Cimex. 

No thirst: Ant. tart., Apis, Calc. card., 
Camphora, Capsie., Card, veg., China, 
Cimex, Ignat., Pulsat., Sepia. 

Hunger: China, Cina, Phosphor. 

Nausea: Ant. tart., Arsen., Bryon., 
Card, veg., Eup. per/., Ipec., Natr. 
mur., Nux vom. 

Gagging: Cimex. 

Vomiting of bile : Chamom., Cina, Eup. 
perf., Natr. mur. 

after drinking: Arsen. 

after cold drinks: Lycop. 

Vomiting of ingesta: Cina, Eup. per/., 
Eerrum, Ignat., Nux vom. 

, sour: Lycop. 

Gastric and bilious symptoms: Nux vom. 



Cina, 



Stomach, burning in: Arsen. 

, heat in: Apis, Laches. 

, pain in: Arsen., Card. veg. 

Rh us tox. , Sep ia . 
Hypochondrium, left, tension and press- 
ure: Arsen. 

, stitching pain: Bryon. 

Bowels, pain in: Arsen., Card, veg., 

Cina, Ignat., Nux vom., Rhus tox. 

, cutting pain in : Capsie. 

, stitching pain in: Bryon. 

, heat in: Apis, Cact. grand., China, 

Laches. 
Diarrhoea: Cina, Pulsat., Rhus tox. 
, slimy, burning, with much pressing 

and bearing down : Capsic. 
Female organs, heat in: Apis. 
Hoarseness in evening: Card. veg. 
Chest, heat in: Apis. 

, stitching pain in sides of: Bryon. 

, oppression and short breathing: 

Apis, Arsen., Cact. grand., Card, veg., 

Cimex, Ipec. 
Palpitation of heart: Aeon., Arsen., 

Bellad., Calc. card., Sepia, Sulphur. 
Pulsation through whole body: Arsen- 
Limbs, pain in: Arsen., Bryon., Calc. 

card., Capsic, Card, veg., China, Eup. 

perf. Eup. purp., Laches., Pulsat., 

Rhus tox., Sepia, Sulphur. 

numb, dead feeling in legs: Cedron. 

Veins distended: Bellad., Camphora, 

China, Pulsat. 
Nettle-rash: Apis, Ignat., Rhus tox. 



Sleep: Apis, Gelsem., Ignat., Natr. 

mur., Opium. 
Sopor: Ant. tart., Bellad., Opium. 
Sleeplessness : Aeon. , Arsen. , Nux vom. , 

Pulsat. 

, with sleepiness: Bellad. 

Restlessness: Acoti., Arsen., Bellad., 

Capsic, Chamom., Gelsem., Pulsat., 

Rhus tox. 
Inability to remain lying: Cact. grand. 
Wants to uncover: Acoti., Arnica, 

Arsen., China, Eup. perf., Laches., 

Natr. mur., Pulsat. 
Averse to uncover: Apis., Bellad., 

Hepar, Ignat., Nux vom., Rhus tox., 

Stramon. 
Feels chilly when uncovering: Arnica, 

China, A r ux vom., Pulsat. 



&72 



DIGEST TO INTERMITTENT FEVER. 



SWEAT. 

Profuse: Bryon., Cact. grand.. Car/). 
veg. % Cedron, Hepar, Mcrcur., Natr. 
mur., Rhus tox., Sambuc, Veratr. 

and sour: Bryon., Carb. veg., Cha- 

mon., Hepar, Ipec, Lycop., Rhus tox., 
Sepia, Sulphur. 

Drenching', sometimes, generally not 
prominent, even wanting: Eup. pcrf. 

Cold: Arsen., Camphora, China, Cina, 
/per., Lycop., Sepia., Strain on, Veratr. 

Hot: Chamom., Opium. 

Long-continuing": Bryon., Ferrum, Ver- 
atr. 

, lasts through apyrexia, worse dur- 
ing waking; dry heat during sleep: 
Sambuc. 

About head: Chamom., Eup. purp., 
Opium. 

On forehead: China, Cina, Stramon., 
Veratr. 

On head and chest: Cimex. 

On one side only: Acon. % Bryon., Cha- 
mom., China, Lycop., Nux vom., Put- 
sat., Rhus tox., Sulphur. 

On covered parts : Aeon. 

On uncovered parts, exceptface: Thuja. 

Sets in some time after the heat: Arsen. 

, or immediately after the 

chill: Lycop. 

Sweat alternates with dryness of skin: 
Apis. 

ACCOMPANIED BY: 

Thirst: Arsen., Cact. grand,, Capsic, 

Cedron, China, Chin, sulph., Natr. 

mur. 

after the sweat: Lycop. 

No thirst: Apis, Calc. carb 

Cina, /gnat., Nux vom., 

Veratr. 
Hunger '• Cimex, Cina. 
Tearing pains in extremities: 
Nettle-rash : Apis, Rhus tox. 
Sleep: Arnica, Arsen., /gnat., J/ezer 

Opium, Podoph., Pulsat., Rhus tox 

Sulphur. 
Wants to uncover: Aeon., Calc. carb 

Eup. per/., Eerrum, Natr. mur, 

Opium, Veratr. 
Covers tightly : Hepar. 
Uncovering causes pain: Stramon. 



Cimex, 

Sambuc, 



Cedron. 



Painful symptoms gradually subside: 
Arsen., Nux vom. 

AFTER THE SWEAT. 

Long-continued headache : Carb. veg. 
Thirst: Bel I ad., Lycop., Nux vom., Sa- 

bina. 
Hunger: Cina. 
Diarrhoea: Pulsat. 
Cough: Eup. per/. 
Weakness: Arsen. 
Chill : Carb. veg. 

PAROXYSMS IN GENERAL. 

Regular at the same hour with clear in- 
termissions, though not always: Chin, 
sulph : 

All Stages strongly marked, or very 
light; no great thirst: /pec. 

in general not very violent, and 

mostly unattended by thirst: Pulsat. 

Return every da3 T , but seem altered every 
other day: Rhus tox. 

Incomplete: Arsen., J/augan., Mezer. , 
Sabad. 

(Compare: no chill, or no heat, or no 
sweat. ) 

Irregular, commencing with sweat, fol- 
lowed by chill: Carb. veg. 

, sweat after chill: Lycop. 

, several stages mixed up: Pulsat. 

Chill predominating: Bryon., Cam- 
phora, Cedron, Diad., J/enyanth., 
Sabad., Ver. alb. 

Heat predominating: Bell ad., Bryon. , 
Cact. grand., Chamom., Hepar, /pec, 
Rhus tox. 

Sweat wanting: Apis, Arsen., Bellad., 
Diad., Eup. per/., Gelsem., Lycop., 
Pulsat., Rhus tox., Sulphur. 



Headache is better: Natr. mur. 



Gastric symptoms : /pec 

Bitter taste and vomiting; oppression 
about the heart; diarrhoea; irritable, 
excited, complaining, restless, anxious: 
Chamom. 

During afternoon, talkative, headache, 
red face, oppression of chest, pain in 
small of back and limbs, restless: La- 
ches. 

Pain in dorsal vertebrae on pressure, in 
liver and spleen on bending, breathing 
and coughing; brick-dust or fatty sedi- 
ment in urine; ringing in ears with diz- 



DIGEST TO INTERMITTENT FEVER. 



873 



ziness, and enlarged feeling of head; 
Chin, sulph. 

Spasmodic Symptoms ; heaviness of 
head; aching in occiput; vomiting and 
pressi ve pain in pit of stomach ; urticaria 
over whole body: Ignat. 

Anaemia, and total prostration of the re- 
productive sphere of system: Arsen., 
China, Ferrum. 

Recent cases of young individuals of a 
full habit: Aeon. 

Children and old people: Opium. 

Chronic cases : Calc. card., Card, veg., 
Sepia, Sulphur.. 

After abuse of quinine: Arsen., Fer- 
rum, /pec., Laches., Natr. mur., Nux 
vom., Pulsat. 

Swamp miasma : Cedron., China, Ipec, 
Nux vom., Natr. mur. 



DURING APYREXIA. 

Cina, Nux 



'om. 



Tearful: Bellad. 

Pulsat. 
— — and peevish: Pulsat. 
Irritable: Aeon., Bellad., Bryon., Cha- 

mom., Nux vom., Pulsat. 
Anxiety: Aeon., Camphor a., Tart. emet. 
Fear of being left alone: Lycop. 
Wants to be alone: China. 



Headache: Arnica, Arsen., Bellad., 
Bryon., China, Gelsem., Ignat., Natr. 

. mur., Nux vom., Opium, Pulsat., 
Rhus tox., Sepia. 

Heat on top of head, with cold extremi- 
ties: Sulphur. 

and burning in eyes: Card. veg. 

Yellowishness of white of eyes: Sepia. 

Swelling of lids: Apis. 

Sinking 1 down of one of upper lids: 
Sepia. 

Hardness of hearing: Calc. card. 

Ringing in ears: China. 

Face bloated: Arsen., Ferrum. 

pale: Arsen., Camphora, Card, 

China, Ferrum, Ignat., Lycop., 
vom., Pulsat., Sulphur. 

, and flushing up easily 

any excitement: Ferrum. 

, with circumscribed redness of 

cheeks: Lycop. 

— , sunken, earthy, sallow: Arsen. 

yellow: Arnica, Arsen., China, 



veg., 
Nux 

from 



Fup. perf., Ferrum, A r atr. mur., Nux 
vom., Rhus tox., Sepia. 

, and also chest and region of 

stomach: China. 

greenish yellow: Pulsat. 

, brownish. yellow saddle across bridge 

of nose: Sepia. 

yellowish around mouth: Nux vom., 

Sepia. 

Around mouth and corners of mouth, 
fever-blisters and eruption at: Hepar, 
Ignat., Natr. mur., Rhus tox. 

Lips pale, cracked, swollen and crusty: 
Arsen. 

red: Sulphur. 

About neck, glandular swellings: Calc. 
card. 

Pain in back of neck: Fen um. 

Mouth, bad smell from: Card. veg. 

, taste bad: Pulsat. 

, of water: Natr. mur. 

, bitter: Ant. crud., Arnica, 

Arsen., Bryon., Chamom., China, 
Nux vom., Pulsat., Rhus tox., Sul- 
phur. 

, lost: Arsen., Pulsat. 

, foul: Arnica, Bellad., Fer- 
rum., Natr. mur. . Nux vom. , Podoph. , 
Pulsat. , Rhus tox. 

Mouth, taste sour: Lycop., Nux vom., 
Sepia. 

Tongue blistered: Natr. mur. 

broad and indented: Podoph., Rhus 

tox. 

, brown streak down the middle: Ar- 
nica, Fup. purp., Laches. 

— — dry: Arsen., Bellad., Natr. mur., 
Pulsat., Stramon. 

on tip: Rhus tox., Sulphur. 

pale: E up. perf., Ferrum, Ipec. 

, red papillae: Aeon., Apis, Bellad., 

Nu x vom., Sir a mon . 

, red: Apis, Bellad, Lycop., Sulphur, 

Tart. emet. 

on tip: Arsen., Laches., Nux 

vom., Rhus tox., Veratr. 

white: Ant. crud., Arsen., Natr. 

mur., Nux vom.. Pulsat., Sulphur. 

yellow: Arsen., Bryon., China, Fup. 

perf., Ipec, Nux vom., Podoph., Pul- 
sat., Sulphur. 

Inner mouth pale: Ferrum. 

Appetite, loss of : Ant. crud., Arnica, 
Arsen., Bryon., Card, veg., China, 



8 7 4 



DIGEST TO INTERMITTENT FEVER. 



Ant. crud. 
Card, veg., 



Nux 



Ignat., I pec, Natr. mur., Nux vom , 
Podoph., Pulsat., Rhus tox. 

for beer: Nux vom., Pulsat. 

sometimes increased, with heat and 

nausea when satisfied: Arsen. 

Loathing" of milk and meat: Sepia. 

Hunger: A?it. crud., Arnica, Card. 
vcg., China, Cina., Jlenyanth., Nux 
vom., Rhus tox., Sepia, Sulphur, 
Veratr. 

, with faintness in forenoon: Sul- 
phur. 

Thirst: China, Cimex., Sulphur, Veratr. 

, loss of: Pulsat. 

, little or no thirst: 

Belching .* Ant. crud., 
vom. 

, sour, after eating: Natr. mur. 

Nausea: Ant. crud., Ar?iica, Arsen., 
Cina, Eup. per/., Ipec, Nux vom , 
Pulsat., Rhus tox., Tart, emet., Veratr. 

Vomiting: Ant. crud., China, Cina., 
Eup. per/., Ferrum, Ipec, Lycop., 
Nux vom., Sepia, Veratr. 

of bile: Arsen., Eup. per/., Ipec , 

Nux vom., Pulsat., \ T eratr. 

Vomiting after eating: Natr. mur. 
of ingesta: Arsen., Eup. perf., 

rum, Ipec, Nux vom., Pulsat. 

of slime: Nux vom., Pulsat. 

, followed by a clean tongue 

ravenous appetite: Cina. 
Stomach bloated: Calc card., Card. veg., 

Lycop., Natr. mur., Nux vom. 
, pressure in: Ant. crud., Natr. mur., 

Rhus tox. 
, sense of relaxation, as though it 

were hanging down: Ipec. 
Bowels bloated: Apis, Arsen., Calc 

card., China, Natr. mut . 
, pain in: Ant. crud., Cina, Sulphur, 

Tart. emet. 

, rumbling in: Lycop. 

Constipation: Ant. crud., Bellad., Bry- 

on., Natr. mur., Opium, Sulphur, Ver- 
atr. 
or diarrhoea: Ant. crud., Sulphur., 

Veratr. 
Diarrhoea: Ant. crud., Arsen., Calc. 

card., Gelsem., Podoph., Pulsat., Rhus 

tox., Sepia, Sulphur, Veratr. 
— — after drinking milk: Sepia. 
Haemorrhoidal complaints: Sulphur. 
Liver, pain in: Arsen., Bellad., Bryon., 



Fer- 



and 



Ch ina , Lycop. , Natr. mur. , Nux vom. , 
Pulsat. 

, , with inclination to rub and 

stroke this part: Podoph. 

, , worse on moving: Bryon., 

China, Sepia. 

, , and spleen: China, Nux vom . 

, swollen: China, Nux vom. 

Spleen enlarged: Arsen., Bellad., Calc 
card., Card, veg., China, Diad., Fer- 
rum., Pulsat. 

, pain in: Apis., Arnica, Arsen, Bel- 
lad., Card, veg., China, Ferrum., Natr. 
mur., Nux vom. 

Hypochondriac regions, worse left, 

pain in: Apis. 
, right side: Eup. per/., Nux 

vom. 

, swollen: Arsen. 

, ■ and hard: Ferrum. 



Kidney region painful: Natr. mur. 
Urine scanty: Apis, Arsen., Bryon., 

China, Natr. mur. 
, turbid: Arsen., China, Cina, Lycop,, 

Natr. mur. 

profuse: Eup. perf., Pulsat. 

Micturition, cutting in urethra after: 

Natr. mur. 



Menses suppressed: Arsen., Calc card., 

Ferrum, Lycop., Nux vom., Pulsat., 

Sepia, Sulphur. 
scanty: Lycop., Natr. mur. Pulsat., 

Sulphur. 
profuse; Calc. card., Diad., Nux 

vom. 
Leucorrhcea, Sulphur. 



Cough: Apis, Arsen., Bellad., Bryon., 

China, Cina, Eup. perf., Ipec, Nux 

vom., Pulsat., Sulphur. 

in evening on lying down: Sulphur. 

, loose: Eup. perf. 

, thick, yellow, salty expectoration: 

Lycop. 
, with heavy breathing and pain in 

chest: Sadad. 
, with oppression; pain in left side: 

Lycop. 
, with pain in chest, head and pit of 

stomach: Pulsat. 
Congestion of lungs; shortness of breath: 

Ferrum. 



PERNICIOUS INTERMITTENT FEVER. 



875 



Palpitation of heart: Aeon., China, 
Lgnat., Laches., Lycop., Natr. mur., 
Pulsat., Sepia, Sulphur. 

Nun's murmur in veins: Ferrum, Pul- 
sat . 



Fainting : Tart. emet„ 



Spine, soreness of: Nux von. 

, , between shoulder-blades: Chin. 

sulph. 
Limbs, aching as though beaten: Arnica. 

, cramps in: Veratr. 

Limbs, soreness in: Apis. 

Pain in lower extremities: Tart. emet. 

Feet swollen: Apis, Arsen., Bryon., 

China, Ferrum, Nux vom., Pulsat., 

Sepia. 



Sleepy, drowsy: Bellad., Bryon., Calc. 

card., Opium, Pulsat., Tart. emet. 
Sleepless: Arsen., Bellad., China, 

Cina, Ipec, Natr. mur., Rhus tox., 

Sulphur. 
C hilline s S : A rsen . , Bryon . , Hepar. , 

Pulsat., Sabad., Veratr. 
Feverish through the night: Sulphur. 
Flushes of heat: Sepia. 
Sweating: China, Sambuc, Veratr. 
, one side: Pulsat. 



Skin pale, covered with cold sweat: Ar- 
sen. 

itchy: Hepar, Ignat., Rhus tox., 

Sulphur. 

, tettery eruptions: Sepia, Sulphur. 

, on chest: Hepar. 

, nettle-rash: Apis. 



Debility, prostration: Apis, Arsen., 
China, Ferrum, Gelsem., Lycop., Natr. 
mur., Nux vom., Sulphur, Veratr. 



Diathesis, scrofulous: Calc. card., Silic, 
Sulphur. 

, psoric: Calc. card., Card, veg., Cina, 

Sepia, Sulphur. 

, gonorrhceic: Thuja. 

Arsenic poison: Hepar., Lpec, Nux 
vom. 

Mercury poison : Hepar. 

Quinine poison: Arnica, Arsen., Bel- 
lad., Card, veg., Ferrum, Lgnat., 
Laches., Natr. mur., Nux vom., Pul- 
sat., Sulphur, Veratr. 

Apis follows well after Natr. mur., 
Thuja. 



Pernicious Intermittent; Remittent and Continuous Malarial 
Fevers; Congestive Fevers. 

1. Pernicious fevers are characterized by special dangerous, local affec- 
tions of important organs; they often appear in the form of an epidemic; 
their paroxysms are usually of the same duration as those of a simple inter- 
mittent; sometimes they last longer; their separate stage, may be distinct or 
ill-defined, with complete or incomplete intermittance of various types. When 
there are severe disturbances of the nervous system, the most common 
forms are the comatose, or the intermittens apoplectica, with unconsciousness, 
stertorous breathing, etc.; the eclamptic form, mostly found among children 
and puerperal women, with convulsions and unconsciousness; the tetanic 
form, the severest of all pernicious forms, with tetanic spasms; the hydro- 
phobic form, with symptoms of hydrophobia. When the alimentary canal 
is especially affected, we have the choleraic form, especially found in hot 
climates, which may increase to an algid intermittent; the cardialgic form, 
with great pains in the region of the stomach; the dysenteric form, with all 
the symptoms of dysentery; the hemorrhagic form, with haemorrhages from 
the stomach or bowels. The pneumonic and pleuritic forms show serious 
affections of the lungs and pleura, and the icteric form especially attacks the 
liver. 



876 PERNICIOUS INTERMITTENT FEVER. 

2. Remittent and continuous malarial fevers are frequently met with in 
the south and southwest of the United States, and in the tropical countries. 
They are all of a malarial origin, which is proved by the fact that they occur 
exclusively in regions where ague prevails, in regions, therefore, which, bv 
their conformation of soil and climate, constitute the necessary conditions 
for the development of the miasma: and it is further proved by the fact, that 
remittent fevers, when improving, gradually change into the intermittent 
type. Hence remittent fevers are only graver forms of the effects of the 
same unknown virus, called miasma, that causes the ague, and this cor- 
responds again with the fact, that we find remittent fevers oftener in such 
regions in which the common intermittent cases are likewise much more 
severe than in other regions. 

Remittent fever has no apyrexia, but in place of it there is merely a slack- 
ing off of the fever, which is again succeeded by another exacerbation. If 
it be of a severe type there is not even such a remission of its violence. 
These remittent fevers may be divided into three forms: 

1 . The bilious or gastric remittent, characterized by commencing with a 
chill, which is followed by a violent fever and many gastric symptoms; the 
spleen is swollen; there is slight icterus; irregular and whitish stools; herpes 
labialis; headache; pain in the limbs; dizziness; ringing in the ears; epis- 
taxis; bronchial irritation; great debility. It might be confounded with the 
beginning of typhus if it were not for the fever blisters around the mouth 
and the exacerbations, recurring at first irregularly, but later, regularly, as- 
suming a regular remittent type. It ma}' last from several days to three 
weeks, and corresponds to the febris intermittens subintrans. 

2. The typhoid form gradual^ loses the remissions and becomes con- 
tinuous. The patient is delirious or lies in a stupor; his tongue is dry and 
his spleen swollen. In addition to all this there may be icterus, or symp- 
toms of pneumonia, dysentery, etc. This form lasts from eight to fourteen 
days, and, on getting better, works over into an intermittent type; if fatal, 
the patient dies in a comatose condition, corresponding thus to the comatose 
form of a pernicious intermittent. 

3. The gravest form is characterized by a high degree of adynamia and 
a tendency to rapid collapse. Such patients are deeply apathetic from the 
very beginning, and exhibit functional disturbances in almost all organs. 
Many patients are icteric; others bleed from the nose, stomach or kidneys; 
others show albuminuria, or suppressio urinae; and still others have cholera- 
like or dysenteric discharges from the bowels. Liver and spleen are swollen, 
terminating sometimes in inflammation and suppuration. The serous mem- 
branes show exudates, and the external skin is covered with petechias, or 
destroyed by decubitus and gangrene. 

Congestive fever, malignant bilious fever, typho-malarial fever, etc., are 
only other names for the above-described different forms of remittent mala- 
rial fevers. 



yellow fever. 877 

Therapeutic Hints. 

Compare Intermittent Fever. 

The comatose form requires principally Bellad. y Hyosc, Laches., Opium, 
Stramon., Tart. emct. 

The adynamic form especially Arnica, Arsen., Bryon., Camphora, Carb. 
veg., Chin, sulph., Ferrum, Hydr. ac, Laches., Phos. ac, Rhus tox., 
Veratr. 

Yellow Fever. 

The following is from the special report of the Homoeopathic Yellow 
Fever Commission: 

" Yellow fever is a specific disease, entirely independent of malaria, oc- 
curring rarely a second time in the same person, infectious and capable of 
transmission to any distance by means of fomites or infected material. 

11 The yellow fever germs, for we accept provisionally the germ-theory 
of the disease, are indigenous to the West Indies and perhaps to the west 
coast of Africa, and have been thoroughly naturalized in many localities in 
the southern portion of the United States. They were imported into New 
Orleans during the last quarter of the eighteenth century, and have existed 
in the soil or atmosphere of that place ever since, either in a latent or an 
active condition. They may lie dormant for many years consecutively, and 
they require a concurrence of causes to develop them into a state of disease- 
producing activity. 

4 ' Some of the factors which seem to be favorable to the excitation of the 
yellow fever germ are the following: 

''Low, swampy ground near the level of a tropical sea. Long contin- 
uance of a very high temperature, following heavy rains. Long continuance 
of south and east winds. Aggregations of human beings with the excreta 
of their bodies in small spaces. A crowded and dirty ship may be a nidus 
for yellow fever, as well as a crowded and dirty city. Long continuance of 
calm weather, unbroken by thunder-storms. Exposure of decaying vege- 
table and animal matter to a burning sun. Inefficient drainage and the gen- 
eral accumulation of filth, especially the city garbage. Deficiency of ozone 
in the atmosphere. Pestilential exhalations from an upturned soil. 

' ' When the yellow fever germ has been waked into activity by these 
causes, it may be transported to places where none of them exist. It seems 
that a certain concurrence of several of the above factors is necessary to the 
generation of yellow fever. There is probably one combination in one epi- 
demic, and a somewhat different combination in the next epidemic. An 
epidemic may be mild or severe, according to the number and force of the 
concurring causes. There may also be other unknown but discoverable 
factors, which may be necessary at one time to produce an epidemic, and 
not necessary at another. No one of the above suggested causes could ex- 
cite an epidemic by itself, and it is not probable that they all ever concurred 



878 YELLOW FEVER. 

equally to the formation of the disease. The most extensive collections and 
comparison of facts are necessary to illumine the very great darkness which 
lies upon these complex questions. 

' ' The naturalized yellow fever germs may receive so slight a stimulus 
as to produce only a few sporadic cases. Or they may be vitalized in 
certain localities to such a degree as to occasion quite an outbreak in those 
localities, not easily communicated to other quarters. Or thirdly, the dis- 
seminated germs may be vivified in all directions, and a general epidemic 
excited. Or lastly the naturalized germs may lie entirely quiescent, until 
fresh and active germs are brought in from foreign ports, which then act as 
sparks to ignite the inflammable material already existing. We thus have 
four shades or degrees of yellow fever visitation: sporadic cases; local and 
limited outbursts; epidemics from naturalized germs, and epidemics from 
importation. 

In sporadic cases and limited outbreaks the specific nature of the fever 
is not clearly brought to light, and it is sometimes difficult to diagnose it 
from the dominant malarial or bilious diseases. The imported epidemic, 
whether from Havana to New Orleans or from New Orleans to Memphis, 
etc. , etc. , is always a more quick-spreading and malignant disease than that 
arising from our naturalized germs. The comparative mildness of the late 
epidemic in New Orleans, is one out of several reasons for believing that the 
disease was of local origin. 

1 ' The yellow fever of domestic origin can only be prevented by local 
sanitary measures. So long as the public authorities ignore the crying evils 
at home, and watch only for the enemy at the seaside, we shall continue to 
be scourged with repeated epidemics of yellow fever. Quarantine may or 
may not keep out the tropical foe, but our utmost energies should be con- 
centrated against the enemy which has been domiciliated in our households 
for nearly a century. ' ' 

The incubation is short, frequentty not longer than a day or two; in 
some cases fourteen days. 

Its course is an acute one, lasting from three to ten days, and consists 
of three distinct stages. 

1. The febrile stage. — ''Very high fever, preceded or not by a chill, 
with extremely severe pains in the head (occipital region predominantly), 
back and limbs. Temperature from 103 to 107 F.; great restlessness and 
malaise, accompanied sometimes with mental anxiety and fear of death; 
vomiting of ingested bile; red, watery eyes; suffused countenance; sleepless- 
ness or stupor with intense heat; delirium, sometimes violent, sometimes 
muttering; skin very hot and dry, but very easily excited to perspiration." 

2. The stage of exhaustion. — "Passing in most cases by insensible 
gradations from a state of great apparent, but of really little danger, the 
patient enters the second stage of yellow fever, in which he may seem to be 
doing very well to an inexperienced eye, while in fact he may be in an 
alarming and even hopeless condition. The pulse becomes natural again, or 



SPECIAL HINTS TO YELLOW FEVER. 879 

weak and irregular, or in some cases very slow, forty or even thirty to the 
minute. The patient expresses himself as well, wants to eat or drink, would 
commit great imprudence in diet, or talking, or throwing off cover, or get- 
ting out of bed, if permitted; apathy, indifference, no realization of danger; 
at night sleeplessness, sometimes a terrible pervigilium, restlessness, great 
nervousness; sour or acid eructations; epigastric pains; tenderness on press- 
ure over the liver and spleen; vomiting of ingesta, of a claret-colored water, 
of mucous substances specked with blood, of pure blood, of floating shreds 
like bees' wings, of brown vomit, of genuine coffee-grounds, black vomit; 
excesssive irritability of stomach; black stools; hiccough. Sudden and un- 
accountable changes of color; alternate flushing and paleness; yellow tint 
of the sclerotica; increasing yellowness of the surface, even in some cases to 
the deepest jaundice, and haemorrhages; oozing of dark blood from gums, 
nose, eyes, ears; haemorrhage from the uterus, bowels, or kidneys; petechiae; 
decided albuminuria; scanty or suppressed urine, followed by coma or con- 
vulsions; secondary fever, from local congestions or inflammations." 

3. The stage of collapse. — "Skin of a dirty yellow or almost bronze 
color; large petechial spots; slow oozing of blood from every orifice of the 
body; black vomit; bloody, black, or totally suppressed urine; extreme 
jactitation; total apathy or muttering delirium; hiccough; cold extremities; 
feeble and flickering pulse; convulsions; involuntary discharges of black 
matter, and utter prostration, sometimes with precordial anguish and undy- 
ing irritability of the stomach." {Report of Homoeopathic Yellow Fever Com- 
mission.} 

Therapeutic Hints. 

In the first stage most physicians have used Aeon., Bellad., Bryon.; 
some have recommended Gelsem. and Ver. vir.; one has called attention to 
Eupat. per/., Cimicif., Baptis. In the second stage all used Arsen., many 
also Laches., or Crolal., and on failure of these remedies, Card. veg. Phos- 
phor, is barely mentioned by two physicians. In the third stage the choice 
lay between Arsen., Crotal., Carb. veg., Hydr. ac, Secale and Tincture of 
Aeon. 

Special Hints. 

Aeon. First stage; burning heat and dry skin; full, hard, quick pulse; 
desire to be uncovered; great restlessness and anxiety; fear of death; dizzi- 
ness on rising; pain in the forehead and temples; face dark red; eyes in- 
jected, sometimes sensitive to light; lips and mouth dry; great thirst; nausea, 
vomiting; heat in the stomach; short, anxious respiration; distress in car- 
diac region; pain in the back and extremities. Useful only for a short time; 
is followed well by Bellad. (Taft, Hardenstein.) 

Apis. Pain in forehead and temples, relieved by pressure; burning, 
stinging heat in face with purple color; dry, swollen and inflamed tongue 
with difficulty of swallowing; strangury, or urine scanty and high colored; 
sleep disturbed by many dreams; restlessness and delirium. (Angell.) 



88o SPECIAL HINTS TO YELLOW FEVER. 

Arg. nitr. Second stage; vomiting of a brownish mass, mixed with 
coffee-ground-like flakes. (Holcombe.) Meningeal symptoms. (Harden- 
stein.) 

Arscn. Second and third stage; dull, heavy or throbbing pain in the 
head; face yellowish and livid, or deep, dull red; eyes dull and sunken, with 
dark rings around and yellow sclerotica; nose pointed; nosebleed; lips and 
tongue brown or black; vomiting, especially after drinking; black vomit; 
burning or stitching pain in the epigastrium and region of the liver; great 
pressure in the pit of the stomach; cramp-pains in the bowels; diarrhoea, 
with tenesmus, or painless and involuntary; bloody discharges; retention of 
urine; bloody urine; oppression of the chest, with short, anxious breathing; 
pulse irregular, frequent, small, trembling; internal heat and external cold- 
ness of the body, and cold, sticky perspiration; stiffness and lameness of the 
limbs; rapid sinking of strength; anxiety and restlessness; wants to go from 
one bed to another; delirium with desire to escape. (Taft, Holcombe.) 

Baptis. Stupid stare and bewildered look; cannot collect himself; face 
dull red, listless, besotted; dry, red tongue, or with a dark yellow coating; 
difficulty of protruding the tongue; fetid breath; urine scanty and high 
colored; all symptoms worse from evening till one o'clock A. m. (Angell.) 

Bellad. First and second stage; dry, burning heat, with changing pulse; 
sharp, stitching, shooting and throbbing pains in the head and ears; face 
scarlet red, shining and swollen; eyes red, glistening, staring, dilated and 
oscillating pupils; carotid arteries pulsating; dry, hot tongue and throat; 
nausea and violent vomiting; cramp-like pain in the stomach; burning and 
throbbing in the pit of the stomach; urine red or brown; painful heaviness 
and cramp-like pain in the back, loins and legs; head and body hot, feet 
cold; delirium, afraid of creeping things. (Hardenstein, Taft.) 

Bryon. First and second stage; headache in back of head down to neck 
and shoulders, worse from motion; pain in the eyes when moving them; the 
eyes are red or dull and glassy, or glistening and watery; tongue dry and 
coated white, or dirty-yellowish, or brownish; burning thirst; vomiting worse 
after drinking; fullness and oppression in the pit of the stomach and bowels; 
pleuritic pains in the chest with or without cough; pain in the back and 
limbs; yellow skin; anxiety and fear about the future; loss of memory; de- 
lirium. (Taft, Hardenstein, Angell.) 

Cadm. sulph. When nausea is not relieved by Ipec. or Arsen., in first 
stage. Taste like pitch in the mouth; salty, rancid belching; nausea in 
mouth, chest and abdomen, often with pain and cold sweat in face, pain in 
abdomen; vomiting of sour, yellow and black matter; burning and cutting 
in stomach; vertigo, room and bed seem to spin around. (Hardenstein.) 

Camp/wra. When there is a severe and long-lasting chill at the com- 
mencement. (Holcombe.) Trembling of the internal parts; coldness of 
limbs. ( Hardenstein. ) 

Canthar. Second and third stage; complete insensibility; cramps in 
the abdominal muscles and legs; suppression or retention of urine; haemor- 



SPECIAL HINTS TO YELLOW FEVER. 88 1 

rhages from the stomach and intestines; cold sweat on the hands and feet. 
(Taft.) Strangury. (Holeombe.) 

Chamom. Suitable especially for women and children with gastric 
irritations. (Holeombe.) An intercurrent remedy for colic. (Harden- 
stein.) 

Card. veg. Like sulphur in cholera, so is, according to Hering, Card. 
veg., that medicine which, more than any other, corresponds in the totality 
of its action, to yellow fever. Taft recommends j.t, especially for the third 
stage, and Howard gives the following indications: haemorrhages with great 
paleness of the face, violent headache, great heaviness in the limbs and trem- 
bling of the body. — The report of the Yellow Fever Commission gives the 
following indication: pupiis do not respond to the light; haemorrhage from 
the eyes; repeated nosebleed, with small, intermittent pulse; hippocratic face; 
grayish -yellow; red cheeks, covered with cold sweat; bloody saliva; rancid 
eructations; enormous flatulence; burning in the stomach, with vomiting of 
blood; all discharges fetid and offensive; menorrhoea; capillary stagnation; 
cyanosis; thread-like pulse, sleepless, intensely restless, from suffocating sen- 
sations; icy coldness of the body; ecchymoses. 

Cepa. Is said to have cured a case of yellow fever when raging in 
Philadelphia; there are a good many symptoms in its pathogenesis which 
might suggest its further application. 

Cimicif. Delirium with excessive restlessness; subsultus tendinum; wak- 
ing from sleep with start; dreams and delirium about negroes, devils, etc. 
(Angell.) Violent pains in small of back; stiff neck; soreness of all mus- 
cles; pains like electric shocks here and there; sharp pains from neck to 
vertex. Melancholy, indifferent, taciturn. (Report of H. Y. F. Commis- 
sion.) 

Coloc. For colic and colicky pains. 

Crotal. Is indicated especially by the haemorrhages from the eyes, nose, 
mouth, stomach and intestines. (Bute.) The report of the Commission, 
and Hardenstein, give the following indications: delirium with open eyes; 
utter apathy; confused speech; disconnected answers, with coldness of the 
skin and rapid pulse; terrible headache, with red, puffed face; face yellow, 
or sometimes of a leaden color; blood flows from the eyes, ears and nose, in- 
deed from all the orifices of the body, even bloody sweat; thirst; sour, acrid 
eructations; scraping, rancid sensation down the oesophagus to the stomach; 
extreme nausea and vomiting on least exertion; vomiting of bile, of blood; 
swelling of the whole abdomen; enlargement of the inguinal glands; bloody 
stool, sometime involuntary; haemorrhage from the urethra; painful reten- 
tion of urine; menses anticipate; hoarse, weak, rough voice; pains in chest; 
pulse slower than natural (sixty beats), or intermitting and scarcely per- 
ceptible; pains in bones; deep yellow color of the whole body; purple spots; 
extreme depression of the vital powers; spasms; death by syncope; acts 
more on right side. 

. 56 



882 SPECIAL HINTS TO YELLOW FEVER. 

Crot. tig/. Recommended by Haekett, an allopath; he saw from his 
doses aggravations, but afterwards rapid improvement. 

Cuprum. When Arsen. does not relieve the vomiting of blood. 
( Kiistner. ) 

Eupat. perf. Valuable in first stage as an intercurrent remedy in cases 
where the bones ache as if broken, with headache and backache, thirst 
and vomiting. (Angell.) 

Gelsem. Unconnected ideas, cannot follow any idea for any length of 
time; if he attempts to think consecutively, he is attacked by a painful 
vacant feeling of the mind; giddiness with loss of sight; indistinctness of 
vision, or double vision; fullness of head, with heat in face, and cold feet; 
pain in back of neck; heavy, dull expression of countenance and yellow 
face, or nausea and paleness. Sticky feeling in mouth; fetid breath; tongue 
coated whitish or yellowish; dryness and burning in throat; sour eructations; 
pulse frequent, full, but soft. As soon as he goes to sleep, he is delirious. 
(Angell.) 

Ipec. In the first stage; dizziness, chilliness, pain in the back and 
limbs, uncomfortable feeling in the epigastrium, with nausea, vomiting and 
great weakness. (Taft. ) To be followed by Cadmium sulph . if relief is not 
soon attained. (Hardenstein.) 

Laches. Quite important in any of the stages. Kiistner gave it also 
after previous abuse of mercury or quinine. The report of the Commission, 
and Hardenstein, gave the following indications: delirium at night; loqua- 
cious, disposed to quarrel; slow, difficult speech; drowsy; rush of blood to 
the head; red face; yellow conjunctiva; yellow or purplish tint of skin; 
blood dark; non-coagulable; small wounds bleed much; perspiration stains 
yellow; lips dry, cracked and bleeding; tongue heavy, trembling, dry and 
red, cracked at tip; tip red, centre brown; difficult speech; sour eructations; 
heartburn; nausea after drinking; vomiting, with palpitation; dyspnoea; 
anxiety about the heart; cannot lie on left side; irregular, weak pulse; 
urine almost black; persistent sleeplessness; fainting; trembling all over; 
sudden flushes of heat; sensitiveness about the neck and pit of stomach 
against any pressure; worse when waking; better after nourishment. Acts 
more on left side. 

Mercur. Yellow skin; red, injected eyes, sensitive to light; paralysis 
of one or the other limb; tongue moist, coated, thick and white, or dry 
with brown slime; pulse irregular, quick, strong and intermitting, or soft 
and trembling. Drowsy or sleepless from nervous irritation; tired and 
weak; rapid sinking of strength; dizziness and violent headache; violent 
convulsive vomiting of slime and bilious matter; burning pain and sensitive- 
ness of the stomach; constipation or diarrhoea of slime, bile or blood; cold- 
ness of the extremities with cramps. Great irritability of all the organs; 
anxiety and restlessness; weak memory; fears; discouragement; crossness. 
(Taft.) 

Nux vom. After allopathic drugging, or in persons accustomed to 



SPECIAL HINTS TO YELLOW FEVER. 883 

drinking strong liquors. According to Taft: yellow skin, pale or yellowish 
face, especially around the nose and mouth; eyes injected, yellow and watery; 
dark rings around the eyes; tongue slimy or dry, cracked and red on the 
edges; thirst for beer or stimulating drinks; burning in the stomach; press- 
ure or cramp-pain in the stomach; vomiting of sour, bilious, or slimy sub- 
stances; hiccough; dizziness or headache; trembling of the limbs; cramps 
in different parts of the body; contractions of the abdominal muscles; thin, 
slimy, bilious or bloody stools; burning pain in the neck of the bladder, with 
difficult urination; coldness, lameness and cramps in the legs; cold feet. 
Excessive anxiety; fear of death; despondency or loss of consciousness and 
delirium, with moaning and groaning. 

Phosphor. Hemorrhagic form, with petechial spots, or with menin- 
gitis, or especially pleuritic pains after Bryon. (Hardenstein.) " Its power 
of producing acute yellow atrophy of the liver, fatty degeneration, malignant 
jaundice, albuminous urine, the haemorrhagic diathesis, and many of the 
symptoms of Arsen. and Crotal. shows that is a remedy of great homoeo- 
pathic applicability to yellow fever." (Report of Commission.) 

Rhus tox. According to Taft: dirty yellow color of the body; glassy, 
sunken eyes; dry, black tongue; talkative delirium, or coma with rattling 
respiration; constant groaning; torturing pain and burning in the stomach; 
nausea; vomiting; paralysis of the lower extremities; cramps in the abdomen; 
colic; diarrhoea; difficult}' in swallowing; constant restlessness and tossing 
about. According to Angell: bright redness of face (in first stage), or pale 
and sunken face, with pointed nose; epistaxis; dryness of mouth and throat; 
dry cough and red. tongue, or dark brown (mahogany) or black; cracked 
tongue, unable to protrude it; eructation and rumbling in abdomen, causing 
great distress; diminished urine; sleeplessness. 

Sulphur. Melancholic; fearful; undecided; sad; absent-minded; dizzi- 
ness; headache; face pale or yellowish; eyes red or yellowish; itching and 
burning in the eyes; noises in the ears; tongue dry, red, or with white or 
brown coating; aphthae in the mouth; nausea with trembling and weakness; 
vomiting of sour, or bilious, or bloody and black masses; pressure in the 
stomach; pain in the back and loins. (Taft.) 

Tart. emet. Continuous nausea with vomiting, or vomiturition with 
perspiration on forehead; shuddering; attacks of fainting and trembling; 
great prostration. (Angell.) 

Verbena Jam. The juice of the leaves of this plant, the species of 
which is not properly given, is said to have cured a number of the most des- 
perate cases. 

Veratr. According to Taft: yellowish or bluish face, cold and covered 
with a cold perspiration; eyes dull, yellowish, watery; deafness; lips and 
tongue dry, brown, cracked; difficult swallowing; hiccough; great thirst; 
vomiting of bile or blood; burning in the stomach; coldness of the hands 
and feet; trembling and cramps of the hands, feet, legs and abdomen; diarrhoea, 
thin, blackish or yellowish; pulse small, scarcely perceptible, intermitting. 



884 



DIGEST TO YELLOW FEVER. 



Great exhaustion; vertigo; fear; despondency; restlessness; loss of con- 
sciousness; coma or delirium. According to Angell: after purging from 
castor oil; vomiting of slime and diarrhoea, sometimes involuntary stools; 
hopelessness of life. According to Hardenstein: in first stage trembling and 
jerking of external parts; coldness all over the body. 

Ver. vir. Intense fever with occipital pains, and vascular and nervous 
erethism, threatening convulsions, especially in children; developments of 
local inflammations; precordial distress; vomiting with cold sweat on the 
face; great and sudden changes in the pulse. (Report of Commission.) 

Aside from these remedies we find recommended: 

For nausea: Apomorph., Kreos., Hydr. ac, Lobel. inji. 

For nervousness and sleeplessness: Coffea or Bellad., Opium, Daphne 
hid., Sepia. 

For haemorrhages : Plumb, ae., -£$ of a grain (Angell), Sulph. ae., Tereb., 
Millef., Eiiger., Pycop., Arnica, Sabina, Secale, Hamam., Thlaspi bursa 
pastoris. 

For albuminuria: Euonymin , He/on., Cuprum, Merc. corr. 

For retention of urine, with delirium and convulsions: Hyosc, Opium, 
Stra m mon . , Plu m b u 771 . 

For difficult urination and tenesmus : Lycop., Te7eb., Chimaph., Apis, 
Apocy7i., Primus spi7iosa, Ca7in. Ind., Sulphur, Citric ac. 

For cerebro-spinal symptoms: Glo7ioin., Cor all., Cicuta, Zincum. 

During convalescence : Calc. carb., China, Hepar. (Report of Commis- 
sion, Hardenstein/) 



Digest to Yellow Fever. 



Consciousness, loss of : Nux vom., Ver. 

alb. 
Insensibility : Canthar. 
Memory, weak: Mercur. 

, loss of: Bryon. 

Absent-minded : Sulphur. 
Cannot collect himself: Baptis. 
Unconnected ideas ; cannot follow any 

idea for any length of time; if he at- 
tempts it, he is attacked by a painful 
vacant feeling of the mind: Gelsem. 

Disconnected answers, with coldness 
of skin and rapid pulse: Crotal. 

Confused speech : Crotal. 

Stupid stare and bewildered look: Bap- 
tis. 

Delirium : Bryon. 

with open eyes: Crotal. 

at night: Laches. 

as soon as he goes to sleep: Gelsem. 

Delirium and coma: Rhus tax., Ver. alb. 

about negroes, devils, etc.: Cimie. 

, afraid of creeping things: Bel lad. 



, talkative: Rhus tox. 

, with moaning and groaning: 

vom. 

, with desire to escape: Arsen. 

, restlessness: Apis, Cimie. 



Nux 



Loquacious : Laches. 

Moaning and groaning: Nux vom., 

Rhus tox. 
Taciturn : Cimie. 



alb. 



Indifferent: Cimie. 

Apathy: Crotal. 

Fears: Mercur., Sulphur., Ver. 

about the future: Bryon. 

of death: Aeon., Nux vom. 

Anxiety : Arsen., Bryon., Nux vom. 
Anxiety and restlessness: Aeon., Arsen. 

Mercur. 
Sad: Sulphur. 

Melancholy: Cimie, Sulphur. 
Despondency: Nux vom., Ver. alb. 
Hopelessness : Ver. alb. 



DIGEvST TO YEI^OW FEVER. 



885 



Discouragement : Mercur. 
Undecided: Sulphur. 
Crossness : Mercur. 
Quarrel, disposed to: Laches. 



Vertigo : Sulphur, Ver. alb. 

, room and bed seem to spin around: 

Cadm. sulph. 

on rising: Aeon. 

and headache: Mercur. 

or headache: Nux vom. 

• , with loss of sight: Gel son. 

and chilliness: Ipec. 

Headache: Card, veg., Sulphur. 

, dull, heavy, throbbing pain: Arsen. 

, with red, puffed face: Crotal. 

Pain, forehead and temples: Aeon. 

, , relieved by pressure: 

Apis. 
, back of head down to neck and 

shoulders, worse from motion: Bryon. 

, sharp, from neck to vertex: Cimic. 

, ,stitching and throbbing in head 

and ears: Bell ad. ■ 
in occupit, with intense fever: Ver. 

vir. 
Head and body hot, feet cold: Bellad. 

, rush of blood to the: Laches. 

, fullness of, with heat in face and 

cold feet: Gelsem. 
Meningeal symptoms: Arg. nitr., 

Phosphor. 

Eyes itching and burning: Sulphur. • 

painful when moving them: Bryon. 

red, injected : Aeon. , Bellad. , Bryon. , 

Mercur., Nux vom., Sulphur. 
, , sensitive to light: Aeon., 

Mercur. 

glistening, staring: Bellad., Bryon., 

glassy, sunken: Rhus tox. 

, dull and watery: Bryon. 

dull and sunken: Arsen., Card. 

veg. 

and watery: Ver. alb. 

yellowish: Laches., Sulphur, Ver. 

alb. 
and watery; dark rings around 

eyes: Arsen., Nux vom. 
Pupils dilated and oscillating: Bellad. 
do not respond to the light: Carb. 

veg. 
Sight indistinct, or double vision: Gel- 
sem. 



Haemorrhage from eyes: Carb. veg. 
and all orifices of body: Crotal. 



Ears, noises in: Sulphur. 

, deafness: Ver. alb. 

, haemorrhage from: Crotal. 



Nosebleed: Arsen., Crotal., Rhus tox. 
, with small, intermittent pulse: Carb. 

veg. 
Nose pointed: Arsen., Carb. veg., Rhus 

tox., Ver. alb. 



Face, dull, heavy expression: Gelsem. 

, listless, besotted expression : Baptis. 

pale, with nausea: Gelsem. 

, with haemorrhages: Carb. veg. 

and sunken, with pointed nose: 

Rhus tox. 

— or yellowish: Nux vom., Sul- 
phur. 

red: Laches. 

bright red: Rhus tox. 

dark red: Aeon. 

dull red: Arsen., Baptis. 

scarlet red, shining and swollen: 

Bellad. 

purplish, with burning, stinging 

heat: Apis, 
yellowish or bluish, with cold sweat: 

Ver. alb. 

yellowish, grayish, hippocratic: 

Carb. veg. 

, or of a leaden color: Crotal. 

and livid: Arsen. 

, especially around nose and 

mouth: Nux vom. 

, cold sweat on : Carb. veg. 

, , during vomiting: Ver. 

vir. 

, cold sweat on forehead during per- 
spiration: Tart. emet. 



Lips dry, cracked and bleeding: Laches. 

and mouth dry: Aeon. 

and tongue dry, brown, cracked: 

Ver. alb, 

brown or black: Arsen. 

Tongue dry and cracked: Laches., Nux 

vom., Rhus tox., Ver. alb. 

, black: Rhus tox. 

, brown: Ver. alb. 

, red at tip: Laches. 

, on edges: Nux vom. 



886 



DIGEST TO YELLOW FEVER. 



and red: Baptis., Laches., Sul- 



phur 



and hot, and throat: Bellad. 

and brown: Ver. alb. 

and black: Rhus tox. 

and brown or black: Arsen. 

or red: Rhus lo.v. 

and coated white, or dirty-yel- 
lowish, or brownish; Bryon. 

dark yellow: Baptis. ' 

white or brown: Sulphur. 

with brown slime: Mercur. 

; swollen and inflamed, with dif- 
ficulty of swallowing: Apis. 

, tip red and centre brown: 

Laches. 

, red streak in centre: Ver. vir. 

moist and coated thick and white: 

Mercur. 

coated whitish or j-ellowish: Gel son. 

heavy, trembling: Laches. 

difficult of protruding: Baptis., Loa- 
ches., Rhus tax. 

Mouth, and throat dry: Rhus lo.v. 

, aphthae in: Sulphur. 

, haemorrhage from: Crotal. 

, bloody saliva: Garb. veg. 

, sticky feeling in: Gelsem. 

, taste like pitch: Cadm. sulph. 

, fetid breath: Baptis., Gelsem. 

Thirst: Aeon., Arsen., Bryon., Grotal., 
Eup. per/. , Ver. alb. 

for beer or stimulating drinks: Nux 

vom. 

Swallowing difficult: Rhus tax., Ver. 
alb. 

Speech slow, difficult: Laches. 

Throat dry and burning: Gelsem. 

, scraping, rancid sensation to stom- 
ach: Grotal. 



Eructations, rancid: Cadm. sulph., Garb, 

veg. 

, salty: Cadm. sulph. 

, sour: Crotal., Gelsem., Loaches. 

and distressing rumblings in bowels: 

Rhus tox. 
Heartburn: loaches. 
Hiccough: Nux vom., Ver. alb. 
Nausea in mouth, chest and abdomen, 

with pain, and cold sweat in face; 

Cadm. sulph. 
and paleness: Gelsem. 



and trembling and weakness: Sul- 
phur. 

and drinking: Laches. 

and vomiting: Aeon., Be/lad., Nux 

vom., Tart. emet. 

, with great weakness: /pec. 

Vomiting, with sweat on forehead: Tart, 
emet. 

, with cold sweat on face: Ver. vii\ 

, with burning in the stomach: Carb, 

veg. 

, with palpitation: Laches. 

, with thirst: Eup. per/. 

after drinking: Arsen., Bryon. 

, when the water gets warm in 

the stomach: Phosphor. 

of black stuff : Arsen., Cadm. sulph. , 

Sulphur. 

of a brownish mass, mixed with cof- 
fee-ground-like flakes: Arg. nitr. 

of bl( od: Arsen., Garb, veg., Crotal.^ 

Cuprum., Sulphur., Ver. alb. 

sour, bilious: Cadm. sulph., Crotal. , 

Mercur., Nux vom., Sulphur, Ver. 
alb. 

— — slime: Mercur., Nux vom., Ver alb. 

and diarrhoea, sometimes involun 

tary: Ver. alb. 

Gastric irritations: Chamom. 

Stomach, burning in: Card, veg., Vet\ 
alb. 

, and cramp-pain in: Nux vom. 

, and cutting in; Cadm. sulph. 

— •-, burning and sensitiveness in: Mer- 
cur. 

, and throbbing in: Bellad. 

, and torturing pain in: Rhus 

tox . 

, in, and coldness of hands and 

feet: Ver. alb. 

, or stitching pain in, and region 

of liver: Arsen. 

, heat in: Aeon. 

, pressure in: Arsen., Sulphur. 

, fullness and oppression in: Bryon. 

, sensitive to pressure in, and about 

the neck: Laches. 

, distress in: Ver. vir. 

, cramp-like pain in: Bellad. 

, haemorrhage from, and bowels: 

Canthar. , Crotal. 



Abdomen, flatulence: Garb. veg. 



DIGEST TO YELLOW FEVER, 



887 



, swelling: Crotal. 

, cramps in: Arsen., Rhus tox. 

. , and in extremities: Ver. alb. 

, in abdominal muscles and legs: 

Canthar. 

, contraction of abdominal muscles: 

Nux vom. 

, colic in: Cadm. sulph., Coloc, Rhus 

to.v. 

Enlargement of inguinal glands: Crotal. 

Diarrhoea: Rhus to.v. 

, sometimes involuntary: Ver. alb. 

, bilious, slimy: Mercur. Nux vom. 

, thin, blackish, or yellowish: Ver. 

alb. 

, bloody: Canthar. , Crotal., Mercur., 

Nux vom. 

, , sometimes involuntary: Cro- 
tal. 

, with tenesmus, or painless and in- 
voluntary: Arsen. 

or constipation: Mercur. 



Neck of bladder, pain in, with difficult 

urination: Nux vom. 
Strangury: Apis, Canthar. 
Retention of urine: Arsen., Canthar., 

Crotal. 
Urine diminished: Rhus tox. 
scanty and high colored: Apis, Bap- 

tis. 

red or brown : Bellad. 

almost black: Laches. 

blood)-: Arsen., Crotal. 

Menses anticipate: Crotal. 
Menorrhagia : Cat -b. veg. 

Voice hoarse and weak : Crotal. 

Chest, pain in: Crotal. 

, pleuritic pains in: Phosphor. 

, , w T ith or without cough: 

Bryon. 

Respiration rattling, with coma: Rhus 
tox. 

Oppression, with short, anxious breath- 
ing: Aeon., Arsen. 

, anxiety about the heart: Laches. 

Distress in cardiac region: Aeon. 

Palpitation, with vomiting: Laches. 

Pulse frequent, full, but soft: Gelsem. 

, small, trembling: Arsen. 

full, hard, quick: Aeon. 



intermitting: Card, veg., Crotal.? 

Mercur., Ver. alb. 

irregular, quick and strong: Mercur. 

, great and sudden changes: 

Ver. vir. 

and weak: Laches. 

slower than normal : Crotal. 

small, scarcely perceptible: Carb. 

veg., Crotal., Ver. alb. 

soft and trembling: Mercur. 

thread-like: Carb. veg. 

Carotid arteries pulsating: Bellad. 

Neck, pain in back of: Gelsem. 

, stiff, and soreness of all muscles: 

Cimic. 
Back, small of, pains in: Cimic. 
and loins, pain in: Sulphur. 

and limbs, pain in: Aeon., Bryon, 

Lpec. 

, loins and legs, heaviness and cramp- 
like pain in: Bellad. 

— — and headache, and as if all the bones 
were broken: Eup. perf. 

Bones, pain in; Crotal. 

Different parts of body, cramps in: Nux 
vom. 

Limbs, stiffness and lameness of: Arsen. 

, paralysis of one or the other of the: 

Mercur. 

, heaviness of: Carb. veg. 

, coldness of: Camphor a, Ver. alb. 

, , with cramps of: Mercur. 

Legs, coldness, lameness and cramps in: 
Nux vom. 

Feet cold: Nux vom. 



Blood dark, non-coagulable: Laches. 

flows from all orifices: Crotal. 

, discharges of : Arsen., Carb. veg. 

, capillary stagnation, cyanosis; all 

discharges fetid and offensive: Carb. 

veg. 
Small wounds bleed much: Laches., 

Phosphor. 

Trembling all over: Carb. veg., Laches. 

of internal parts: Camphora. 

of the limbs: Nux vom. 

and attacks of fainting: Tart. emet. 

and jerking of external parts: Ver. 

alb. 
Subsultus tendinum: Cimic. 



888 



DENGUE. 



S^pasms : Crotal. 

Paralysis of left side: Laches. 

of lower extremities: Rhus tox. 

Pains like electric shocks here and there: 

Citnic. 
Irritability of all organs: Mercur. 
, vascular and nervous, threatening 

convulsions, especially in children: Ver. 



Coldness all over: Ver. alb. 

, icy, all over: Camphora, Card. veg. 

, external, with internal heat: Arsen. 

Chill, severe and long-lasting, at the 

commencement: Camphora. 
Shuddering : Tart. emet. 
Heat, dry burning: Aeon. 
, , , with changing pulse: 

Bellad. 

, sudden flushes of: Laches. 

, internal, with external coldness, and 

cold, sticky perspiration: Arsen. 
Fever, intense, with occipital pains: Ver. 

vir. 
Local inflammations: Ver. vir. 
Sweat bloody: Crotal. 

cold, sticky: Arsen. 

, on face: Card. veg. 

, on hands and feet: Canthar. 

stains yellow: Laches. 

Coma, with rattling respiration: Rhus 
tox. 

Drowsy : Laches. 

or sleepless from nervous irritation: 

Mercur. 

Sleeplessness : Laches., Rhus tox. 

and restlessness from suffocating sen- 
sations: Card. veg. 

Sleep disturbed by many dreams: Apis. 

Waking with a start from sleep: Cimic. 

Restlessness: Ver. alb. 

and tossing: Rhus tox. 

, w r ants to go from one bed to another: 

Arsen. 



Sinking of strength: Arsen., Mercur 
Exhaustion: Ver. alb. 
Prostration: Tart. emet. 



Depression of vital powers: Crotal. 
Fainting: Laches. 
Death by syncope: Crotal. 



Skin yellow: Bryon., Mercur. 

or purplish: Laches. 

deep yellow: Crotal. 

dirty yellow: Rhus tox. 

, purplish spots: Crotal. 

, ecchymoses: Card. veg. 

, petechial spots: Phosphor. 



Worse on right side: Crotal. 

on left side: Laches. 

lying on left side: Laches. 

from evening till i o'clock . 

Baptis. 

when waking: Laches. 

Desire to be uncovered: Aeon. 
Better after nourishment: Laches. 



Aeon, is followed well by Bellad. 

Cadm. sulph., when nausea is not re- 
lieved by Arsen. or Lpec. 

Carb. veg. is, according to Hering, the 
fundamental remedy in yellow fever, 
like Sulphur in cholera. 

Cepa is said to have cured a case of yel- 
low fever. 

Chamom., as intercurrent remedy for 
colic in children. 

Crot. tigl., in allopathic doses, was fol- 
lowed by aggravation and final rapid 
improvement. 

Cuprum, when Arsen. does not relieve 
the vomiting of blood. 

Laches., after previous abuse of mercury 
or quinine. 

NllX VOm., after allopathic drugging. 

Phosphor, is similar to Arsen. and Cro- 
tal. , and produces acute yellow atrophy 
of liver, fatty degeneration, malignant 
jaundice, albuminous urine andhaemor- 
rhagic diathesis. 

Ver. alb., after purging with castor oil. 

Verbena Jam. is said to have cured a 
number of the most desperate cases. 



Dengue, or Break-bone Fever. 

Dengue is an epidemic infectious disease*, which occurs mostly in this 
country, in the Southern States. Zuelzer in Ziemssen's Encyclopedia, says: 
" The name dengue is applied to an acute disease, which mostly occurs as an 



TYPHUS. 889 

epidemic iu hot climates, seldom sporadically, and the course of which, after 
a sudden onset or after slight prodromata lasting several days, consists of 
two paroxysms accompanied by fever, either following immediately one upon 
the other, or after intermission of one, two or three days. But the parox- 
ysms are essentially different one from the other; the first is characterized by 
continuous high fever, reaching its height within the first 12 to 24 hours 
(temperature 106. 7 and 107. 6° F. , and pulse from 120 to 140 per minute), 
and numerous exceedingly painful swellings of the joints, which interfere 
with motion, also, more rarely, by an exanthem. These symptoms subside 
after two or three days, simultaneously with the sudden outbreaks of a sweat, 
or epistaxis, or a diarrhoea, which is often critical. 

11 The second febrile stage, which lasts from two to three days, is marked 
by a remitting fever, and a more or less extensive blotchy or uniform, non- 
elevated, rose-red eruption and great itching of the skin, also less frequently 
by swelling of the joints. 

' ' The subsequent recovery is gradual, and accompanied by decided des- 
quamation. Its course is generally accompanied by great loss of appetite, 
restlessness and sleeplessness. More serious brain-symptoms are absent. 

1 ' The disease attacks all ages and both sexes; with adults it terminates in 
recovery, with children it is occasionally dangerous. It sometimes leaves be- 
hind long continued and painful swellings of the joints, diarrhoea, emaciation 
and great debility. Relapses also occur. It is not yet determined whether 
the disease is contagious or occasioned by miasmatic influence. ' ' 

Typhus. 

Typhus means literally, smoke, stupefaction. In the course of time this 
word has been used to signify different pathological affections, all of which, 
however, were characterized by a dry tongue, stupor, delirium and great 
prostration. Nowadays it has become usus to designate only three forms of 
low fever by the term typhus, namely: the typhus exantheniatieus, or pete- 
chial typhus, which is characterized by a peculiar eruption; the typhus abdo- 
minalis, or ileo-typhus. which is characterized by a peculiar diseased state of 
the small intestines, in this country best known under the name of typhoid 
fever ; and the relapsing fever. 

Typhus Exanthematicus, Petechial Typhus. 

This form is also known under the name of Jail-fever, Ship-fever, or 
Camp-fever. Its immediate Cause is unknown; recent observers, however, 
agree that it is spread by a typhus-germ which has not yet been discovered. 
Its contagiousness is great, and increases with the duration of closer contact 
with typhus patients, therefore assistants and nurses in hospitals are much 
more frequently attacked than the visiting physicians and students; and 
where many persons are confined to a limited space, e. g., in prisons, on 
shipboard, in camps, etc., the pestilence spreads rapidly to those thus con- 



890 TYPHIS BXANTHEMATICUS. 

fined. The disease germ is carried by every article which has been in contact 
with diseased persons, by water, if polluted with excrements from patients. 
by air, if contaminated with diseased exhalations, etc. Famine, atmospheric 
and telluric conditions, damp, marshy soil. etc. , favor its development. It at- 
tacks rich and poor of both sexes and of all ages, but most frequently those 
between the ages of 20 and 40 years. Ordinarily, it occurs but once in a life- 
time. Epidemics have most frequently raged in Ireland, but other parts of 
the globe have also suffered from epidemics. 

The time of incubation varies from a few days to a week and longer, 
and is attended with various disturbances, none in any way characteristic of 
the complaint. 

The stadium invasionis commences in many cases with a severe chill, or 
with several slight chills, sometimes repeated at intervals during the first 
day, which are followed by a continuous great heat, amounting already on 
the third or fourth day to 103 or 104 F. in the morning; and to 104 or 
105.8 , rarely to 107. 6° F. in the evening. The patient is at once stricken 
down by a sense of great weakness and debility, and complains of heaviness 
or pain in the head, which at times is somewhat ameliorated by a spontane- 
ous bleeding from the nose; of vertigo, flickering before the eyes and ring- 
ing in the ears. His hearing becomes impaired; his muscles are sore and pain- 
ful, and on motion his limbs tremble. He lies apathetic on his back, talks 
deliriously while awake, or mutters in his sleep. Others, however, are 
intensely excited, almost wildly, scarcely to be held in bed. With all 
this we observe various catarrhal affections, of the eyes, nose, throat and 
chest, which latter is the most constantly affected part, manifesting itself by 
a harrassing, rough cough, with a scanty, tough, sometimes bloody expec- 
toration. Auscultation reveals numerous rhonchi. The tongue looks, at 
this stage, white; with a pappy taste; there is, at times, nausea, vomiting 
and diarrhoea. This state of things lasts about half a week, when between 
the third and fifth days, scarcely later than the seventh da}*, the second stage, 
the stadium eruptionis et florescentiae, commences. We now observe the 
breaking forth of a rash — roseola spots, greatly resembling that of measles 
— first on the trunk and gradually spreading over the entire body. During 
the first few days these spots disappear on pressure, later, when exudation 
of blood-corpuscles or coloring matter has taken place, they fade no longer 
under pressure; they remain till toward the end of the second week. True 
petechiae, on the contrary, are spotted extravasations of blood from the be- 
ginning; they remain longer and disappear more slowly, and may re-appear 
after the roseola has gone. The appearance of this eruption does not in the 
least ameliorate the condition of the patient; on the contrary, he grows worse 
all the time; his sensorium becomes more clouded; he is unable to think, 
gives slow, incoherent answers, is in constant delirium, either of a mild or 
raving nature, with constant attempts to jump out of bed and run away. After 
recovery the patient scarcely ever remembers anything of this stage. 

The difficult}* of hearing increases; the tongue grows dry and is covered 



TYPHUS KX ANTHEM ATICUS. 89 1 

with a brownish coating, and the respiration, although the cough has lessened 
materially, is quick and superficial, with increased rhonchi and a dull per- 
cussion sound on the dependent parts of the thorax. There is almost always 
constipation at this stage, with involuntary discharge of urine. The heat 
retains its height to the latter part of the first week, when in light cases it 
generally slackens off a little, and by the seventh day shows an appreciable 
remission for the first time. In severe cases, however, the temperature of 
the body increases during the second part of the first week , and shows no re- 
mission on the seventh day. The spleen is considerably enlarged toward the 
end of the first week, and the eruption commences to grow more livid with 
the commencement of the second week. Now the patient lies flat on his 
back, with his eyes half closed, and his hands on his genitals; in deep stupor, 
out of which he can scarcely be roused; he mutters single, unintelligible 
words, draws faces according to the nature of his ever- working imagination, 
gesticulates, catches at something in the air, or picks the bedclothes, tries to 
rise or to put his feet out of bed, in fact, his mind seems to be constantly 
busj~ at something, although entirely disconnected with the world around 
him. He manifests no desire for drink, which, however, is taken when of- 
fered, though sometimes with great difficulty, as the tongue is parched and 
trembling and the swallowing difficult. The teeth and gums are covered 
with sordes, the nostrils appear blackened as by soot, and the breath exhaled 
has a terrible smell. By this time the petechial eruption is joined by the 
breaking forth of a miliary eruption; the bronchial catarrh may increase to 
pneumonia or collapse of the lungs, and a number of cases, even light once, 
are complicated with parotitis. The fever increases in all cases with the 
beginning of the second, may there have been a remission on the seventh 
day or not. In light cases, however, this aggravation is not very severe, nor 
does it last more than a few days, while in severe cases it reaches up to 
106. 8° or even 107. 8° F., lasting to the end of the second week, -even to the 
sixteenth and seventeenth day of the disease. 

The third stage, or the stadium criticum, commences almost always in 
the latter part or the second week, or, in severe cases, in the first days of 
the third week. The change sets in remarkably quick, often in one single 
night, in which the patient at once, after so many sleepless nights, enjoys a 
deep, quiet sleep, out of which he awakes for the first time conscious again, 
but without remembrance of what has passed. The temperature has sunk, 
perhaps, two degrees and the frequency of the pulse, perhaps, twenty to 
thirty beats per minute; instead of the pungent heat, the body is in a gentle 
perspiration and the roseola spots appear much paler. Now convalescence 
commences, which goes on, however, quite slowly. The crisis is accom- 
panied by the formation of sediments in the urine, an increase in its quantity, 
a disappearance of the albumen, and a normal amount of urea and chlorides, 
though these changes occur slowly. Often recovery is delayed or even frus- 
trated by a renewance of a slow fever, which takes away the last strength 
of the patient, or other sequelae retard its progress, among which the most 



892 TYPHOID FEVER. 

frequent are inflammation and suppuration of the parotid glands, pneumonia, 
pleurisy, diphtheritic or follicular inflammation of the intestines, numerous 
furuncles, ecthyma pustules or large abscesses in the subcutaneous or inter- 
muscular cellular tissue; even thrombi in the veins of the legs, and their 
consequences. 

There have been observed light, abortive cases of exanthematic typhus, 
in which it did not even come to an eruption or to an enlargement of the 
spleen, and where the whole morbid process was finished in two weeks. Loss 
of hair is not uncommon after an attack of typhus. 

Therapeutic Hints. 
See the following chapter. 

Typhoid Fever, Typhus Abdominalis, Enteric Fever. 

Typhoid fever is an acute infectious disease the exciting cause of which 
is probably a specific pathogenic bacterium known as the typhoid bacillus 
(bacillus of Eberth ). Owing to the frequency of its occurrence it is one of 
the most important of all the fevers. The water we drink is undoubtedly 
the chief vehicle by which the germs gain access to the system, although 
other articles of food contaminated with the virus may be the source of in- 
fection. Once having entered the alimentary tract the germs attach themselves 
to the intestinal walls. Here they penetrate the solitary follicles and Peyer's 
patches, which become infiltrated and swollen, finally undergoing necrotic 
changes and leaving large ulcers. The}* then pass into the mesenteric glands 
through the lymphatic vessels and thence into the blood, being thus carried 
to the spleen and liver. 

The faeces ol typhoid fever patients containing as they do millions of the 
bacteria are especially dangerous, affording a ready means for the propaga- 
tion of the disease. It is therefore imperative that they be disinfected, as 
well as all linens and clothing that have been contaminated by the patient. 
Poisoned water can be disinfected by boiling. 

It was formerly held that infection took place through the respiratory 
tract, the atmosphere being the carrier of the contagion, but since the dis- 
cover}' of the bacillus and a thorough study of its life history this seems un- 
tenable. (Fraenkel.) 

The period of incubation is generally about two weeks; it may, however, 
be from three to four weeks in exceptional cases. 

In large cities sporadic cases happen at any season ; epidemics of typhoid 
fever occur most frequently from August to November. 

The greatest individual disposition to take the disease seems to prevail 
between the ages of fifteen and thirty years. Children less than one year 
old are very seldom attacked; after this up to fifteen years the predisposition 
steadily increases, while after the age of thirty years it steadily decreases. 
On the whole the disease attacks by preference the strong and healthy; it 



TYPHOID FEVER. 893 

avoids those already suffering with chronic ailments, and also pregnant and 
puerperal women, and those who are nursing infants, although exceptions 
exist. Persons who have passed through the disease once before are not al- 
ways exempt from another attack, and "real recurrences, that is a new 
attack coining on soon after the first has run its course, and relapses before 
the completion of the disease are often seen." (Liebermeister.) 

The principal anatomical changes which typhoid fever produces, are: 
catarrh in the chest, even in the finest bronchial tubes; enlargement of the 
spleen to double and even six times its natural size; and ulceration of the 
small intestines. These last, more or less constant, anatomical changes have 
given rise to the appellation of ileo-typhus. Rokitansky distinguishes four 
stages of this typhoid process upon the mucous membrane of the small in- 
testines: 

1. The congestive state, by which the whole membrane appears swollen, 
injected and covered with slime, worse so, however, on its lower portion in 
the neighborhood of valvula Bauhini. 

2. The state of infiltration, by which the general redness and swelling 
gradually disappear and become concentrated to the solitary and Peyer's 
glands in the lower part of the ilium. 

3. The state of softening, by which the swelling of the glands is ab- 
sorbed, or the glands burst and become covered with a dry, crumbly crust, 
or they burst and discharge their contents without getting covered with a 
crust. 

4. The state of ulceration, by which the affected glands suppurate and 
form the typhoid ulcer. These ulcers are round when originating out of a 
solitary foliicle and elliptic when originating out of Peyer's plaques; their size 
varies from that of a hemp-seed or pea to the size of half a dollar. Their 
basis is the submucous cellular tissue which lines the muscularis of the gut. 

The Symptoms and Course of typhoid fever are the following: The 
patient has generally several days previous to the attack a sense of general 
indisposition, weakness and debility, with headache, dizziness of soreness of 
the limbs, and sometimes repeated attacks of bleeding from the nose, or none 
at all. The attack itself begins almost always with a more or less violent 
chill, or repeated chilly sensations, but sometimes without a chill. It is, 
therefore, not always possible to fix accurately the time of the disease. The 
chill is followed by heat, which keeps a regular, quite characteristic, typical 
rise and fall every day for the first three or four days. " rising about i.8° to 
2. 7 F. from morning till evening, and falling from every evening till next 
morning about .9° to 1.3 P., so that on the third or fourth evening a tem- 
perature of 104 F. is reached, or a little exceeded. The formula of this 
ascent is nearly as follows: 

First day, morning: 98. 6° F., 

Second day, " 100.2 1 ° F., 

Third day, " 101.66 F., 

Fourth day, " 102. 56 F., 



evening: 


101.8 F. 


(< 


102. 56 F. 


' ' 


103.64 F. 


1 . 


104.54 F. 



994 TYPHOID FEVER. 

This pyrogenic course in the initial stage of typhoid fever is so decisive 
a test for its diagnosis that Wunderlich further says: " If the temperature of 
the second, third and fourth evenings is only approximately normal; if the 
temperature of the first three evenings, or of two of them, is of the same 
height; if the temperature of two out of the first three mornings is alike; if 
the temperature of the first two days rises to 104 F. or more; if the temper- 
ature retrogrades only once on any of the first four mornings and evenings: 
in ever}- one of these cases w r e may or must exclude typhoid fever from our 
diagnosis; and contrarily, said diagnosis is the more certain as the course of 
the temperature of the first four days comes nearer to the above formula." 

" Meanwhile, exceptions must not be overlooked. The rise ma} T be com- 
pleted in two days, or protracted to five; both foreboding a severe course, the 
latter a delay in the favorable turn (crisis or lysis) till the middle of the third 
week; the temperature may return to normal the second morning, and be 
succeeded by a greater rise the second evening; the rise of the first and sec- 
ond day being less, that of the third and fourth will be much more; the 
height reached the third and fourth day is not always 104 F., but may be a 
few tenths less or more by a whole degree, 105. 8° F. When the typhoid 
fever is secondary to another disease its initial is obscure, often unrecog- 
nizable. ' ' 

' ' In the second half of the first week, and the first half of the second, the 
course of the temperature is quite uniform, but cannot help the diagnosis. 
At this time the maximal height, 104 to 106. 7 F., is rarely reached more 
than once between noon and evening of the fourth or fifth day, meantime 
the morning temperature is .9° to 2.7 F., lower than the evening's — one 
remission may be accidentally even lower." (Wunderlich' s Thermometry, 
by Seguin, page 123.) 

The course of the temperature during a whole attack may be character- 
ized in this way, that in the first week it rises steadily, in the second week it 
is continuous, having the same maximum and minimum even- day, in the 
third week it becomes remittent, showing greater remissions in the morning 
although the exacerbations in the evening keep still the same height, while 
in the fourth week the remissions become more marked and the exacerbations 
gradually lower. (Liebermeister.) 

With the temperature rises also the pulse, amounting generally during 
the first week fiom ninety to one hundred beats per minute; sitting up, 
bodily exertion, or mental excitement, is apt to accelerate it considerably, 
even to twenty or thirty beats. 

With all this the patient complains of great weakness and prostration, 
severe headache, dizziness, flickering before the eyes, and ringing in the ears; 
his sleep is restless and disturbed by tiresome dreams, sometimes of the same 
thing over and over again; he calls out in sleep or talks incoherently. 
When awake he is full}' conscious but indifferent, answers questions slowly 
and reluctantly. His thirst is great, his appetite gone, and his taste pappy, 
disagreeable. The bowels are during the first days frequently constipated, 



TYPHOID FEVER, 895 

but change towards the end of the first week to diarrhoea. There is in many 
cases repeated bleeding from the nose, and already at this time a catarrhal 
irritation in the chest. The face is flushed, especially the cheeks look dark 
red as long as the patient lies quietly on his back, but it turns pale and 
sunken when he sits up a while. The tongue is soft, flabby, showing the im- 
prints of the teeth, and is covered by a slight whitish fur, which gradually is 
thrown off, leaving the tongue moist, smooth and red, as though it were cov- 
ered with a fine gold-beater's skin; it soon, however, grows dry. In cases 
where the tongue is thickly coated, this covering commences to disappear 
either on the tip and edges, whereby the yellowish-white coating becomes 
encircled by a gradually broader-growing, deep, red belt, or it disappears at 
first in the centre, and constitutes that well-known, dry, red streak in the 
middle of the tongue, which is frequently broader at the point of the tongue, 
and forms, in this wa} T , a kind of triangle, with its base down at the tip. 

The abdomen at this time appears somewhat bloated and is sensitive to 
strong pressure. A deep pressure upon the ileo-caecal region may cause a 
gurgling noise in that region, especially if there be already diarrhoea present. 
The spleen is swollen, which can be detected by percussing the patient when 
he lies upon his right side. Finally, there appear toward the end of the first 
week, single, pale, reddish, lentil-sized roseola spots upon the epigastrinm 
and adjacent parts of the chest and abdomen. 

In the second week the temperature of the body ranges between 104° F. 
and more; towards morning there is only a slight remission, and the pulse 
grows softer, weaker, and more frequent, from no to 120 beats, revealing 
more or less weakness of the heart. The dizziness increases, the ringing in 
the ears changes to hardness of hearing, which is generally dependent upon 
a catarrhal affection of the Eustachian tubes and tympanum. The expres- 
sion of the face becomes more and more stupid, and the indifference of mind 
increases. By and by the consciousness of the patient becomes clouded and 
he sinks gradually in a state of somnolence and stupor. Although the tongue 
is as dry as " chip," yet he utters no desire for drink; takes it, however, when 
offered, very greedily. When asked to show his tongue, he does not seem to 
comprehend at first, but finally, with great effort, he brings it forth, pointed 
and trembling. Stool and urine pass off involuntarily. The patient lies 
always on his back, and having lost consciousness of all muscular power, the 
body follows its own weight and the patient slides gradually down in bed, 
without any effort of his own to change this position. The mental opera- 
tions are still going on; we see it on the now and then trembling lips, as 
efforts to speak, and in the low murmuring of unintelligible words now and 
then. This is febris nervosa stupida. 

Other patients, although likewise mentally disconnected with the ex- 
terior world, neither knowing nor understanding what is going on about 
them, manifest a vivid, dreamful perturbation of the mind. 

They are in constant agitation, throw off the covers, try to get out of 
bed and to escape, talk loud or lisp some unintelligible words, gesticulate 



896 TYPHOID FEVER. 

and become angry when interfered with. Their obstinacy in gaining their 
imaginary ends is sometimes astonishing; when all at once it changes to some 
other object. In other cases there seems to be no intelligible connection be- 
tween the constantly-changing phantasmata, with which they seem to be 
haunted. This agitation of the mind is generally greatest during the night. 
This is febris nervosa versatilis. There are again cases where both of these 
states make a regular turn; the febris stupida prevailing through the day, 
and the febris versatilis through the night. 

During this w T eek the bowels are almost always loose, owing to the 
catarrhal affections of the intestines; the cheeks have a brownish-red or 
bluish color; the eyelids are half closed; the conjunctiva is injected; the 
nose is thoroughly dry, and the nostrils are blackened as by soot. On the 
gums and teeth we observe sordes; the tongue is covered with a brownish 
crust, which gradually grows black from the mixture of blood; it is stiff, 
making swallowing quite difficult. The abdomen is inflated like a drum; 
the spleen has grown still larger, and the roseola-spots have, in some cases, 
likewise increased, and are joined b3^ numerous sudamina. On the chest, 
physical examination reveals solidification of the dependent parts of the 
lungs and far-spread catarrhal affections. There is a less full percussion 
sound, weak vesicular breathing, fine, bubbling rattles in the dependent 
parts anH loud rhonchi ever} T where else. 

The third week does not bring any amelioration as yet. The tempera- 
ture of the body is still on the increase, and the morning remissions are quite 
indistinct. Only where the case turns favorably, there is in the second half 
of the third week a decided improvement in this respect. While the even- 
ing temperature still rises to 104 or over, the morning temperature shows 
greater remissions. 

The prostration reaches, in this week, its climax; the patient slides 
down in bed; there is a constant jerking of the tendons; somnolence and 
stupor are complete, and stools and urine are passed unconsciously, or the 
urine is retained in consequence of a paralysis of the detrusor vesicae; the 
roseola-spots commence to get paler, the sudamina increase more and more, 
and in some cases there appear petechias. To all this associates an erythema 
in the region of the sacrum, which, by throwing off the epidermis, is soon 
converted into a bed-sore — decubitus. This is, indeed, the week when the 
mortality of typhoid patients is the greatest, while in favorable cases its 
latter part is the turning point. We observe then a gradual abatement of 
all the above-detailed symptoms. The stupor changes into a natural sleep, 
consciousness gradually returns: diarrhoea, respiration, pulse, countenance, 
all improve. 

This improvement continues in the fourth week, or in some instances 
commences then, and finally passes over into the state of convalescence. 
During this time nearly all the patients lose their hair, which, however, is 
soon followed by a new crop. 

This is about the course which a majority of typhoid fever cases run. 



TYPHOID FEVER. 897 

Besides this, however, there are a number of variations, of which the follow- 
ing are the most important: 

The Abortive typhoid fever is, in every respect, much lighter, and cor- 
responds to the "gastric fever, or nervous fever" of older writers. Although 
it shows all the symptoms of a regular tyhoid fever, yet they are all much 
milder; the temperature of the body never reaches such an intensity, and 
already on the eighth or ninth day there is a considerable morning remission, 
which sinks at the end of the second or during the third week to a normal 
state, with only slight aggravations in the evening. Still the patients gain 
their usual strength quite, slowly. 

The Typhus ambulatorius is a peculiar form, corresponding to the "walk- 
ing cases' ' of yellow fever, in which the patient complains only of general 
debility and exhaustion, but still attends to his business, until suddenly he 
sinks under the signs of perforation of the intestines or intestinal haemor- 
rhage. In such cases it seems that the poison has localized exclusively in the 
intestines, without affecting the general circulation. 

The Typhus tumultuarius, on the other hand, sets in at once so violently 
that the temperature of the body rises already in the first week to 106 F. 
and above, and the pulse to 120 and 130; all other symptoms are correspond- 
ingly severe, so that the disease reaches its climax towards the end of the 
first or the beginning of the second week. Such cases are mostly fatal at 
this early period, or the symptoms grow milder again in the second week, 
and take then the usual course. 

The Pneumo-typhus and Broncho-typhus are forms in which the poison 
seems to affect principally the chest, causing hypostasis of the lungs, pneu- 
monia, or violent bronchitis, while the characteristic affections of the small 
intestines are comparatively light, or even wanting. Pneumo-typhus must 
not be confounded with Typhoid-Pneumonia. 

Cardiac weakness, the result of degeneration of the muscular tissue of 
the heart, is responsible in part for the tendency to disintegration which is 
found in all tissues of the body, and is the most frequent immediate cause of 
death, and consequently "the observation of the pulse is of even greater sig- 
nificance than the observation of the temperature for the prognosis of some 
cases. So long as the pulse is, in a measure, strong, and its frequency only 
moderately increased, no immediate danger exists on the side, even when 
the constant elevation of temperature is very considerable. ' ' ( Liebermeister. ) 
This degeneration of the heart-muscle exists, to a greater or less degree, in 
all severe cases without exception. 

Parenchymatous degeaeration. of the Liver is also found in every severe, 
prolonged and fatal cases of typhoid fever, and may reach so high a grade 
as to present a distinct complication, a group of symptoms characteristic of 
icterus gravis or acute yellow atrophy of the liver. Still, jaundice occurs 
less frequently during typhoid fever than in pneumonia. 

Parotitis begins most frequently during the third or fourth week, is 
always confined to the most severe cases only and is a bad prognostic sign. 
57 



898 THERAPEUTIC HINTS TO TYPHOID FEVER. 

In still other cases the normal progress of the disease is interrupted by 
an intercurring perforation of the intestines, when the typhoid ulcers eat 
through the muscularis and serosa of the gut or by the imprudent use of 
solid food during early convalescence, which, acting mechanically, ruptures 
the gut at the weakest spot. This is always followed either by a partial or 
diffuse peritonitis, the symptoms of which compare under the corresponding 
chapter. The most reliable sign, however, of perforation, during typhus, is 
tympanites, or the sudden escape of gas into the peritoneal sac, which presses 
the liver back from off the thoracic wall, and causes, on percussion, in place 
of the dull liver sound, a clear tympanitic sound. 

Or the natural progress of the disease is interrupted by an intercurring 
haemorrhage from the bowels, This takes place either in consequence of er- 
rosions of blood-vessels near the ulcers, or in consequence of the bursting of 
overfilled capillaries. It causes bloody stools, and, if profuse, collapse and 
a sudden sinking of the temperature, which sometimes restores consciousness 
for a while, but generally ends fatally, in consequence of the exhaustion 
which it produces. Less dangerous are the intercurring profuse haemorrhages 
from the nose, which take place sometimes in the second or third week of 
typhus, and the haemorrhages from the womb in female patients. But as 
both are the consequence of a highly debilitated state of the system, none of 
them can be considered as a favorable sign. 

Or the whole course of the disease is protracted by the slow healing pro- 
cess of the intestinal ulcers. In such cases we find the typhus followed by a 
low, asthenic fever for weeks afterwards, or in fact there is no cessation of the 
fever; the sensorium remains clouded; the weakness increases; the emacia- 
tion grows excessive; the bed-sores enlarge; any part of the body, wherever 
its own weight rests upon, shows the signs of decubitus. Man)" of these 
patients die about the fifth or sixth week, as such afar-spread decubitus alone 
seems to be sufficient to consume the little strength that is left. 

As Sequels of typhus may be mentioned: neuralgia, partial paralysis, 
partial anaesthesia, mental disturbances, tabes, anaemia and hydrsernia. It is 
not unfrequent that, during the period of reconvalescence, phthisis pulmonalis 
is developed. 

Therapeutic Hints. 

As long as there is fever it will be necessasy to enforce a strict liquid 
diet, which may consist, of milk (2-4 pints per day, administered in suitable 
quantities about every 2 hrs.). meat broths, albumen, koumiss, etc. After 
the subsidence of the fever it is well to return cautiously and slowly tosolid 
food, beginning with semi-solid and easily digested substances. 

Retention of urine should be anticipated; obstinate constipation of the 
lower bowel should be relieved by a gentle enema. 

Agar. muse. Constant delirium, attended with attempts to get out of 
bed, with a tremulous propulsion of the tongue and a general tremor of the 
whole body. (G. C. Hibbard.) Desire for alcoholic drinks, which are easily 
borne. It suits well typhoid fever in drunkards. (A. Charge.) 



THERAPEUTIC HINTS TO TYPHOID FEVER. 899 

Alumen. Great masses of coagulated black blood pass from the anus in 
the third week of typhus, with signs of the greatest exhaustion. (Hering.) 

Alumina. Is often indicated when Bryon. , though indicated, does not 
act deep enough. (Gosewitsch.) 

Apis. According to Wolf, in the presence of: apathic conditions, uncon- 
sciousness, stupor, with murmuring delirium, hardness of hearing, inability 
to talk and put out the tongue, which is cracked, sore, ulcerated or covered 
with vesicles; difficulty in swallowing, great soreness and bloatedness of the 
abdomen; constipation, or frequent, painful, foul, bloody and involuntary 
discharges from the bowels; unconscious flow of urine; dry, burning skin, or 
partial, clammy sweats; trembling and jerking of the limbs; white miliary 
eruption on the chest and abdomen, greatest weakness and sliding down in 
bed; frequently changing, weak and intermitting pulse. 

Arnica. Stupefied condition; sits as if in thought, yet thinks of noth- 
ing, like a waking dream; forgets the word while speaking; confusion of the 
head; loss of consciousness; delirium; great weakness, weariness and bruised 
soreness, which compels to lie down, and yet every position feels too hard; 
unrefreshing sleep, with anxious dreams, talking, and loud blowing during 
expirations; bleeding from the nose; trembling of the lower lip; dry tongue; 
with a brown streak in the middle; putrid smell from the mouth; distention 
of the abdomen; involuntary discharges of feces and urine; pleuritic stitches 
at every inspiration; great sinking of strength. 

A? sen. Especially for weak or debilitated individuals, old age and 
children; in slow, protracted cases, with mild delirium ; loss of consciousness; 
great restlessness and anxiety, manifesting itself in constantly moving head 
and limbs, while the trunk lies still, on account of too great weakness; pick- 
ing of the bedclothes; sopor; face distorted, sunken, anxious, hippocratic; 
lower jaw hanging down; cheeks burning hot, with circumscribed redness; 
eyes staring, glistening or sunken, dull and watery, or closed with sticky 
matter; hardness of hearing; lips dry and cracked; lips, gums and teeth 
covered with brown or black slime; tongue red and dry, cracked; stiff, like 
a piece of wood; black tongue; speech unintelligible, lisping, stammering, 
as though the tongue were too heavy; excessive thirst, but little drinking at 
a time; the fluid rolls audibly down into the stomach; vomiting and retching; 
burning in the stomach and bowels, sensitive to pressure; meteoristic disten- 
tion of the abdomen; constipation or looseness of the bowels; brownish or 
watery, bloody, foul, involuntary discharges; involuntary discharge of urine 
or retention of urine. "Frequent urging to urinate, with burning and scanty 
discharge." (W. J. Martin.) Voice weak and trembling, or hoarse, coarse 
or crowing; breathing short and anxious, oppressed, rattling; dry cough; 
fetid breath. On chest and abdomen roseola spots; white miliary eruption, 
even petechia; decubitus; excessive prostration and rapid emaciation; pun- 
gent, hot, dry skin, like parchment; cold, clammy perspiration, pulse frequent, 
small, trembling, intermittent. A cadaverous smell scents the whole atmos- 
phere. All symptoms worse about and soon after midnight or noon. 



900 THERAPEUTIC HINTS TO TYPHOID FEVER. 

Arum. trip. Lips and corners of mouth sore and cracked; excessive 
salivation; saliva acrid; breath very fetid; picking the ends of the fingers 
with the nails; picking the lips until they bleed; boring with the fingers in 
the nose; great restlessness, tossing over the bed, wants to escape while per- 
fectly unconscious of what he is doing, or what is said to him; urine generally 
suppressed. ( Lippe. ) 

Baptis. "She cannot go to sleep, because she cannot get herself to- 
gether. Her head feels as though scattered about, and she tosses about the 
bed to get the pieces together." (Dr. Bell.) Dull, stupefying headache, 
confusion of ideas; delirious stupor; heavy sleep, can scarcely be aroused 
long enough to answer a question, falling asleep in the middle of the sen- 
tence; dark red face, with a besotted expression; injected eyes; coated 
tongue, brown and dry, particularly in the centre, or dry and red; sordes on 
the teeth; fetid breath; fetid sweat; fetid discharges from the bowels; fetid 
urine; great debility and nervous prostration; ulcerations; chilliness all day; 
heat at night; chilliness, with soreness of the whole body. Sensation as 
though there were a second self beside the patient in bed. 

Bellad. During the early stage, especially of tumultuous cases, when 
there is great congestion to the brain, with great drowsiness, and an inability 
to go to sleep, and frequent starting during sleep; violent delirium, with 
attempts to run away, to strike, bite, or spit at his attendants; sparkling, 
staring eyes; throbbing of the carotid and temporal arteries, and also in the 
forehead; deafness; burning heat and redness of the face; distortions of the 
mouth; dryness of nose, mouth and throat; tongue with red margin and 
white centre; trembling and heaviness of the tongue, with stammering as if 
drunk; sore throat and dry cough from bronchial irritation. 

Bryon. In any stage when there is delirium, especially at night, about 
the affairs of the previous day or business matters; visions, especially when 
shutting the eyes; irritableness ; peevishness; easily offended; hasty speech; 
headache; dull, pressive, or stitching, tearing pains, worse from motion and 
opening the ey T es; eyes dull, watery; hardness of hearing; dryness of nose; 
lips dry, brown, cracked; tongue coated thick, white, or yellowish, later 
brown and dry; dry feeling in the mouth, without any thirst, or else great 
thirst, with drinking large quantities at a time; bitter taste in the mouth; 
nausea; retching; great soreness in the pit of the stomach to touch or motion; 
bowels constipated; hard cough, with stitching pain in the chest and region 
of the liver; bronchitis; great lassitude and weakness; wants to lie quiet; pain 
in all the limbs when moving; restless sleep, with groaning and moaning, 
and frequent movements of the mouth, like chewing; eruption of white mil- 
iary rash, with anxiety in the region of the heart; sighing, groaning and 
moaning, and a peculiar sour smell of the body, with or without sweat. 

Calc. carb. According to Goullon, during the aggravations, which pre- 
cede the outbreak of the miliary rash, about the fourteenth day of the disease; 
palpitation of the heart, tremulous pulse, anxiety, restlessness, redness of 
the face, delirium, jerkings, especially in children; short, hacking cough: 



THERAPEUTIC HINTS TO TYPHOID EEVER. 901 

excessive diarrhoea. Also when a pneumonia develops, tending to gray 
hepatization with its characteristic sputa; great soreness of the soles of the 
feet. Beside this, it may be indicated at the very onset, and then cut off all 
further progress, in persons inclined to grow fat; after great anxiety and 
worriment of mind; utter sleeplessness from overactivity of the mind; it is 
the same disagreeable idea which always rouses toe patient as often as he falls 
into a light slumber; constant tickling under the middle of the sternum, 
causing a hacking cough, worse from talking or moving; during coughing, 
painful shocks in the head; the brain feels hot and burning. (Lippe.) Urine 
very dark, but clear. 

Camphora. In extreme cases like Card, veg., only that the symptoms 
set in much more rapidly. Greatest weakness; cold sweat all over; quickly 
decreasing temperature, especially of the extremities; small, very frequent, 
scarcely perceptible pulse; great nervous restlessness of body and limbs; 
collapse in face; cold, pointed nose and cold mouth; automatic motions of 
the muscles; delirium; syncope; snatches of sleep; great thirst, with red, 
dry tongue; frequent involuntary stools, after much rolling and rumbling in 
the bowels. (Trinks. ) 

Ca7ithar. May be indicated by its characteristic urinary symptoms. 

Card. veg. Often at the brink of death a saviour, in those states of 
collapse, dissolution of blood, and paralytic conditions, which seem rapidly 
to invade the whole organism. All this is indicated by stupor, out of which 
the patient can scarcely be roused for moments; the eyes are dull, without 
lustre, and the pupils without reaction against light; the hearing is gone; the 
face is pale, sunken, hippocratic, cold; there are haemorrhages from mouth 
and nose; the tongue is sometimes moist and sticky; other times parched and 
cracked, heavy, scarcely movable, bluish or pale; the pit of the stomach is 
bloated; the abdomen meteoristic, with loud rumbling and gurgling of wind 
in the intestines; there is colliquative diarrhoea, brownish, grayish, or bloody, 
of a cadaverous smell, and involuntary. The cough has ceased, and the col- 
lecting secretions cause loud, rattling breathing, a sign of beginning paralysis 
of the lungs; the circulation is without energy; the blood stagnates in the 
capillaries and causes cyanotic blueness of face, lips and tongue; ecchymotic 
spots here and there; decubitus; the pulse is extremely weak, frequent, small, 
scarcely perceptible; face and extremities grow cold and become covered 
with cold perspiration — all signs of beginning paralysis of the heart; in 
short, the patient offers a picture of complete torpor of all vital functions, 
thus differing entirely from that of Arsenicum, which is always more or less 
associated with erethism of the system. 

Chma. Especially where there is painless diarrhoea, bloatedness of the 
abdomen, haemorrhages, and slowly progressing convalescence after such 
weakening influences. 

Coccul. In cases which are mainly characterized by a deprimation 
of the nervous system, showing little or no disturbance in the vegetative 
sphere of the system, except enlargement of the spleen. There is a slowness 



902 THERAPEUTIC HINTS TO TYPHOID FEVER. 

of comprehension; he does not find the right expressions for his ideas, what 
has passed he cannot remember; he talks muttering, mumbling; it costs him 
a great deal of effort to speak the words plainly; and then again for a short 
while he is very irritable, cannot endure either noise or contradiction, and 
speaks hastily. Most of the time, however, he sits in silence or feels an un- 
conquerable inclination to sleep; his eyelids are heavy, fall shut, as if para-' 
lyzed; the drowsiness may increase to coma. There is dizziness in the head, 
especially when rising up in bed, with nausea, compelling to lie down again; 
ringing in the ears; heat in the head and chilliness elsewhere in the body; 
pappy taste in the mouth; belching; nausea; distention and rumbling in the 
abdomen; great general weakness and weariness; great heaviness in the feet; 
attacks of trembling and jerking of the eyelids, muscles of the face and limbs; 
and fits of fainting from bodily movement, with spasmodic distortion of the 
facial muscles. Especially indicated after mental and bodily overexertion. 

Cholchic. According to Wells, great weakness, as if after exertion. If 
the patient be raised up the head falls constantly backwards, and the mouth 
opens to the widest extent. Sudden sinking of the forces, so that in ten 
hours he can hardly speak or walk; cadaverous aspect and extreme prostra- 
tion; emaciation; lying on the back; comatose; eyes half open; respiration 
audible and accelerated'; hands and feet cold; trunk hot and extremities 
cold; skin dry; sweating; suppressed, cutaneous transpiration; forehead 
covered with cold sweat; pulse small and contracted, quick and hardly per- 
ceptible, small and frequent, quick and thready; pulseless; delirium, with 
cephalalgia; intellect beclouded, though he gives correct answers to ques- 
tions; unless questioned he says nothing of his condition, which does not 
seem to him dangerous; perception entirely lost; he is unconscious; eyes 
hollow, staring and sunken; pupils much dilated and little sensitive to light, 
or immovable, and but slightly dilated; nostrils dry and black; face sunken 
and hippocratic; risus sardonicus; lips, teeth and tongue covered with a 
thick, brown coating; lips cracked; face covered with perspiration; grinding 
of teeth; tongue protruded with difficulty; tongue bright red; tongue heavy, 
stiff and numb; loss of speech; inextinguishable thirst; epigastrium and 
stomach extremly sensitive to pressure; abdomen distended, tense and 
hard; surface of the abdomen hotter than the rest of the body; tympanites 
with pain in the back; watery diarrhoea; the stools are passed insensibly; 
stools fluid, offensive, with white flakes; involuntary stools; numerous, 
liquid, dark, offensive stools, with severe pain; secretion of urine suppressed; 
urine copious; involuntary urination; respiration irregular and intermittent. 

Cuprum. According to Baehr, in typhus without high fever, but with 
excessive weakness, which increases rapidly under the signs of dissolution of 
blood (nosebleed and petechia), until under general paralytic symptoms 
death ensues. 

Fluor, ac. Recommended by Hering when there is decubitus. 

Gelsem. Stage of invasion with sense of extreme prostration; trem- 
bling from weakness; muscles refuse to obey the will; pulse slow, but greatly 



THERAPEUTIC HINTS TO TYPHOID FEVER. 903 

accelerated by lifting or turning the patient; severe pains in head, back and 
limbs; chilliness, cold hands and feet; crimson flush of face; thick, brown, 
coated tongue; occasional moisture here and there; sleeps frequently half 
waking and talking incoherently; head feels "big as a bushel;" vertigo; 
blind spells; epistaxis; iliac tenderness. (J. C. Morgan.) 

Ginseng. Loud gurgling noise in the ileo-caecal tract, dry tongue, heat, 
delirium on going to sleep. (Liedbeck.) 

Hamam. Haemorrhage from the bowels of fluid, dark, fetid blood; 
great soreness of the abdomen. 

Helleb. nig. Facies quatrata; stupid expression, though the face is 
not collapsed; vacant look of the eyes with dilated pupils; constant som- 
nolence, out of which the patient may be roused, but does not gain full con- 
sciousness; he stares at the physician, is slow in comprehending and answer- 
ing his questions; all perceptions by the senses grow only slowly or not at 
all conscious. The patient utters no desire; when left alone sinks in slum- 
ber; he lies upon his back with limbs drawn up; sliding down in bed. 
Mucous membranes but little or not at all affected; abdomen not bloated, 
unpainful; no diarrhoea; sometimes unconscious discharge of urine; slow 
action of the heart; pulse only 80 per minute; respiration slow; temperature 
of skin nearly normal; no miliary eruption; no sign of putrid dissolution of 
the blood; loss of flesh trifling; only the brain seems to be the invaded part 
of the body. (Trinks.) 

Hydr. ac. When the drink which is swallowed rolls audibly down the 
throat, as though it were poured into an empty barrel. (Heynel.) 

Hyosc. Entire loss of consciousness, and of the functions of the organs 
of the senses; does not recognize relatives or friends; illusions of the imagina- 
tion and senses. Delirium which is continued while awake, and which sees 
persons who are not and have not been present. Indistinct and muttering 
loquacity; muttering with picking of the bedclothes; inability to think, the 
thoughts cannot be directed or controlled; constant staring at surrounding 
objects, with apparent entire self-forgetfulness; or else great agitation; rest- 
lessness; jumping out of bed; attempts to run away, etc. Byes red and 
sparkling, staring, rolling about in their orbits; squinting; deafness; dis- 
torted face, stupid expression; tongue red or brown, dry and cracked; para- 
lyzed; loss of speech, or indistinct speech; cadaverous smell from the mouth; 
involuntary or unnoticed stools in bed; suppressed secretion or retention of 
urine; involuntary discharge of urine, leaving streaks of red sand on the 
sheet. Paralysis of sphincter ani and vesicae. Convulsive motions; grating 
of teeth; jerkings; subsultus tendinum; trembling; sleeplessness, or constant 
sleep with muttering; coma vigil. Roseola spots on chest and abdomen; 
cold extremities. 

Ignat. Great impatience and despair about pains and bad feelings, 
which he cannot describe; gets easily frightened, and feels as though he were 
swung to and fro in a cradle or in a swing. Attacks of yawning, stretching, 
followed by pain in the front of the head, which does not allow opening the 



904 THERAPEUTIC HINTS TO TYPHOID FEVER.' 

eyes; choking sensation from the stomach up into the throat, with oppression 
in the chest, better from belching; palpitation of the heart; sinking, weak 
feeling in the pit of the stomach; convulsive motions of the limbs; jerking 
of the tendons. Sleeplessness on account of various visions as soon as he 
falls into a doze; troublesome dreams. 

Kali card. Intermitting pulse, vomiting, headache, nervous, easily 
frightened, pale, sickly complexion. (Goullon, Jr.) 

Kreos. Typhoid haemorrhages, with fetid stools, followed by great 
prostration. (Trinks. ) 

Laches. Fever worse in the afternoon; sweat without alleviation; sleep 
with following aggravation of all the symptoms; loss of consciousness; mut- 
tering; stupor; sunken countenance; dropping of lower jaw; dry, red or 
black tongue, cracked on the tip and bleeding; in the attempt of protruding 
it, it trembles; or the tip remains under the lower teeth, and does not come 
out; dry lips, cracked and bleeding; stools very offensive, whether formed 
or loose; haemorrhage from bowels, with flakes of decomposed blood, having 
the form and appearance of charred straw, in longer or shorter pieces, to- 
gether with portions more or less ground up; sore throat with deafness; nasal, 
indistinct speech; dyspnoea; cough, with slimy, bloody expectoration; after 
sleeping a short time, terribly restless, tossing about and throwing the bed- 
covers off. 

Lauroc. Clonic spasms of the upper and lower extremities with para- 
lytic weakness of the limbs; no loss of consciousness. (Trinks.) 

Lycop. Sopor; delirium; uses wrong words for correct ideas, which he 
intends to express; fear to be left alone; restless sleep, with outcries and 
loud laughing; when awaking, exceedingly cross, irritable, scolding, scream- 
ing, behaving disagreeably; violent jerkings of the limbs, shaking the whole 
body, awake or asleep; subsultus tendinum ; catching at flocks; sunken face, 
yellowish, or with circumscribed redness in the afternoon; tongue red and 
dry; sometimes it is spasmodically thrust to and fro between the teeth; lower 
jaw sunken; bowels much distended, with rumbling and constipation; urine 
leaves, if voided in bed, a red, sandy stain; cold hands and cold feet; one 
foot hot and the other cold; wants to be uncovered during heat. 

Mercur. May be indicated at the beginning of the disease, when there 
is; swollen and bleeding gums; fetor from the mouth; pain in the liver; 
yellow-green stools; dark urine; bronchitis; icteroid color of the skin. 
11 Obtuseness of mental operations, with great inclination to sleep; heaviness 
and muddledness of the head; thick and dirty-whitish coating of tongue; in- 
sipid, pappy, slimy, foul taste, with desire for refreshing things; thirst; pain- 
ful sensitiveness of precordial, hepatic, umbilical and ileo-caecal region; 
bilious, slimy or watery diarrhoea, which, however, may be absent altogether; 
prostration; sometimes copious, debilitating perspiration; pale and sunken 
face and eyes; also dirty-yellowish color of face." (Trinks.) 

Moschus. In cases of impending paralysis of the lungs, where the 
cough ceases and the collected mucus cannot be expectorated; where respira- 



THERAPEUTIC HINTS TO TYPHOID FEVER. 905 

tion and pulsation of the heart grow weaker and weaker; where in swallow- 
ing, the fluid rolls audibly down the throat, and stool and urine pass off in- 
voluntarily. 

Mur. ac. Febris stupida; constant sliding down in bed, with groaning 
and moaning in sleep, and muttering and unconsciousness while awake; ex- 
cessive dryness of mouth and tongue; the tongue is heavy, paralyzed; the 
patient cannot move it at will, even if conscious; the pulse intermits every 
third beat; profuse discharge of watery urine; watery diarrhoea; stools and 
urine in vol untary. "Febris nervosa versatilis after Bryon., if the disease 
still grows in intensity. Continuous delirium, hindering sleep and rest; the 
patient is all the time occupied with things past and present; he forgets time, 
place and all he has said. Vivid hallucinations; the eyes shun the light; 
the ears are sensitive to slightest noises and hear sounds — the falling of rain, 
or music — which do not exist; smell and taste very acute. The eyes glisten; 
the pupils are contracted; the cheeks reddened; nose, lips and tongue are 
dry; the tongue is not or only slightly coated; great thirst; little or no affec- 
tion of the mucous membrane of the intestines; discharges from the bowels 
none, or but seldom; urine clear, of acid reaction; pulse very frequent, irri- 
tated, without energy, no to 130; respiration accelerated; skin mostly dry, 
hot. Great desire to sleep, without ability to go to sleep; muscular power 
not very much decreased; slight feeling of weakness and weariness." 
(Trinks.) 

Nitr. ac. In cases of typhoid haemorrhages; great sensitiveness of the 
abdomen; green, slimy, acrid diarrhoea; tenesmus; white, coated tongue, 
with sore spots; inflammatory affection of the lungs, with rattling cough and 
breathing; brownish, bloody expectoration and irregular pulse; after 
calomel. 

Nuphar. Liquid, yellow, fetid stools most frequent between four and 
seven in the morning. 

Nux mosc/i. Profound coma; lying silent, immovable; insensible; dif- 
ficult comprehension; slowness of ideas; dwells long on her answer, or does 
not answer at all; very deaf; putrid, colliquative diarrhoea; rolling, rum- 
bling and gurgling in bowels; dreamy state, with drowsiness and drooping of 
eyelids; dryness of mouth, tongue and throat, with fullness of stomach and 
loss of appetite; in the evening the dryness is so great that the tongue sticks 
to the roof of the mouth, yet there is no thirst. (Hering, confirmed by 
Nash.) 

Nux vom. " In the early stage; if there be chilliness on slightest move- 
ment; dryness of the front of the mouth and tip of the tongue; intolerance 
of impressions on the external senses, all of which seem much exaggerated; 
great sensitiveness to the open air; thirst, with aversion to water; strong de- 
sire to lie down, and considerable relief on doing so." (Wells.) 

Opium. Febris nervosa stupida; the stupor is complete; he cannot be 
roused or only with great difficulty; lies speechless, with open eyes and stiff 
limbs; delirium, mild or furibund, with loud talking, laughing or singing; 



906 THERAPEUTIC HINTS TO TYPHOID FEVER. 

attempts to escape; congestion to the head; face dark red and bloated; res- 
piration slow, deep drawn and sighing, stertorous, rattling; constipation or 
offensive watery diarrhoea; involuntary stools; retention of urine. 

Phosphor. Pneumo-typhus; violent bronchitis and even hepatization; 
hard, dry cough with tightness in the chest; or loose, rattling cough, with 
tough, transparent, or thick, yellowish, or reddish expectoration; cough 
worse from evening until midnight; vomiting of watery, bilious and slimy 
masses with great pain; frequent, unpainful diarrhoea, with meteorism and 
loud rumbling; the discharges are watery, greenish, grayish, or black from 
decomposed blood; great weakness after each discharge; numerous roseola 
spots, ecchymosis and miliary eruption on the trunk; great heat of the 
trunk, with cold perspiration on head and extremities. "Rapid sinking of 
strength; very quick, small, thread-like pulse; stupor; unconsciousness; 
sopor and stupefaction; delirium and flaccilegium ; hardness of hearing; dull, 
half-shut eyes; hippocratic face; lying on back; dry, immovable tongue, 
covered with black crusts; very sensitive abdomen, painful to touch; rolling 
and rumbling in abdomen during and after drinking; rattling in windpipe; 
impending paralysis of brain and collapse; burning pain in the brain." 
(Trinks.) 

Phosph. ac. Complete apathy and indifference; don't want to talk; 
answers slowly and reluctantly, or short, incorrectly; stupid sleep from which 
he may be roused, when he answ T ers correctly; but soon falls asleep again; 
stupor; stupid and indifferent expression of the face; bleeding from the 
nose; meteroristic distention of the abdomen, with a great deal of rumbling 
and gurgling, and unpainful, watery, grayish diarrhoea, also involuntary 
stools; great debility; relaxed pale skin; ecchymosis; bluish-red spots on 
the parts which the patient lies upon; decubitus; temperature of the body 
not high; constant, sticky or profuse sweat; pulse weak and small, frequent 
and intermitting. " Dryness of the mouth and throat; gray- whitish coating 
of the tongue; the patient slumbers even in daytime, with murmuring de- 
lirium; the eyes are dim, sleepy; the skin remains dry or clammy; a miliary 
rash appears first about the neck, then upon the back, then on the chest, etc., 
at last upon the feet." (Trinks.) 

Psorin. Retarded convalescence from profuse perspiration; patient 
hopeless and despairing of recovery; extreme prostration. (Hering. ) 

Pulsat. At the early stage where external heat is intolerable, causing 
a sense of heat with distress; uncovering, however, is followed immediately 
by a chill; or there is heat only of one side, or heat of one side with coldness 
of the other, or sweat of one side; there may be great drowsiness; delirium; 
frightful visions; try tongue, as if burnt, and yet no thirst; rumbling in the 
bowels and diarrhoea, with pinching pain, worse at night; pulsating in the 
epigastrium. 

Rhus fox. Mental operations are slow and difficult; he answers cor- 
rectly but slowly, sometimes hasty; delirium; talks much to himself, or talks 
incoherently, without any seeming connection of ideas; headache; worse 



THERAPEUTIC HINTS TO TYPHOID FEVER. 9°7 

from opening and moving the eyes; bleeding from the nose, especially after 
midnight; the lips are dry and covered with brown crusts; the tongue is red 
at the tip, in the shape of a triangle; the bowels are loose, worse at night; 
involuntary alvine discharges during sleep. There is often severe cough, 
with tough, bloody expectoration; bronchitis; pneumonic infiltration of the 
lower lobes of the lungs; severe rheumatic pains in the limbs, worse in rest; 
somewhat ameliorated by moving and changing position; constant restless- 
ness; tossing about; restless sleep, with frightful dreams, and frequent wak- 
ing, and never that state of quiet, profound coma; dry heat or sweat, during 
which the patient desires to be covered; roseola spots; miliary eruption; 
great exhaustion. 

Secale. Large purple spots on the body, particularly on the feet; body 
cold, especially hands and feet, and would not be covered; cold perspiration, 
mostly on face and forehead; copious vomiting of thick, black bile, mixed 
with mucus. (Lippe. ) 

Silic. Sometimes in the very worst cases, with excessive debility, pro- 
fuse perspiration and a strong desire to be magnetized: magnetizing relieves 
the great weakness, and Silicea promotes the forming of abscesses, boils, etc., 
thus throwing the poison to the surface, and securing a gradual though slow 
recovery. 

S tram o?i. Loss of consciousness; imbecility; stupefaction of the senses; 
delirium; hallucinations; singing; laughing; whistling; screaming; constant, 
involuntary, odd motions of the limbs and body; spasmodic distortions of 
the face; staring look; wrinkled skin on forehead; loss of sight, hearing and 
speech; all objects appear oblique to him; inner mouth feels raw and sore, 
or is ulcerated; red rash upon the chest; blackish diarrhoea every hour; 
stools smell like carrion; suppressed secretion of urine; retention of urine; 
copious, involuntary discharge of urine. Febris nervosa versatilis. 

Sulphur. When in psoric individuals the well-selected remedy has no 
or onry a superficial effect; besides, if there be sleepless nights; slow com- 
prehension when being asked; heat and fullness in the head; chronic sore 
and inflamed eyelids; great dryness of the ears; pale, sickly aspect; bright 
red lips; undefined redness on the tip of the tongue; bleeding from the nose, 
teeth and gums; offensive smell from the mouth; diarrhoea, worse early in 
the morning, unpainful or with tenesmus; great prostration after stool; 
offensive urine; catarrh and inflammation of the lungs, especially during 
commencement of infiltration, recognizable by the crepitation sound. 

Tarax. During rest intolerable tearing pains only in the lower extremi- 
ties {Rhus tox. has such pains in all the limbs) ; constant muttering to him- 
self, similar to that of Hyos.; violent, tearing pain in the occiput; great 
chilliness after taking anything to eat or drink. (Von Boenninghausen.) 
Map-tongue. 

Tart. emet. In pnemo-typhus, with great rattling in the chest, d5 T spnoea, 
etc. ; symptoms of oedema pulmonis. 

Tereb. Bloody urine. 



908 GENERAL HINTS TO TYPHOID FEVER. 

Veratr. During cholera epidemics; great prostration; cold sweating; 
coma; vomiting and watery diarrhoea; bluish face; pointed nose; wrinkled 
skin. 

Ver. vir. Constant talking and muttering unintelligibly, with open 
eyes; squinting; ocular conjunctiva injected, secretion of yellow mucus at 
inner canthus; nightly agglutination; face pale, with cold sweat; boring 
occiput into pillow, jerking head backward, sometimes forward. Pupils 
dilated; dropping of lower jaw; corner of mouth drawn down on left side- 
champing teeth; tongue coated white; red streak down the centre; beating 
of heart when turning over in bed, shaking left side of thorax; pulse irregu- 
lar; urine dark and turbid, fetid, involuntary; great restlessness; constant 
moving, thrusting out one leg, then drawing it up; position on back with 
thighs flexed on pelvis; carphologia; picking at bedclothes; subsultus ten- 
dinum, like galvanic shocks; twitching of facial muscles (G. W. Sherbino.) 
Zincum. Staring eyes; delirium with attempts to get out of bed; com- 
plete unconsciousness; lying on the back and sliding down in bed; grasping 
at flocks; subsultus tendinum; constant trembling of the hands and coldness 
of the extremities; relaxation of the muscles of the face; hippocratic face; 
pale, waxy complexion of the face; decubitus on the sacrum and trochanter; 
frequent, involuntary discharges from the bowels; frequent, small, intermit- 
ting, scarcely perceptible pulse; impending paralysis of the brain. 

.General Hints. 

In predominant cerebral symptoms compare: Apis, Bel/ad., Bryon., 
Cuprum, Hyosc, Laches., Mur. ac, Opium, Stramon., Zincum. 

In predominant abdominal affections: Apis, Arsen., Bryon., Card. veg. } 
China, Colchic, Ginseng., Mercur., Nux vom., Phosph. ac, Rhus fox., Secale, 
Sulphur, Veratr. 

In pneumo-typhus : Apis, Bellad., Bryon., Calc. carb., Hyosc, Mercur., 
Phosphor. , Pulsat. , Rhus fox. , Sulphur, Tart. emet. 

In febris nervosa stupida : Arnica, Arsen., Carb. veg., Coccul., Hyosc, 
Laches. , Mur. ac. , Phos. ac. , Rhus tox. , Secale. 

During convalescence, when there is too great hunger: Pulsat. 

Diarrhoea, with cutting in the bowels after sour things: Ipec 

Overexertion of the body: Rhus tox. 

Fright: Ignat. 

Chagrin: Nux vom. 

L<oss of memory: A?iac 

Complaints, which go from above downwards: Selen. 

When commencing below and spreading upwards: Guaco. 

Protracted convalescence: Pso?iu. 



DIGEST TO TYPHOID FEVER. 



909 



Digest to Typhoid Fever. 



MIND, 

Consciousness, no loss of: Lauroc. 

— •— , loss of: Apis, Arnica, Arsen., Bel- 
lad., Colchic, Hyosc, Laches., Lycop., 
Mur. ac, Opium, Phosphor., Rhus tox., 
Stramon , Zincum. 

, , and of senses: Helleb., Hyosc, 

Nux mosch., Stramon. 

Unconsciousness of what he is doing, 
or is said to him: Arum triph. 

and groaning, moaning and mutter- 
ing in sleep: Mur. ac. 

Stupor, stupefaction: Arnica, Laches., 
Phosphor., Stramon. 

, delirious: Baptis. 

, indifferent expression of face: 

Phosph. ac. 

, lies speechless with open eyes and 

stiff limbs: Opium. 

, lying silent immovable: Nux mosch. 

Febris stupida: Arnica, Arsen., Bellad., 
Carb. veg., Coccul., Hyosc, Laches., 
Mur. ac, Opium, Phosphor., Phosph. 
ac, Rhus tox., Secale. Stramon. 

Self-forgetfulness, with constant staring 
at surrounding objects: Hyosc. 

Does not recognize relatives or friends: 
Hyosc 

Forgets time, place and all he has said: 
Mur. ac. 

the word while speaking: Arnica. 

what has passed: Coccul. 

Answers correctly but slowly, sometimes 
hasty: Rhus tox. 

slowly and reluctantly, or short, in- 
correctly: Phosph. ac. 

slowly and comprehends slowly: 

Sulphur. 

, stares at the physi- 
cian: Helleb. 

or not at all: Nux mosch. 

Does not find the right expression for 
his ideas: Coccul. 

Uses wrong words for^correct ideas: Ly- 
cop. 

Comprehension slow and difficult: Coc- 
cul., Mercur., Nux mosch., Rhus tox. 

Thoughts cannot be directed and con- 
trolled: Hyosc. 

Confusion of thoughts: Arnica, Baptis. 

Incoherent talking to himself: Rhus tox. 



Sits in thought, yet thinks of nothing; 
like a waking dream: Arnica. 

Intellect beclouded, though he answers 
correctly; unless questioned, he says 
nothing of his condition, which does 
not seem dangerous to him: Colchic 

Thoughts all the time occupied with 
things past and present: Mur. ac. 

The same disagreeable idea rouses the 
patient as often as he falls into a light 
slumber: Calc carb. 

Can not get rid of one and the same idea: 
Petrol., Pulsat., Stramon. 

Hallucinations: Hyosc, Mur. ac. 

Frightful visions: Bellad., Calc. carb., 
Carb. veg., Cincho?ia, Hyosc, Mur. ac, 
Pulsat., Stramon. 

Sees persons who are not and have not 
been present: Hyosc, Stramon. 

Illusions: Hyosc 

, especially when shutting the eyes: 

Arsen., Bryon., Calc. carb., Carb. veg. 

, as though there were a second self 

beside the patient in bed: Arsen., Bap- 
tis., Petrol. 

Delirium: Am., Arsen., Bellad., Calc 
carb., Camphor a, Lycop., Pulsat., Rhus 
tox., Stramon. 

Delirium, murmuring: Apis, Arnica, 
Bellad., Hyosc, Lycop., Phosph. ac, 
Rhus tox., Stramon. 

, furious: Beltad., Canthar., Colchic, 

Hyosc, Opium, Pulsat., Stramon. 

about the affairs of the day or busi- 
ness matters: Bryon. 

, with loud talking, laughing and 

singing: Opium. 

on going to sleep: Ginseng. 

, hindering sleep and rest: Mur. ac 

, with cephalalgia: Colchic. 

, with attempts to run away: Bryon., 

Opium. 

, and to strike and bite: 

Bellad. 

, to get out of bed: Bellad., Hy- 
osc, Stramon., Zincum. 

, , and a tremulous propul- 
sion of the tongue and a general tremor: 
Agar. 

andfiaccilegium: Phosphor. 

Febris versatilis : Bellad., Bryon., Hy- 



gio 



DIGEST TO TYPHOID FEVER. 



osc , Lycop., Mur. ac, Xux vom., 
Opium, Phosph. ac, Pulsat., Rhus tox., 
Stramon . , Zincum . 



Wants to go from one bed into another: 
Arsen., Bellad., Calc. card., Hyosc, 
Rhus tox., Sepia , Ver. alb. 

Attempts to get out of bed: Agar., Bry- 
on., Zincum. 

Jumps out of bed: Bellad., Hyosc, Xux 
vom., Zincum. 

Attempts to run away to escape : Bellad. , 
Bryon., Hyosc, Opium, Stramon. 

, , while perfectly uncon- 
scious: Arum triph. 

to strike, bite or spit: Bellad., Can' 

thar., Hyosc, Stramon. 
Loud talking, laughing or singing: 

Opium . 
Talking incoherently: Bellad., Gelsem., 

Hyosc, Laches., Lycop., Rhus tox., 

Ver. vir. 

to himself: Hyosc, Opium, Rhus 

tox., Tarax., Ver. vir. 

Loquacity: Apis, Bryon., Hyosc, La- 
ches., Stramon. 

Muttering, murmuring: Apis, Coccul., 
Hyosc, Laches., Lycop., Phosph. ac, 
Tarax., Ver. vir. 

, , with a happy expression, 

which looks strange: Apis. 

, , with picking bedclothes: Hy- 
osc. 

Singing: Bellad., Opium, Stramon. 

Laughing, whistling: Stramon. 

Screaming: Stramon. 

Sighing, groaning, moaning: Bryon. 

Picking at the bedclothes: Arnica, Ar- 
sen., Colchic, Hyosc, Lycop., Opium, 
Psorin., Stramon., Zincum. 

Catching, grasping at flocks: Lycop., 
Opium, Phosph. ac, Stramon., Sulphur, 
Zincum . 

Playing with his own hands: Hyosc 

Sits in silence: Arnica, Coccul. 

Don't want to talk: Phosph. ac. 



Apathy, indifference: Apis, Arnica, 
China, Phosph. ac. 

, , has no desire: Helleb. 

, does not complain of anything: Hy- 
osc, Opium. 



-, thinks nothing the matter with him: 

Arnica, Arsen., Hyosc 
, thinks his condition not dangerous: 

Colch ic 
Fear of being left alone: Hyosc, Lycop. 
of death: Aeon., Arsen., Baptis., 

Bryon., Coccul., Rhus tox., Ver. alb. 
Anxiety and restlessness: Arsen., Bryon., 

Calc. carb., China, Rhus tox., Ver. alb. 
Hopeless and despairing of recovery: 

Psorin. 



Embarrassed: Hyosc, Sulphur. 

Impatient and despairing about pain and 
bad feeling: Lgnat. 

Irritable, peevish, easily offended: Bry- 
on. 

, cannot endure noise or contradic- 
tion, speaks hastily: Coccul. 

on awaking, scolds, screams, behaves 

disagreeably: Lycop. 

Bad humor : Rhus tox. 

Quarrelsome, angry disposition: Bellad., 
Bryon., China, Xux vom. 

Easily frightened: Lgnat., Kali carb. 



Sensibility increased: Bellad., China, 
Mur. ac, Xux vom., Phosphor. 

decreased: Apis, Bellad., Carb. veg., 

Colchic, Helleb., Opium, Phosphor., 
Stramon., Sulphur. 



Vertigo: Gelsem. 

when rising up from bed, with nau- 
sea, compelling to lie down again: Coc- 
cul. 

, as if he were swung in a cradle or 

swing: Lgnat. 

Brain, impending paralysis of: Zincum. 

, , and collapse: Phosphor. 

seems to be the only invaded part of 

the body: Helleb. 

, burning pairmn: Phosphor. 

, hot and burning: Calc carb. 

, congestion to the: Bellad., Opiutn. 

Headache : Kali carb. 

, with delirium: Colchic 

, stupefying: Baptis. 

and pain in back and limbs: Gelsem. 

, worse from opening and moving the 

eyes: Bryon., Rhus tox. 



DIGEST TO TYPHOID FEVER. 



911 



Head, heat and fullness in: Sulphur. 

, in, and chilliness in remaining 

body : Coccul. 

, heaviness and muddlednessof: Mer- 

cur. 

feels as big as a bushel: Gelsem. 

Occiput, tearing pain in: Tarax. 

Front of head, pain in, follows attacks 
of yawning and stretching; does not al- 
low opening the eyes: Ignat. 

Forehead covered with cold perspiration: 
Col chic, Mercur., Veratr. 

Head and extremities, cold perspiration 
on; great heat of trunk: Phosphor. 

boring in pillow, jerking head back- 
ward and sometimes forward: Ver. vir. 

falls backwards if the patient is 

raised, and the mouth opens to its 
widest extent: Colchic. 

Eyes dim and sleepy: Phosph. ac 

dull, half shut: Phosphor. 

, watery: Arsen., Bryon. 

, without lustre: Card. veg. 

sunken: Arsen. 

and pale face: Mercur. 

, hollow, staring: Colchic. 

staring, glistening: Arsen., Mur. ac. 

, sparkling: Bellad. 

, , red and rolling about: 

Hyosc. 

staring: Colchic, Hyosc, Opium, 

Phosph. ac, Secale, Stramon., Zincum. 

, with slow comprehension: Hel- 

leb. 
Pupils dilated: Ver. vir. 

, and vacant look: Hellab. 

and little sensitive to light, or 

immovable: Colchic 

contracted: Mur. ac. 

without reaction against light: Card. 

veg. 
Lids sore and inflamed: Sulphur. 

nightly agglutinated: Ver. vir. 

closed with sticky matter: Arsen. 

fall shut, as if paralyzed: Coccul. 

tremble and jerk, also muscles of 

face and limbs: Coccul. 

Conjunctiva injected: Bapiis. 
with secretion of yellow mucus 

at inner canthus: Ver. vir. 
Squinting: Hyosc 
Moving" eyes increases headache: Bryon., 

Ignat., Rhus tox. 
Blind spells: Gelsem., Zincum. 



Loss of sight, hearing and speech: Stra- 
mon. 

Shuns the light: Bellad., Nux vom., 
Pulsat. 

All objects appear oblique to him: Stra- 



Ears, great dryness of: Sulphur. 

sensitive to noise: Bellad., Bryon., 

Coccul., Lycop., Phosphor., Sulphur. 

hear sounds like the falling of rain 

or music, which do not exist: Mur. ac 

, ringing in: Coccul. 

, hardness of hearing: Apis, Arsen., 

Bryon., Phosphor. 

, loss of hearing, sight and speech: 

Stramon. 

, deafness: Bellad., Carb. veg., Hyosc, 

Mercur. , Nux mosch. , Phosph. ac. stra- 
mon, Sulphur. 

, , with sore throat: Laches. 



Nose bleeding: Arnica, Gelsem., Laches., 
Phosph. ac, Secale. 

, especially after midnight: Rhus 

tox. 

, also teeth and gums: Sulphur. 

, haemorrhages from, and mouth: 

Carb. veg. 

, dryness of: Bryon. 

, , and of mouth and throat: Bel- 
lad. 

, , and lips and tongue: Mur. ac. 

pointed: Ver. alb. 

, cold, and cold mouth: Cam- 
phor a. 

Nostrils dry and black: Colchic 

sooty, smoked: Arsen., Helleb., 

Hyosc. 

, fan-like motions of the: Lycop. 

Boring with fingers in nose: Aurum 
triph. 

Smell and taste very acute: Mur. ac 



Face pale, with cold sweat: Secale, Ver. 
vir. 

, cold, sunken: Carb veg. 

and sickly: Kali carb., Sul- 
phur. 

and sunken: Mur. ac 

and waxy complexion: Zincum. 

red: Calc carb., Mur. ac 



912 



DIGEST TO TYPHOID FEVER. 



red and burning: Bel lad. 

red, circumscribed and burning hot: 

Arsen. 
dark red, with besotted expression: 

Baplis. 

and bloated: Opium. 

— »-, crimson flushes of: Gelsem. 

, cyanotic blueness of: Carl), veg., 

Laches., Ver. alb. 

yellowish: Mercur. 

, with circumscribed redness in 

afternoon: Lycop. 
Pace, stupid expression: Helled., Hyosc. 

, facies quatrata : Helleb. 

, sunken countenance: Arsen., Carb. 

veg., Colchic., Laches., Lycop., Mur. ac. 

cold with perspiration: Camphora, 

Carb. veg., Colchic,, Secale, Ver. vir. 

hippocratic: Arsen., Carb. veg., 

China, Colchic, Phosphor., Secale, 
Zincum. 

collapsed: Camphora . 

, cadaverous aspect and extreme pros- 
tration: Colchic. 

Skill on forehead wrinkled: Slramon. 

Facial muscles twitching: Ver. vir. 

trembling and jerking: Coccul. 

, distortion of: Bell ad., Coccul., Hy- 
osc, Str anion. 

Risus sardonicus : Colchic 

Relaxation of muscles of face: Zincum. 

Dropping" of lower jaw T : Arsen,, Baplis., 
Laches., Lycop., Mur. ac, Opium, Ver. 
vir. 

Comer of mouth, drawn down on left 
side: Ver. vir. 

Mouth distorted: Bellad., Camphora, 
Opium. 

open to its widest extent, when on 

lifting the head falls back: Colchic 

frequent chewing motions during 

sleep: Bryon. 

Lips bright red: Sulphur. 

dark red: Bellad. 

bluish or pale: Carb. veg. 

dry, and dry nose and tongue: Mur. 

ac. 

dry and cracked: Arsen., Bellad. 

and bleeding: Laches. 

and brown: Bryon. 

and parched: Carb. veg. 

dry and covered with brown crusts: coated not at 

Rhus tox. Mur. ac. 



, teeth and tongue covered with 

brown coating: Colchic. 
, teeth and gums covered with brown 

or black slime: Arsen. 

cracked: Colchic, Pulsal., Sulphur. 

at tip: Laches. 

, ulcerated and covered with 

vesicles: Apis. 

and corners of mouth sore and 

cracked: Arsen., Arum triph. 

, trembling of lower: Arnica. 

, picking until the}' bleed: Arum 

triph . 
Tongue bright red: Colchic. 
red: Arsen., Hyosc, Laches., Rhus 

tox. 

red and dry: Baplis., Camphora, 

Lycop. 

red at tip, undefined: Sulphur. 

red, in shape of a tringle: Rhus 

tox. 

red at edges and white in centre: 

Bellad. 

, red streak in the centre: Ver. vir. 

black: Arsen., Laches., Opium, 

Rhus tox., Secale. 

, brown streak in middle: Arnica. 

brown and dry: Bryon. 

-, particularlv in the centre: 

Baplis. 

and cracked: Hyosc. 

dry: Ginseng., Mur. ac. 

dry, as if burnt, yet no thirst: Pulsat. 

dry, it sticks to the roof of the mouth, 

without thirst: Xux mosch. 
dry, immovable, covered with black 

crusts: Phosphor. 
dry, and dry mouth and throat, with 

fullness of stomach and loss of appetite: 

Nux mosch. 
dry on tip, and front of mouth: Nux 

vom. 

dry and red: Baplis., Lycop. 

— ■ , great thirst: Camphora. 

, and cracked on tip and bleed- 
ing: Laches. 

dry, brown and cracked: Hyosc 

dry, brown, particularly in centre: 

Baplis. 
, moist and stickv sometimes: Carb. 



all or onlv slightlv 



DIGEST TO TYPHOID FEVER. 



913 



white, with a red streak through 

the centre: Ver. vir. 

white, with sore spots: Nitr. ac 

thick, dirty-whitish: Mercur. 

thick white or yellowish: Bry- 
on. 

gray-whitish: Phosph. ac. 

coated thick brown: Gelsetn. 

, and also lips and teeth: 

Colchic. 

, map-tongue: Tarax. 

, tremulous propulson of, and general 

tremor of the whole body: Agar. 
is spasmodically thrust to and fro 

between the teeth: Lycop. 

, trembling and heaviness of: Bellad. 

, in the attempt of protruding 

it: Laches. 

heavy, stiff and numb: Colchic. 

heavy, scarcely movable: Card. veg. 

immovable: Phosphor. 

stiff, like a piece of wood: Arsen. 

, inability to put out the tongue and 

to speak: Apis. 

protruded with difficulty : Colchic. 

, the tip remains under the lower 

teeth and cannot be protruded: Laches. 

paralyzed: Hyosc, Mur. ac. 

Speech, stammering: Arsen., Bellad. , 

Card, veg., Lycop., Secale, Stratnon. 

, , as if drunk : Bellad. 

, , lisping, unintelligible: Arsen., 

Bellad., Opium, Stramon., Veratr. 

, indistinct: Hyosc, Laches. 

, costs him a great effort to speak 

plainly: Coccul. 
, unable to talk and to put out the 

tongue: Apis. 

, loss of: Colchic, Hyosc, Ver. alb. 

, , and of sight and hearing: 

Stramon. 
Voice weak and trembling, hoarse,- 

coarse, or crowing: Arsen. 



Teeth grinding: Arsen., Colchic. 

, grating: Hyosc. 

, champing: Ver. vir. 

, sordes on: Baptis., Stramon. 

, brown or black slime on: Arsen. 

, thick brown coating: Colchic 

Gums swollen and bleeding at the begin- 
ning: Mercur. 

bleeding: Card, veg., Mercur., Phos- 
phor., Sulphur. 

58 



, brown mucus on: Rhus tox. 

Mouth, haemorrhages from, and nose: 

Card. veg. 

raw, sore, ulcerated: Stramon. 

cold: Camphora. 

, dryness of, and throat: Phosph. ac. 

, , and nose : Bellad. 

, , , with fullness of stomach : 

Nux mosch. 
, , and tongue: Mur. ac, Nux 

vom. 

, , with or without thirst: Bryon. 

, , without thirst: Pulsat. 

, salivation, acrid: Arum triph. 

, fetid breath from: Arsen., Arum., 

Baptis., Mercur., Sulphur. 

, cadaverous smell from : Hyosc. 

, putrid smell from: Arnica., Nux 

vom. 
Taste very acute: Mur. ac. 

bitter: Bryon., Laches., Pulsat. 

pappy : Coccul. 

, pappy, insipid, slimy, foul: Mercur. 

Appetite, loss of: Bryon., Nux mosch. 
, too great during convalescence: 

Pulsat. 
, wanting during convalescence: Psor- 

in,, Sulphur. 
Thirst: Mercur., Mur. ac. 

, excessive: Colchic, Hyosc 

, excessive, with dry, red tongue: 

Camphora. 
, excessive, but drinking little at a 

time: Arsen. 
, excessive, and drinking large quanti- 
ties: Bryon. 

, with aversion to water: Nux vom. 

, absent: Bryon., Nux mosch., Pulsat. 

Desire for refreshing things: Mercur. 
for alcoholic drinks, which are easily 

borne: Agar. 
After drinking rumbling in abdomen: 

Phosphor. 
Swallowing difficult: Apis, Baptis., 

Bellad., Helled. 

impossible: Stramon. 

, the fluid rolls audibly down the 

throat: Arsen., Hydr. ac, Mosch us. 
Choking sensation from the stomach up 

into the throat, better from belching: 

Lgnat. 
Sore throat : Bellad. 
Burning in throat: Ver. vir. 
Belching: Bryon., Coccul. 



914 



DIGEST TO TYPHOID FEVER. 



compelling to 



Nausea, when rising up, 

to lie down: Coccul. 
Vomiting" : Kali carb. 

of thick, black bile, mixed with 

mucus: Secale. 
of water}-, bilious and slimy masses 

with great pain: Phosphor. 

and retching: Arsen. 

and watery diarrhoea: Ver. alb. 

Epigastrium, weak and sinking feeling 

in: Ignat. 
, soreness to touch or motion, in: 

Br yon., Colchic. 

, bloated: Carb. veg. 

, pulsating in: Pulsat. 

, burning in, and sensitive to pressure: 

Arsen. 
Liver, painful: Bel/ad., Bryon., Laches., 

Lycop., Mercur., Phosphor. , Sulphur. 
Spleen, enlargement of: Arsen., China, 

Coccul., Phosph. ac, Rhus tox. 
Abdomen, sensitive to touch: Hamam., 

Laches., Mercur., Nitr. ac, Phosphor. 
, umbilical and ileo-csecal region 

sensitive: Mercur. 

, iliac tenderness: Gelscm. 

, surface of, hot: Colchic, Laches. 

Meteorism, distention: Apis, Arnica, 

Arsen., Carb. veg., China, Coccul., 

Colchic, Lycop., Opium. 
, distention, with rumbling and un- 

painful diarrhoea: Phosphor. 
, distention, with rumbling and gurg- 
ling: Phosph. ac. 
Tympanitis with pain in back: Colchic. 
Rumbling, gurgling, rolling: Carb. veg., 

Nux mosch. 
, with pinching pain and diarrhoea, 

worse in the night: Pulsat. 

, with painless diarrhoea: Phosph. ac. 

, with involuntary stools: Camphora. 

, with constipation: Lycop. 

, after drinking: Phosphor. 

in the ileo-csecal tract: Ginseng. 

Diarrhoea: Arsen. 

, bilious, slimy: Mercur. 

, blackish, every hour: Stramon. 

, from decomposed blood, or 

greenish, grayish: Phosphor. 

, brownish, grayish: Carb. veg. 

, greenish, acrid: Nitr. ac. 

, watery: Arsen., Colchic, Mercur., 

Phosphor. 
, excessive: Calc carb., Carb. veg. 



worse at night: Rhus tox. 
— , with pinching pains: Pulsat. 

. frequent and painful: Apis. 

, with tenesmus: Nitr. ac 

, , early in morning: Sulphur. 

, unpainful: China. 

, , watery, grayish: Phosph. ac. 

, , early in morning: Sulphur. 

, , with meteorism and loud rum- 
bling: Phosphor. 

, involuntary: Apis. Colchic, Hyosc, 

Opium, Phosph. ac, Zincum. 

, , bloody and foul: Apis, Arsen. 

, , during sleep: Rhus tox. 

, — — , after much rolling and rum- 
bling: Camphora. 

. , and involuntary discharge of 

urine: Arnica, Mosch us. 

Paralysis of sphincter ani- Phosphor. 

and vesicae: Hyosc. 

Stool smells cadaverously: Carb. veg. 

smells like carrion: Stramon. 

, fetid: Baptis., Kreos. 

, fetid, liquid, yellow, between 4 and 

7 a.m.: Xuphar. 

, foul: Apis, Arsen. 

, offensive, whether formed or loose: 

Laches. 

, offensive, painful, liquid, dark: 

Colch ic 

, offensive, watery: Opium. 

, putrid, colliquative: Nux mosch. 

followed by prostration: Kreos., 

Phosphor., Sulphur. 

Haemorrhages from bowels: Nitr. ac 

, fluid, dark, fetid blood: Ha mam. 

, coagulated, black blood in the third 

week: A lumen. 

, decomposed, like charred straw, or 

more or less ground up: Laches. 

Constipation: Apis., Arsen., Hyosc, 
Lycop., Opium. 

Little or no affection of mucous mem- 
branes: Mur. ac. 

No diarrhoea : Helleb. 

Discharges none or but seldom: Mur. ac 

• 

Urine bloody: Tereb. 

dark: Mercur., Nux vom., Pulsat., 

but clear: Calc. carb. 

clear and acid: Mur. ac. 

turbid: Ver. vir. 

fetid: Baptis., Ver. vir. 

offensive: Sulphur. 



DIGEST TO TYPHOID FEVER 



915 



leaves a red, sandy stain: Hyosc, 

Lycop. 

copious: Col chic, St rain on. 

profuse and watery: Mur. ac. 

Urging', frequent to urinate, with burn- 
ing and scanty discharge: Arsen., Can- 
thar., Secale. 

Discharge involuntary: Arnica, Arsen., 

Col chic, Hellcb., Hyosc, Lycop., Mos- 

chus, Opium, Phosphor., Stramon., 

Ver. z'ir. 
and stools involuntary 

JIu 1 . ac 

unconscious: Apis, Helleb. 

Paralysis of sphincter vesicae 

Hyosc 
Retention of urine: Arsen 

Opium, Stramon. 
Suppression of urine: Arum triph., 

Canthar., Colchic, Hyosc, Secale, 

Stramon. 



Bellad. , 

Mercur. 
and ani: 

Hyosc. , 



Voice hoarse, coarse and crowing: Arsen. 
and hollow: Secale. 



Bronchitis^ Bellad., Bryon., Mercur., 

Rhus tox. 
Cough dry: Arsen., Bellad., Phosphor. 

short and hacking, from tickling 

under middle of sternum, worse from 
talking or moving: Calc card. 

rattling and rattling breathing: 

Nitr. ac. 

, with tough, transparent or 

thick yellowish or reddish expectora- 
tion: Phosphor. 

Bronchitis, with tough bloody exectora- 

tion: Rhus tox. 
- , with slimy, bloody expectoration: 

Laches. 
, with brownish, bloody expectora- 
tion: Nitr. ac. 
, worse from evening until midnight: 

Phosphor. 
— — , with painful shocks in head: Calc 

card.. 
, with stitches in chest and liver: 

Bryon. 

, with tightness in chest: Phosphor. 

Breathing rattling: Arsen., Card, veg., 

Opium, Phosphor., Tart. emet. 
accelerated: Arsen., Colchic, Mur. 

ac. 
slow: Helleb., Opium. 



oppressed: Arsen., Laches., Phos- 
phor. 

, better from belching: Ignat. 

irregular, intermittent: Colchic 

deep, sighing, stertorous: Opium. 

weak: Moschus. 

, with pleuritic stitches: Arnica. 

Pneumonia : Bryon., Laches., Nitr. ac, 
Phosphor., Rhus tox., Sulphur, Tart. 
emet. 

, infiltration of lower lobes: Rhus tox- 

, gray hepatization with sputa falling 

to the bottom in water and leaving a 
trail of tough mucus behind, like a fall- 
ing star: Calc. carb. 

(Edema: Tart, emet., Carb. veg., Phos- 
phor. 

Paralysis of lungs impending: Moschus. 
Nitr. ac, Tart. emet. 

Pneumo-typhus : Apis, Bellad., Bryon., 
Calc. carb., Hyosc, Mercur., Nitr. ac, 
Phosphor., Pulsat., Rhus tox., Sulphur, 
Tart. emet. 



, Ignat. 
shaking left 



Heart, pulsation grows weaker: Moschus- 

, beginning paralysis: Carb. veg. 

, slow action: Helleb. 

, palpitation: Calc carb. 

, beating when turning, 

side of thorax: Ver. vir. 

Pulse, weak: Apis, Arsen., Carb. veg., 
Hyosc, Laches., Mercur., Phosphor., 
Phosph. ac, Pulsat., Ver. alb. 

, and small: Arsen., Carb. veg., 

Hyosc, Laches., Phosphor., Phosph. 
ac, Pulsat., Rhus tox. 

, without energy: Carb. veg. 

, , 1 10-130: Mur. ac. 

, scarcely perceptible: Camphora, 

Carb. veg., Zincum. 

, without pulse: Arsen., Carb. veg., 

Colchic. , Mercur. 

, small, thread-like: Arsen., Cam- 
phora, Carb. veg., Colchic, Hyosc, 
Phosphor., Rhus tox., Zincum. 

, frequent: Arsen., Bellad., Cam- 
phora, Carb. veg., Colchic, Hyosc, 
Laches., Mur. ac, Phosph. ac, Stra- 
mon., Zincum. 

, frequent by lifting or turning the 

patient, but otherwise slow: Gelsem. 

, slow: B apt is., Gelsem., Helleb., 

Opium, Secale. 

, intermitting: Apis, A/scir, Kali 



9 i6 



DIGEST TO TYPHOID FEVER. 



card., Mur. ac, Phosph. ac, Secale, 

Ver. alb., Zincutn. 
, irregular: Apis, Baptis., Gelsem., 

Hyosc, Nitr. ac. Ver. vir. 
, tremulous: Arsen., Calc. card., 

Phosphor. 
Carotids throbbing: Bellad., Hyosc, 

Stramon. 



Back, pain in, -with tympanites: Co/chic. 

, , and limbs: Gelsem. 

, sensitive when fever sets in: Nux 

voni. 
Hands, trembling of: Zincum. 
, , when trying to lift them: 

Gelsem . 
and feet cold: Colchic, Gelsem., 

Lycop. 
, would not be moved: Se- 

cale. 
, one cold, the other hot: China, 

Puis at. 
Finger ends, picking at: Arum triph. 
Lower extremities, pain only in, dur- 
ing rest: Tarax. 
Feet, one hot, the other cold: Lycop. 

, heaviness in: Coccul. 

, soles of, great soreness; Calc. card. 

Extremities, pain in, worse moving: 

Pry on. 

, pain in, when in rest: Rhus tbx. 

, convulsive motions of: Ignat. 

, clonic spasms of, with paralytic 

weakness: Lauroc. 
— — , jerkings of, and of whole body, 

awake or asleep: Lycop. 



Yawning", stretching, followed by pain 

in forehead, which does not allow to 

open the eyes: Ignat. 
Sleepy, drowsy: Coccul., Laches., Mer- 

cur., Pulsat., Ver. alb. 
in daytime: Phosph. ac, Rhus tox., 

Sulphur. 

, when left alone: Helleb. 

, with falling of eyelids: Nux tnosch. 

, with inability to go to sleep: Bellad. , 

Mercur., Mur. ac, Opium. 
, but cannot go to sleep, because she 

cannot get herself together; head feels 

as though scattered about: Baptis. 
, but can sufficiently be roused to 

answer correctly, then falls asleep 

again: Phosph. ac. 



, cannot be roused to full conscious- 
ness: Baptis., Helleb., Opium. 

Sopor : Arsen., Laches., Lycop., Opium, 
Phosphor., Rhus t ox. 

Coma: Coccul., Nux mosch., Opium, 
Rhus tox., Ver. alb. 

, with open eyes: Colchic, Opium. 

On going to sleep, and shutting eyes, 
frightful visions: Arsen., Bellad., Calc 
carb., Ignat., Mercur., Opium. 

, delirium: Ginseng. 

During sleep, groaning, moaning, mut- 
tering: Hyosc, Mur. ac, Opium. 

, , , and chewing motions of 

the mouth: Bryon., Carb. veg., Opium. 

, outcries and loud laughing: Lycop. 

, talking and loud blowing during 

expiration: Arnica. 

, talking incoherently: Gelsem. 

, murmuring delirium: Phosph. ac 

, frequent starting: Bellad., Opium. 

, with picking: Hyosc. 

, involuntary alvine discharges: Rhus 

tox. 

, anxious dreams: Arnica, Calc. carb , 

Ignat. 

, frightful dreams and frequent wak- 
ing: Rhus tox. 

After sleep, restless, tossing about and 
throwing the bed-covers off: Laches. 

, cross, irritable, screaming, behaving 

disagreeably: Lycop. 

Sleepless, restless: Arum, triph., Hyosc. , 
Phosphor. 

, restless during the night: Sulphur. 

, gets only snatches of sleep: Cam- 

phora. 

from overactivity of mind; the same 

idea rouses him as soon as he falls 
asleep: Calc carb. 

, from nervous excitability: Hyosc. 

, feels as though the head were scat- 
tered about, tossing about to get the 
pieces together: Baptis. 

, from various visions, as soon as fall- 
ing in a doze: Ignat. 

, from continuous delirium, which 

hinders sleep: Mur. ac. 



Chilliness : Gelsem. 

on slightest motion: Nux vom. 

, on uncovering: Pulsat. 

after eating or drinking: Tarax. 

all day: Baptis. 



DIGEST TO TYPHOID FEVER. 



917 



of body with heat in head: Coccul. 

Cold extremities: Camphora. 

body and especially hands and feet, 

would not be covered: Secale. 

face and extremities with cold sweat: 

Card. veg. 

one side, and heat of the other: Pul- 
sat. 

one hand, and the other warm: 

China. 

, one foot and the other warm: 

Lycop . 
Pever heat not high: Cuprum, Phosph. 

ac. 
Temperature nearly normal: Helleb. 
Heat in head, with chilliness of body: 

Arnica, Coccul. 

, worse in afternoon: Laches. 

, worse towards 4 p. m. : Lycop. 

at night: Baptis. 

, wants to be uncovered: Lycop. 

or sweat, during which he wants to 

be covered: Hepar, Rhus tox. 
and distress from external warmth : 

Pulsat. 

of trunk, with cold perspiration of 

extremities: Phosphor. 

of one side, with coldness of the 

other: Pulsat. 

Dry skin: Colchic. 

, hot, pungent skin, like parchment: 

Arsen. 

, burning skin, or partial clammy 

sweats: Apis. 

Sweat covers face: Colchic. 

, excessive debility and a strong de- 
sire to be magnetized: Silic. 

profuse, retarding convalescence: 

Psoi'in . 

copious, debilitating: Mercur. 

of one side only: Pulsat. 

here and there: Gelsem. 

or dry heat, during which he wants 

to be covered: Hepar, Rhus tox. 

without alleviation: Laches., Mer- 
cur., Phosphor. 

cold on forehead: Colchic, Coccul., 

Ver. alb. 

cold on forehead and face: Secale. 

cold on face: Bellad., Vir. vir. 

, cold on face and extremities: Caib. 

veg. 
, , , with heat of trunk: 

Phosphor. 



, , all over: Camphora, Ver. alb. 

— ■ — , , clammy: Arsen. 

, clammy, partial, or dry, burning 

skin: Apis. 
, sour smell of body, or without 

sweat: Bryon. 
, sour, with sour diarrhoea: Rhus 

tox. 

, fetid: Arsen., Baptis. 

, with offensive breath: Arsen. 



Blood, dissolution of: Carb. veg., Cup 

rum, Laches. 
, , and paralytic conditions: Carb. 

veg. 

, , no signs of: Helleb. 

Haemorrhages : China, Kreos. 
from nose: Cuprum. 



Nervous : Kali carb. 

restlessness of body and limbs: 

Camphora. 

Tremor of body and tremulous propul- 
sion of the tongue: Agar. 

Trembling* : A rsen . , Bellad. , Hyosc . , 
Lgnat., Lycop. 

of whole body: Stramon. 

and jerking of limbs: Apis., Coccul. 

from weakness: Gelsem. 

Jerkings: Bellad., Hyosc, Lgnat., Ly- 
cop., Opium. 

, especially in children: Calc carb. 

Subsultus tendinum: Hyosc, Lycop., 
Psorin., Rhus tox., Secale, Sulphur, 
Ver. vir., Zincum. 

Automatic motion of muscles: Cam- 
phora, Rhus tox. 

of hands and feet: Coccul., Rhus 

tox. 

Involuntary motions : Bellad., Colchic, 
Hyosc, Rhus tox. 

odd motions of limbs and body: Stra- 
mon. 

, thrusting out one leg, then drawing 

it up: Ver. vir. 

Convulsive motions : Hyosc, Lgnat. 

of mouth and face: Bellad. 

Picking at bedclothes: Arnica, Arsen., 
Colchic, Hyosc, Lycop., Opium, 
Psorin., Stramon., Ver. vir., Zincum. 

Flaccilegium : Lycop., Opium, Phos- 
phor., Phosph. ac, Stramon., Sulphur, 
Ver. vir., Zincum. 



9i8 



DIGEST TO TYPHOID FEVER. 



Paralytic symptoms : Card, veg., Coc- 
cul., Cuprum. 
Muscles refuse to obey the will: Gel sent. 



Weakness and weariness but slight: 
Mur. ac. 

great and general: Camphora. 

Coccul., Phosph. ac, Rhus tox., Secale, 
Stramon. 

better from magnetizing: Si lie. 

and nervous prostration : Baplis. 

and lassitude: Arnica, Bryon., Phos- 
phor., Sulphur. 

as from exertion; Col chic. 

and bruised soreness, compelling to 

lie down: Arnica. 

Muscular power not very much de- 
creased: Mur. ac. 

Great sinking of strength: Arnica, Hy- 
osc, Phosphor., Phosph. ac. 

Rapid Sinking of strength: Arsen., 
Card, veg., Colchic, China, Nux vom., 
Phosphor., Secale, Veratr. 

Prostration: A heme n, Arnica, Arsen., 
Baplis., Colchic, Gel sent., Mercur., 
Psorin., Phosph. ac, Rhus lox., Stra- 
mon., Veralr. 

at first stage : Gelsem. 

with cadaverous aspect: Colchic. 

Sliding down in bed: Apis, Arsen., 
Baplis., Helled , Mur. ac, Zincum. 

Fainting: Bryon., Camphora. Laches., 
Secale. Tarax. 

from bodily movement, with distor- 
tion of face: Coccul. 

Emaciation: Arsen., Colchic, Mercur., 
Opium, Secale. 

LOSS Of flesh trifling: Helled. 



Position on back: Arsen., Colchic, La- 
ches., Phosphor., Zincum. 

, with limbs drawn up: Helled., 

Pulsat. 

, with knees drawn up: Arsen , 

Pulsat. 

, with thighs flexed on belly: 

Ver. vir. 

, and forearm stiffly 

bent on arm: Bellad. 

, head thrown back: Baplis. 

, any, feels too hard: Arnica. 

— , tosses hands about: Phosph. ac. 

, constant change of: Arsen., Bryon., 



China, Hyosc, Lgnat., Pulsat., Rhus 

tox. 

, can't lie long in an}-: Baptis. 

, tossing about: Apis, Bellad., Can- 

thar., Rhus tox. 
-, moving of head and limbs, while 

trunk li^s still: Arsen. 



Blood stagnates, causing cyanotic blue- 
ness: Card. veg. 

, large purple spots, particularly on 

feet: Secale. 

, bluish-red spots or spots where the 

patient lies upon: Phosph. ac. 

, decomposition of fl\iids: Arsen. , 

Baplis., Laches., Rhus tox. 

, haemorrhages: Alumen., Arsen. , 

Bryon., Card, veg., China, Hamam., 
Nitr. ac, Phosphor., Rhus tox. 

Decubitus: Arnica, Arsen., Card. veg. y 
China, Fluor, ac, Moschus, Nux vom., 
Phosph. ac, Zincum. 

Ulcerations : Baptis. 

Abscesses, boils: Mercur., Silic 

Ecchymotic spots : Arnica, Card. 
Phosphor., Phosph. ac. 

Petechise : Arsen., Bryon., Rhus 
Secale, Stramon. 

Roseola spots: Arsen., Hyosc, Phos- 
phor., Rhus tox., Stramon. 

Miliary Eruptions: Apis, Arsen., Hel- 
led., Phosph. ac, Rhus tox. 

, with anxiety in region of heart: 

Bryon. 

, preceding its outbreak about the 

fourteenth day: Calc card. 

Skin dry and hot: Mur. ac. 

dry or clammy: Phosph. ac. 

bluish: Card. veg. 

relaxed, pale: Phosph. ac. 

waxy, pale: Rhus tox. 

wrinkled: Ver. aid. 

icteroid: Mercur. 

Cadaverous smell, scents the whole at- 
mosphere: Arsen. 



-eg. 



tox. , 



Better from lying: Bryon., Nux vom. 

from moving and changing position: 

Rhus tox. 

Worse in open air: Nux vom. 

after sleep: Laches. 

about and soon after midnight: Ar- 
sen. 

from 4-8 p. M.: Lycop. 



RELAPSING FEVER. 9 19 

After bodily and mental overexertions: I In extreme cases like Carb veg., only 



Co ccul. 

anxiety and worriment of mind: 

Calc. carb. 

For drunkard? : Agar. 

For debilitated persons, old age, or 
children: Arsen, 

For protracted cases : Arsen. 

For psoric individuals : Psorin , Sul- 
phur. 



more rapid: Camphora. 
During" cholera epidemics: Cuprum, Sul- 
phur, Ver. alb. 
At the commencement: Calc. carb., 

Gels em. 
After calomel : Nitr. ac. 
Bryon., Alumina, Mur. ac. 



Relapsing Fever, Typhus Recurreris. 

This fever has been described as early as 1741 by Rutty, by Barker and 
Cheyne from 1816-21, still later by Griesinger, Wunderlich, and many others. 
Epidemics of the same have prevailed at different periods in Ireland, Scot- 
land, England, Germany, Africa, and North America. Some of these epi- 
demics were intermingled with other forms of typhus, were often wide- 
spread, at times preceded or followed by epidemics of intermittent fevers. 
But also single cases have now and then been observed, and in London the 
fever seems to have become stationary. 

If yellow fever is essentially a fever of one paroxysm, the relapsing fever 
consists in the majority of cases of two (seldom more) paroxysms, which 
are separated by an interval of comparative health, lasting from four to seven 
or to fourteen days. This long remission made the second paroxysm appear 
like a relapse of the disease, wherefore the name " relapsing fever " was ap- 
plied to it by English physicians. 

It is highly contagious, occurs epidemically and is predisposed by filth 
and overcrowding. A specific micro-organism, the Spirillum of Obermier 
constantly found in the blood, particularly during the stage of pyrexia, is 
apparently the exciting cause, although it is as yet not definitely known 
how and by which channels it enters the body. 

The Symptoms of typhus recurrens are the following. Mostly in the morn- 
ing or in the middle of the day, less frequently in the evening or night, the 
patient is, in many cases without any premonitory signs, suddenly attacked 
with high fever, which may or may not be preceded by chilliness or a severe 
chill. The temperature rises rapidly to 102. 2 ° F. in the morning, and to 
107 F. in the evening, in a few days to 105.8 ° F. in the morning, and to 
104. 6° F. in the evening. The pulse amounts to 108 or 112 in the morning, 
and to 120 and over in the evening. In spite of this high temperature the 
skin is usually moist. At the same time the patient experiences severe head- 
ache, and severe pain in the limbs, joints and loins; in fact, all the muscles 
of the bod}^ are the seat of severe pain, especially the calves; there is dizzi- 
ness, congestion towards the face, sensitiveness to light and noise, restless- 
ness and sleeplessness at night, loss of appetite, bad taste in the mouth, 
thickly coated tongue, later dry, nausea, vomiting and intestinal catarrh. 
On the second day already the patient complains of heaviness in the upper 



920 RELAPSING FEVER. 

part of the abdomen, and of pain in the left hypochondrium; the spleen be- 
gins to swell and rapidly increases in size, and so does the liver. There ap- 
pears at times a miliary rash and herpes facialis, which latter are never ob- 
served in typhus fever. Bleeding at the nose is rare, and delirium is not a 
frequent symptom. But the loss of strength is rapid, and emaciation goes on 
progressively. Thus the disease increases all the while for five, six or seven 
days, producing sometimes at the very height a deadly paleness of the face 
and lips, when all at once, with the appearance of a profuse sweat, a remission 
sets in, that is truly astonishing. The pulse sinks within a few hours, in many 
cases within two or three days, to 88, 60 or still lower per minute, and the 
temperature decreases some five, six, even seven degrees in the same time. 
With this remission of the fever, also all the other symptoms above described 
cease, and the patient although still very weak, feels comparatively well. In 
some cases, however, where the remission does not take place so suddenly or so 
completely, the patient experiences even during this apyrexia severe pains in 
the limbs, and now and then some febrile aggravations. Yet, nevertheless^ 
the whole process looks to any one unacquainted with the character of the 
disease entirely as a state of convalescence. This interval of freedom from 
fever lasts for about four, seven or fourteen days, when the relapse begins 
unexpectedly, sometimes in the forenoon, or afternoon, but most generally at 
night. This new paroxysm is quite similar to the first. After a chill or 
mere chilliness, or neither, the temperature rapidly rises again to 102. 4 F. 
and over, and the pulse to a frequency of from 112 to 120 or more. With 
this rise, all the other symptoms set in again; feeling of great malaise, vomit- 
ing, violent pain in the head and limbs, swelling of the spleen, etc. This 
second attack is usually somewhat milder than the first, lasts, in favorable 
cases from two to four days, when again a sudden cessation of the fever and 
of all the other symptoms takes place, which leads either to complete con- 
valescence or is followed, though only in exceptional cases, after the lapse 
of several days by a third, or even a fourth, much milder attack. Recovery, 
even in favorable cases, is generally slow; it takes a great while before the 
patient recuperates the lost strength, and he experiences often for a long 
time severe pain in the limbs, while in other cases it is followed by various 
ailments. 

Not all cases, however, take so favorable a course, especially if they 
take the form of a bilious typhoid or typhus biliosus, which by some authors 
is considered as a distinct disease. In severe cases the second paroxysm does 
not terminate in sweat, may be not even the first one, but the symptoms keep 
on increasing until they assume the character of the gravest form of typhus. 
There is great prostration, stupor, delirium, hardness of hearing, dry, brown 
tongue, involuntary discharges from the bowels, sometimes continual vomit- 
ing, jaundice, coma, convulsions and death. In other cases death takes 
place unexpectedly during a short apyrexia by a sudden collapse with vomit- 
ing. In some epidemics the remission is very inconsiderable, and the second 
paroxysm appears almost as a continuation of the first; or there is indeed 



RELAPSING FEVER. 921 

no remission at all, but a continuous fever lasting from three to four weeks. 
Or, instead of the first paroxysm being the stronger and longer, it happens 
that the second is by far the more severe. Often there has been found at the 
height of the paroxysm, when the sweat appeared, a sudden eruption of mil- 
iaria; also, especially when petechial typhus was prevalent at the same 
time, roseola eruptions and a spotted appearance of the skin. Quite unlike 
other forms of typhus, febris recurrens frequently produces herpes facialis. 
Icterus has frequently been seen in some epidemic, in others less frequently, 
and in still others none at all. The liver now and then shows a moderate 
swelling and some sensitiveness. Peculiar is the great hunger in some cases, 
which the patient experiences during the height of the disease, and in other 
cases the continual vomiting of grass-green fluid, or the copious bilious diar- 
rhoea. Dysentery has been observed in a great many cases either as a com- 
plication or a sequela of the disease. The second paroxysm is now and then 
attended with urinary difficulties, even cessation of the urinary secretion. 

There are also haemorrhages to be noticed, which may take place from 
the nose either at the commencement or at the end of the first paroxysm; or 
from the mouth, stomach, intestines, bladder, or beneath the epidermis as pe- 
techial effusions, in very severe cases which are generally complicated with 
a high degree of icterus. Decubitus, gangrene, parotitis, erysipelas are only 
occasional occurrences. An attack during pregnancy frequently causes 
abortus, which, however, has only seldom proved fatal. 

As Sequee^E have been mentioned: abscesses, furuncles, parotitis and 
laryngeal affections; anaemia; palpitation of the heart; pain in the limbs; 
oedema; frvdrops and albuminuria; tuberculosis; diabetes; paraplegia; loss 
of speech; amaurosis; mental derangements. 

Diagnosis. — The distinguishing feature of febris recurrens in the first 
week is the extreme high temperature of the body and great frequency of the 
pulse, which, however, show marked daily remissions in the morning, a tem- 
perature which cannot be explained in the total absence of any local affec- 
tion. There is in short no corresponding relation between the intensity of the 
fever and the intensity of the attending symptoms. 

Abdominal typhus scarcely ever, except in the worse cases, attains in the 
first week such a height of temperature; scarcely ever takes such a rapid 
beginning; and never shows such a rapid remission of fever. 

Petechial typhus shows mostly about the sixth day the roseola-exanthema, 
and never such a sudden remission of fever about the end of the first week. 

The Prognosis differs essentially in different epidemics; some are 
severer than others. It is stated that the mortality in febris recurrens 
amounts from three to four per cent. , scarcely ever to six or eight. The 
fatal issue takes place mostly in the second, but frequently also at the height 
of the first paroxysm by a rapid collapse. Other patients die with uraemic 
symptoms, sudden convulsions, coma and collapse, and still others lie for 
several days in a profuse perspiration, which is followed by collapse. 



922 influenza, la grippe. 

Therapeutic Hints. 

There are mentioned: Arg. nitr., Arsen., Bryon., China, Enpat. perf., 
Nux vom. Compare Typhoid and Intermittent Fever, Influenza, Parotitis, 
Diphtheria, Pertussis, C. — S. Meningitis, Acute Tuberculosis, Anthrax, 
Hydrophobia, Tetanus and Cholera. 

Influenza, La Grippe. 

Influenza is an acute infectious epidemic disease, characterized by a series 
of catarrhal manifestations affecting the respiratory and frequently the diges- 
tive tract; attended by prostration, pains in the bones and limbs, severe nerv- 
ous symptoms, and fever. It attacks all persons without distinction of age, 
sex or occupation. 

The exciting cause is probably a specific micro-organism, perhaps the 
baccillus recently described by Pfeiffer. 

It usually commences with a chill or chilliness followed by fever of a 
remittent character, anorexia, headache, apathy and prostration, and may be 
divided into three forms, the Catarrhal, Gastric and Nervous, depending upon 
the organs which receive the brunt of the attack. 

Complications are frequent and apt to be severe, Pneumonia, Pleurisy, 
Phthisis, Bronchitis, Gastritis, Neuralgia, Meningitis, Melancholia and 
Acute Mania all having been observed. It spreads rapidly in its local diffu- 
sion, advances comparatively slowly on a grand scale over countries and seas 
without being essentially influenced by human intercourse or the direction of 
the wind; in other cases it remains limited to narrow circuits, while at still 
other times it appears simultaneously at different points of the earth's surface 
or attacks districts far removed from one another with inexplicable leaps. 

Its Diagnostic difference from a common epidemic catarrh lies in its 
marked march of progression and its independence of weather and season, 
while from a commencing typhoid fever it differs by its persistent elevation 
of temperature and the absence of enlargement of the spleen and rose spots, 
the moderately frequent pulse, etc. It is not a very fatal disease; but as it 
modifies and complicates all other existing diseases, it is especially hard on 
the weak and also on the aged. 

Therapeutic Hints. 

An epidemic is usually manageable b\ T one or a few remedies, but differ- 
ent epidemics require different remedies, as the genius of their combination 
is an ever-changing one. To detect the specifics for a prevalent grippe, a 
comparison of the hints given above under catarrh may bt of help; the fol- 
lowing are additional hints. 

Aeon. Dry cough and stitches in chest. 

Arsen. Cough and all symptoms worse after midnight; great thirst; 
great restlessness and great debility. 

Bellad, Cerebral symptoms; drowsiness; starting in sleep; delirium 



PAROTITIS. . 923 

when shutting the eyes; wants to sleep and cannot sleep. Severe headache; 
dryness in mouth and throat; spasmodic cough. 

Bryon. Pain in all the limbs, worse from motion; cough with pain in 
pit of stomach, around the short ribs and in chest; affection of liver. 

Eupat. per/'. Severe backache, or bone-pains, with bilious symptoms. 

Gclsem. Feels ' ' played out, ' ' feverishness, catarrhal running from nose, 
collection of mucus in throat; pain in throat up to ear when swallowing; 
cough. 

Laches. Feels worse after sleep; fever worse in the afternoon; sweat 
without relief. 

Mercur. Rheumatic pains not relieved by sweat; flabby tongue, with 
imprints of teeth; diarrhoea; boiling heat from pit of stomach over the 
entire body. 

Nitx vom. Fever-heat with chilliness by slightest motion; dull, heavy 
headache; vertigo; hard cough; sour taste; nausea and vomiting; belching; 
pain in chest; constipation. 

Phosphor. Bronchial affection with dry cough, tightness of chest, worse 
before midnight; great debilit}^. 

Pulsat. Evening aggravation; loss of appetite; bitter taste; diarrhoea; 
chilliness. 

Rhus tox. Great aching in all the limbs, worse in rest; great restless- 
ness; red tip of tongue; typhoid symptoms. 

Sabad. L,achrymation in open air, when looking at a bright light, when 
coughing or yawning. Sleepy in daytime; chilliness, with heat of face; 
cough on lying down. 

Sanguin. Smell in nose like roasted onion; wheezing- whistling cough 
and finally diarrhoea, which relieves the cough. 

Tart. emet. Shaking ; loose cough, with oppressed breathing, which is 
relieved by expectorating; gastric symptoms. 

Parotitis, Mumps. 

1. Its idiopathic form is known under the name of Epidemic Parotitis. 
It frequently appears epidemically, and is contagious. Children from two 
to fifteen years of age are most prevalently affected, while nurslings and old 
people are exempt. One attack protects against re-infection. The distinct 
character of the Parotitis virus is as yet unknown. There can be no doubt 
that Mumps is due to systematic infection; it is not a merely local disease. 

Its onset may not be marked by any precursory symptoms; sometimes it 
is preceded by pains in the limbs, headache, loss of appetite, chilliness and 
feverishness towards evening; sometimes by vomiting and diarrhoea, great 
anxiety, fainting, even convulsions. Its period of incubation is estimated 
from about six to eight or ten days. The inflammation of the gland mani- 
fests itself by pain in the region where the affected gland is situated, espe- 
cially when opening the mouth, and a swelling below the lobe of the ear — 
almost always only on one side, — which rapidly increases, and gives to the 



924 THERAPEUTIC HINTS TO PAROTITIS. 

face an odd look. This swelling is of a doughy feel and never sharply cir- 
cumscribed; it is caused by enlargement of the gland itself, and still more by 
an cedematous infiltration of the adjacent connective tissue, and may, indeed, 
attain to such an enormity that the movements of expression of the face be- 
come entirely suspended, giving to the patient an idiotic appearance. It also 
extends to the tonsils, the pharynx, and may invade even the larynx, when 
corresponding symptoms will develop. The skin over the swelling is either 
pale, waxy, glistening or somewhat reddened, or of a purplish hue. 

Besides stiffness, pain and incapability of all movements which talking, 
chewing, and swallowing would require, the patients are sometimes troubled 
with hardness of hearing, pain in the ear, salivation or great dryness in the 
mouth, loss of appetite, vomiting, constipation and even with symptoms of 
cerebral hyperaemia, the result of pressure upon the veins in the neck. 

As a rule only one parotid is thus attacked; sometimes, however, the 
inflammation goes from one side to the other successively, and this lengthens 
the course of the disease for a few days; a simultaneous attack of both glands 
has not been observed. 

The elevation of temperature and increased rapidity of the pulse, in 
most epidemics, is of no great amount; by the fourth or fifth day usually all 
fever has left; in some cases, however, a rise of temperature in the evening 
to 104 F. for several days, has been observed. 

In most cases the local and general symptoms have culminated in from 
three to six days, when they gradually subside in about the same length of 
time, so that the entire morbid process is completed in from one to two weeks. 

At times, however, we meet with complications in pubescent youths and 
men, consisting of an inflammation of one testicle, most commonly that of 
the right side, or of both sides successively, in the same manner as a bilateral 
parotitis. It does not set in until the parotideal inflammation has ceased, 
and is attended with a renewal of the fever. In some cases there is an 
epididymitis combined with an acute hydrocele and oedema of the subcuta- 
neous connective tissue of the scrotum; in severe cases there is also a gonor- 
rhoea-like discharge from the urethra and burning pain during micturition. 
Patients suffering with gonorrhoea, on the contrary, are according to Blondeau, 
not at all disposed to orchitis, and the mumps generally pursues its course 
free from all complications. 

In the female sex a metastatic swelling of the mammae or the external 
genitals, of the ovaries or of the inguinal glands, has been observed, while 
in still other cases the conjunctiva and mucous membrane of the throat, 
urethra and vulva have become involved. Some cases terminate in gangre- 
nous destruction of the gland from unknown causes. 

Therapeutic Hixts. 

Dellad. Bright red swelling, especially on right side; fever and brain 
symptoms. 

Mcrcur. Pale swelling, little fever; often indicated. 



DIPHTHERIA. 925 

Rhus tox. Dark red swelling, especially on left side, or going from left 
to right; restlessness and fever. 

Euph. off. If Rhus tox. should not help, also dark red color, with burn- 
ing and stinging pain. 

Card. veg. If Mercur. should not be sufficient or should have been 
abused; lingering fever; also when there are hoarseness or metastatic symp- 
toms of the stomach. 

Coccul. If Card. veg. should not relieve the lingering fever. 

Arsen., Aurum., Card, veg., Nux vom., Pulsat., in metastasis to 
testicles. 

Arnica. Testicles inflamed; great tenderness; loose stools during day; 
complains of hardness of bed on which he lies. 

Apis, Laches. , Pulsat. , Sulphur, metastasis to female organs. 

2. The secondary form of parotitis, called Deuteropathic or Metastatic 
parotitis, is most frequently associated with typhus in all its forms, with 
scarlet fever, measles, and small-pox; with pyaemia, puerperal fever, dysen- 
tery, typhoid cholera, and in the tropics, with yellow fever. 

The swelling of a metastatic parotitis is much harder and more defined, 
and also more prone to suppuration than that of mumps. In fact, absorption 
occurs only rarely in metastatic parotitis; it goes on to suppuration or even 
to mortification, if the patient lives long enough. If it breaks in time and 
discharges fully, cicatrization by granulation may follow; or new absceses 
in other parts of the gland may form and fistulous openings be the result; 
or the walls of the abscess may be transformed into an ichorous cavity and 
finally become gangrenescent, involving by degrees adjacent parts by further 
infiltration and gangrene. In the latter case the discharge assumes a cadav- 
erous odor and consists of gangrenous shreds; the external skin darkens and 
becomes black. 

Its Prognosis depends much upon the nature of the disease which it 
attends. As a rule it may be stated, " that it is the more unfavorable and 
dangerous the earlier it appears in connection with t}^phus, scarlatina, etc. , 
while its course is mostly favorable when it occurs during convalescence from 
these infectious diseases. ' ' 

Therapeutic Hints. 

When suppurating: Arsen., Hepar, Phosphor., Silic. 

When fistulous openings have formed: Lycop., Nitr. ac, Phytol. 

When indurated: Bar. mur., Calc. carb., Card, veg., Clemat., Conium, 
lodium, Kali card., Lycop., Silic, Sulphur. 

When gangrenous: Arsen., Kreos., Laches. 

After scarlet fever: Arsen., Bar. mur., China, Kali carb., Laches., 
Lycop., Nitr. ac, Rhus tox., Silic. 

Diphtheria, Diphtheritis. 

Diphtheria is an acute infectious disease, highly contagious, and charac- 
terized by the formation of a grayish white exudate most frequently in the 



926 DIPHTHERIA. 

throat, accompanied by fever and prostration. It is often epidemic and may 
also be found endemic and sporadic. 

The exciting cause is generally believed to be the Klebs-Loemer bacillus 
(bacillus diphtherice) although eminent authorities are not wanting to deny it. 
There is no doubt that the bacillus is innocuous when coming in contact with 
healthy or uninjured mucous membrances, but having once found a favorable 
soil the diphtheritic process is soon established and with the development of 
the ptomaines constitutional symptoms set in. 

Diphtheria may localize itself in different parts of the body. 

i. In the throat, at times spreading to to the upper pharyngeal and 
nasal cavities, into the Eustachian tubes and lachrymal ducts. It produces a 
fibrinous exudation which first appears on one of the tonsils, seldom simulta- 
neously on both, in the form of roundish, dead white-patches of various sizes, 
at the beginning closely adherent to the underlying mucous membrane and 
detachable, for the most part, only at the expense of a haemorrhage. As 
they grow, they cover larger and larger areas, finally enveloping the tonsils, 
uvula, and the walls of the pharyngeal cavity in one sheet of false membrane. 
This membrane, after a continuance of several days, becomes gray, even 
blackish, and less adherent to the subjacent tissue ; it consists of fibrinous 
exudation, the interspaces of which contain serum, or blood or pus corpuscles. 

After several days continuance the false membrane loosens by means of 
infiltration with serum or pus corpuscles, and a continual growth of new 
epithelium. The mucous membrane underneath is hyperaemic, sometimes 
dotted with numerous haemorrhages, for the most part considerably infiltra- 
ted with serum and sometimes with sero-pus. In septic cases the false mem- 
brane undergoes a rapid disintegration, and proportionally with its decompo- 
sition and putrefaction, large quantities of different varieties of bacteria 
appear besides the bacillus. The membrane assumes a dark brown color, 
and is infiltrated in broad streaks by blood corpuscles from frequent capillary 
haemorrhages. An extension into the nose is characterized by a thin, puru- 
lent, greenish discharge, which excoriates the contiguous parts to the exter- 
nal nose. 

2. In the larynx, trachea and bronchi. This forms a chief danger of 
diphtheria, and resembles in all its symptoms true croup. In a series of cases 
it sets in with the pharyngeal affection at the same time, in others it follows 
soon after, or develops not before three or four days, or even a week later. 
It occurs oftener in children than in adults, and much more frequently in 
severe than in mild cases. Its characteristic signs are' the long-drawn res- 
piration, frequent, dry coughs, toneless, hoarse voice, great restlessness, and 
pain in the throat. 

3. In the kidneys, causing an inflammation of their parenchyma, with 
haemorrhages. (Parenchymatous nephritis. ) At the bedside it manifests 
itself as albuminuria, which, when found in the beginning, is said to denote 
unusual severity of the attack. In fact its intensity is thought by some 
writers proportionate to the severity of the disease, which others deny. In 



DIPHTHERIA. 927 

light cases it scarcely ever occurs ; in severe cases it is found in one-half their 
number ; it set in sometimes not until several days, sometimes not until 
towards the termination of the disease, and is, as regards the quantity of 
albumen discharged, very irregular, sometimes even intermitting for days. 
(Wagner. ) 

4. In the heart, especially in long-continued and severe cases, which 
are apt to terminate suddenly in death by paralysis of the heart. On post- 
mortem examination the muscles of the heart appear pale, soft, friable, fatty 
degenerated. 

5. In the stomach, either by direct poisoning from swallowing the diph- 
theritic masses, or by an extension of the affection through the oesophagus 
into the stomach. It causes here, as it does in the fauces, inflammation of 
the mucous membrane, exudation of fibrin, formation of ulcers and sloughs, 
and haemorrhage. 

6. In the brain and in the spinal cord. Post-mortem examinations 
have shown venous hyperaeniia in the vascular linings and substance of the 
brain and spinal cord, also capillary haemorrhages of various sizes scattered 
over different portions of these organs, with consequent softening of the sur- 
rounding substance. Buhl found in one case the spinal nerves of both sides, 
at the point of junction of their anterior and posterior roots, almost double in 
their thickness, and dark red on account of extravasation of blood, and in 
part 3^ellow and softened. 

The period of Incubation occupies, according to a number of well- 
attested observations, from two to four or five days, and may be still longer. 

Diphtheria is not in all cases of a like nature; we meet mild, severe and 
septic forms of this disease. 

Its mild forms, which, by some, are designated as Catarrhal diphtheria, 
usually commence with fever and soreness in the throat. The temperature 
may rise from 101 to 105 F. in the first days, showing always evening ex- 
acerbations with a corresponding acceleration of the pulse from 120 to 140. 
From the fourth or sixth day the temperature gradually declines. The 
fauces look at the beginning onty inflamed but .show in a short time the char- 
acteristic patches first on one tonsil, and then on the other, extending also 
in some cases upon the contiguous portions of the palatine arches, and in 
some upon the lateral portions of the uvula. With this we find the lym- 
phatic glands of the jaw, regularly somewhat swollen, a distinctive feature 
of diphtheria from a mere catarrhal inflammation of the throat. The fever is, 
in most instances, attended with more or less, sometimes excessive, languor 
and debility from the outset, with headache, pain in the back, also at times 
with gastric symptoms, seldom vomiting. The disease ma3^ not reach a higher 
degree, but terminate in from five to fourteen days in recovery ; but there 
may take place from about the fourth to the sixth day, a sudden rise of fever, 
with a rapid spread of the false membrane in the fauces, when the disease has 
assumed one of 

Its severer forms, which some writers have designated as Croupous diph- 



928 DIPHTHERIA. 

theria. In some cases this grave character shows from the beginning, by the 
greater intensity of the symptoms above described. The false membrane 
rapidly gains in thickness and extent, spreading either upward through the 
pharynx into the nasal cavities, affecting the Eustachian tubes or the lachry- 
mal ducts, or even the conjunctivae, or downwards into the larynx, trachea, 
bronchi, or through the oesophagus into the stomach. Its color gradually 
turns to a dark brown or even blackish hue, in consequece of haemorrhage 
underneath and decomposition of its substance with a corresponding terrible 
stench. The cervical and submaxillary glands swell to a still greater extent ; 
the urine becomes scanty, dark colored and rich in salts and shows in at least 
one-half, if not in more cases, signs of albuminuria in different degrees, 
often, though not always, nearly proportionate to the intensity of the disease. 
If the morbid process descends to the stomach, its functions become dis- 
turbed, there is loss of appetite, nausea, at times vomiting, and oftener con- 
stipation than diarrhoea. The affection of the heart ordinarily does not 
become apparent until at a later period, when there is not a trace left of diph- 
theritic appearance in the throat. But the patient remains weak, pale, 
without appetite, has frequent nausea and vomits all he eats. This symptom, 
whether it is derived directly from a diphtheritic condition of the stomach or 
by a mere reflex action from the brain, is, as far as my experience goes, 
always a very ominous sign ; the patient usually dies with paralysis of the 
heart. 

The septic or gangrenous forms of diphtheria are especially characterized 
by extensive disorganization of the tissues, by capillary haemorrhages on the 
surface of the mucous membrane and general blood poisoning. One series 
of these malignant cases is developed from the croupous form, while others, 
a less frequent series, begin to be gangrenous from the onset, especially in 
malignant epidemics. Its phases follow each other in quick succession. 
The false membranes form on a livid cedematous mucous membrane, and 
soon undergo ichorous disorganization ; the discharges from the mouth and 
nose become stinking and corroding ; the cervical and submaxillary glands 
swell enormously, and there is oedema of the surrounding connective tissue. 
The face of the patient becomes bloated, pale, wax-like; his pulse small, 
weak, irregular and sometimes remarkably slow; the temperature is occa- 
sionally high, as much as 107^° F., but usually it is diminished. Not 
unfrequently death is preceded for a few minutes by convulsions, or it 
instantly follows the sudden raising of the patient ; sometimes the evidences 
of collapse continue for several days. 

Diphtheria is often found in connection with Scarlatina, when it may set 
in during the prodromal stage, sometimes during the height of the exanthem, 
less frequently after its disappearance, or even not till the end of the second 
week of the disease. It exhibits the same three forms as described above. 
It also has been found secondarily in typhoid fever, pyaemia, puerperal fever, 
erysipelas, whooping-cough, measles, and in chronic diseases, such as : 
tuberculosis of the lungs, extensive pleural exudations, chronic diseases of 



THERAPEUTIC HINTS TO DIPHTHERIA. 929 

the kidneys ^Bright's disease, so-called second and third stages,) chronic 
suppurative inflammations of the joints and chronic diseases of the liver, 
especially in topers. 

As Seouel.E, we must mention especially different forms of paralyses, 
which ma}' occur after any of the forms of diphtheria. "They appear most 
commonly two weeks, sometimes one week, occasionally three or four weeks, 
after the healing of the local process, and in some cases not until after 
convalescence. They most frequently affect the soft palate and consist in 
paralysis of both motion and sensation ; less often they affect the extremities 
in like manner : with or without the paralysis of the soft palate ; sometimes 
they are all affected at the same time, or one after the other ; preferably the 
lower extremities only ; sometimes the sphincters also. Paralysis of the 
muscles of the eyes and of the larynx is more rare. Not unfrequently there 
are analogous conditions of the higher organs, either alone, or at the same 
time with the paralysis mentioned, most frequently of the organs of vision 
(presbyopia, myopia, even total blindness), more rarely of the organs of 
hearing, smell and taste. Sometimes there is impotence. After a continu- 
ance of the paralysis for weeks or for months complete recovery usually 
takes place — death but seldom." (Wagner.) According to the results of 
minute investigations these functional disturbances in the different muscles 
must be attributed partly to morbid alterations in the muscles themselves 
(fatty degeneration), and partly to diseased conditions of the brain and 
spinal cord (see above). 

The Diagnosis of diphtheria is ordinarily not difficult, especially not in 
epidemics. But its mild forms might be mistaken for a catarrhal angina — 
compare the respective chapter — were it not for the general symptoms and 
the peculiar appearance of the diphtheritic exudation, which differs essen- 
tially from a mere secretion of catarrhal angina, forced out of the follicles as 
a yellowish, sticky mass which easily may be wiped off by a brush, or from 
follicular erosions which show a distinct loss of substance at their borders, or 
from aphthae which commence as small vesicles and gradually form ulcers. 
The severer forms can hardly be confounded with other diseases. Simple 
croup has no affections of the glands and kidneys, and scarlatina — even if 
diphtheria should be accompanied, as it happens in rare cases, by a slight 
erythema of the neck and breast — has no formation of false membrane in 
the fauces. 

The Prognosis of diphtheria, generally speaking, under homoeopathic 
treatment, is not bad. Of course, we meet difficult cases, even fatal ones; 
but the percentage of loss is small. Its danger lies principally in the possi- 
bility of its extension to the larynx, and its septic poisoning. 

Therapeutic Hints. 

In looking over the homoeopathic literature on this subject, leaving alone 
the allopathic, one feels almost tempted to exclaim: " I^ord, hold on with 
thy blessings!" as the parson said, when he received the news that a son 
59 



930 THERAPEUTIC HINTS TO DIPHTHERIA. 

had been born to him, and a little while after, a daughter, and still a little 
while later, another son! Nevertheless they all were welcome, and each one 
showed its own individual character, and got its own share of parental love. 

There is no specific remedy for diphtheria nor for any other so-called 
disease. 

Alcohol. Diluted with water, recommended by Von Grauvogl as a 
gargle and applied by some in the form of a spray, has proved to be not the 
homoeopathic remedy, but a most beneficial adjuvant in the treatment of 
diphtheria, because of its antiseptic properties, its stimulating effects upon 
the system, and its non-interference with the homoepathic remedy given at 
the time. Instead of alcohol, brand}', whisky or rum may be used. 

Acids. Especially organic acids, have proved themselves in various de- 
grees capable of dissolving the diphtheritic membrane. 

Acet. ac. Has not been given, to my knowledge, in diphtheria; but 
it has been found by Dr. Krebs, in Hamburg, Pa., very effective in croup. I 
can confirm his observations, especially when there is a bright redness of the 
face attending it. 

Carb. ac. Has been the sheet-anchor of Dr. Davidson, though it has 
by no means proved a universal remedy for diphtheria. Its indications are: 
low fever with great prostration, weak pulse and paleness of face ; absence of 
severe inflammation and pain in the throat, but abundant formation of false 
membranes, with great danger of septic poisoning and great foetor oris. 

City. ac. Is recommended by Buchner, and thought better than 

Lact. ac. This latter has many throat symptoms, e.g., dryness and 
constriction similar to Laches.; difficulty of swallowing solids, etc. 

Mur. ac. Has proved curative when there were: bleeding from the 
nose, the blood dark and putrid; sordes on the teeth; sore and scabby con- 
dition of the lips; putrid smell from the mouth; great general prostration; 
typhoid condition. 

Nitr. ac. Ulcers in the mouth; great pain on swallowing; excessive 
salivation; stoppage of nose; corroding discharge from the nose; foetor oris; 
fauces and glands swollen; great uneasiness; high fever; intermitting pulse. 
After overdosing with mercury; syphilitic taint. 

Salicyl. ac. When there is little or no fever, but great weakness, diffi- 
cult deglutition, much inflammation, and the exudate soft. First centesimal 
dilution, a few drops in a half glass of water, one teaspoonful every half 
hour or hour, and the same as a gargle. (Oehme.) 

Sulph. ac. Oehme gives the following resume: tonsils bright red and 
swollen; exudate thick, grayish, or yellowish-white, sticky, tenacious; lemon 
colored strings of mucus from posterior nares down to fauces; swallowing 
very difficult, liquids run out of the nose; swallowing almost impossible; 
breathing difficult on account of the accumulation of the exudate; speech 
thick, indistinct, very difficult; violent salivation; excessive foetor oris; 
pulse frequently small, weak; apathy; somnolence. Excessive paleness and 
weakness. 



THERAPEUTIC HINTS TO DIPHTHERIA. 93 1 

Aeon. '' At the beginning or in any stage when first called in until 
perspiration breaks out, and repeating only when perspiration ceases and the 
skin becomes dry and hot. Keep up sweating till convalescence sets in, aid- 
ing this process by the application of woolen clothes around the neck. Give 
cold water ad libitum, but no food, stimulants, tea or coffee." (Dr. Aaron 
Walker. ) 

Ailanth. Especially in scarlatinal diphtheria with livid and swollen 
throat, and tonsils studded with numerous deep, angry-looking ulcerations. 

Amm. carb. Obstruction of the nose; the moment he falls asleep he 
is aroused b}^ the want of breath. 

Amm. canst. Fifteen drops to a glass of water, cured a case with croup- 
ous cough, which threatened suffocation every moment. The lower part of 
the pharynx covered with a white exudate, extending down as far as could 
be seen. Patient in the greatest agony, frequently jumping out of bed and 
gasping for breath. (Spranger. ) Single observation. 

Apis met. Great debility from the beginning; puffiness around the 
eyes and cedematous swelling of face and neck; bright red color, and puffy, 
glossy and varnished appearance of fauces; uvula cedematous; stinging, 
burning pain in throat and dryness; pain in the ears when swallowing; dif- 
ficult swallowing on account of irritation of the epiglottis; sensation as of a 
rapid swelling of the lining membrane of the air-passages; hoarse cough; 
intense sensation of suffocation, could bear nothing about the throat; labored 
inspiration as in croup; headache; painful, or suppressed micturition; albu- 
minous urine; pain in shoulders and neck; darting, cutting, in periodical 
spells; itchy, stinging eruption on the skin; sensation of weakness in the 
larnyx; weakness of feet and hands, even paralysis; marked prostration 
and depression; nervous restlessness; high fever; quick pulse; skin perspires 
and dries up in starts. Combination with scarlatina. 

Arnica helps us in two conditions: i. Where we meet rapid decline of 
strength, small and rapid pulse after a too rapid course of the inflammatory 
fever (but the presence of Bright' s disease may cause Arsen. to be preferable). 
2. After the infiltration had run its course, with tendency to necrotic ichor- 
rhaemia, in lymphatic persons subject to torpidity, with noisy deglutition, 
great debility, adynamia, excessive depression, and deep-seated co-affection of 
the whole nervous system and the brain, in short, absence of all erethismus 
after expulsions of the exudations. Physiological symptoms are: General 
loss of strength; heaviness and paresis of the right side, in contradistinction 
to Lackesis, and of the shoulder; foul breath; burning in the throat, with 
anguish from internal heat; stitching posteriorly, as if some hard substance 
were in the pharynx; noisy and difficult deglutition, prevented by a kind of 
vomiturition, as if the flood could not pass downwards. (Buchner.) 

Arsen. In the latter stages of the disease when there are: Great rest- 
lessness, wants to change bed or room frequently; constant desire for cold 
drink, but taking little at a time, or better from drinking hot water; all 
symptoms worse after midnight. Albuminuria; paralysis of lower extremities. 



932 THERAPEUTIC HINTS TO DIPHTHERIA. 

Ars.jod. Cured a case with asthmatic and croupy symptoms; hoarse 
cough; diphtheritic deposit covering mouth from fauces to outer lips, also 
external auditory canal; pulse weak and slow; great prostration; bad odor 
from patient. (F. Bigelow.) 

Arum, triph. Burning in the throat; constant inclination to clear 
the throat of collections of mucus which increases the burning and rawness; 
haemorrhage from nose (M. Preston); the discharges from the nose and 
mouth are very acrid, and excoriate the skin wherever they come in contact 
with it; the lips are sore and swollen, and the skin peels off; the patient 
continually picks at his lips and nose, making them bleed; nose stopped up, 
necessitating to breathe with mouth open. Drink is refused on account of 
the great soreness of the mouth; the breath is very fetid, and the cavity of 
the mouth covered with diphtheritic deposits and ulcers; great restlessness, 
the patient crying and throwing himself about into all sorts of positions. 
(Lippe.) 

Baptis. Characterized by absence of pain, although the fauces and 
posterior nares are cedematously swollen with constant inclination to swallow. 
Stupefaction and drowsiness; mind wandering; low muttering. Oppressed 
breathing unto suffocation on account of pulmonary congestion. Rising in 
bed does not relieve; the patient must go to the window for fresh air. Stools 
dark and blood-streaked. 

Bellad. In sudden attacks with fear of choking to death; great dry- 
ness and redness of the throat and great pain on swallowing. External 
swelling of the neck. High fever; great drowsiness with inability to fall 
asleep; starting in sleep. Suitable only at the beginning. 

Bromium. Ozanan's favorite remedy. Is indicated by a hoarse, croupy 
cough with rattling in the larynx. 

Bryon. The patient is quickly prostrated, shuns all motion, and com- 
plains, on moving or when being moved, of pain everywhere; white tongue; 
feeling of dryness in the mouth without thirst, or else desire for large quanti- 
ties of water. Only in the beginning, " when the disease commences, or early 
presents an exanthema, or ulceration, upon the border or anterior surface of 
the lower lip." (R. R. Gregg.) # 

Calc. chlor. Recommended and used by Dr. C. Neidhard. 
Canthar. Burning and scraping in the throat with bloody expectora- 
tion; too copious, or scanty and difficult urination; the urine contains casts 
of the uriniferous tubuli; also albumen; extreme prostration; sinking, death- 
like turns; irritable rash upon the skin or showing through the epidermis. 

Gelsem. Local tingling of parts during the fever; incipient paralysis 
or anaesthesia; defective or impaired vision; objects appear a long way off, 
are seen double or inverted. 

Ignat. The honor of having first introduced this remedy for the treat- 
ment of diphtheria belongs to Dr. Boskowitz, of Brooklyn. I have given it 
for several years with the most marked effects, and so have several of my 
colleagues to whom I have recommended it. During an epidemic in Lehigh 



THERAPEUTIC HINTS TO DIPHTHERIA. 933 

county. Pa., Dr. Wm. C. J. Slough did not lose a single case after he com- 
menced using Ignat., 200th trit. , persistently, a teaspoonful every hour or 
two, in spite of delirium, haemorrhage or other untoward symptoms. That 
epidemic was characterized by the following symptoms: "green vomiting; 
putrid throat, seldom painful (^the painful cases were less likely to prove 
fatal); greenish^ellow patches; delirium; headache; green stools; suppres- 
sion of urine; sometimes chilliness; sometimes high fever." I must confess 
I have not yet found any particular indications for this remedy; it acted well 
in all cases. Whether this be attributable to the genius epidemicus in this 
region of the globe is possible. If so, it will lose its efficiency when that 
changes. But there is no doubt that the provings of this drug present 
numerous hints for its application. 

Iodium. Probably useful like Bromium in affections of the larynx. 

Kali bichr. The discharge from the nose is tough and stringy; pain in 
left ear on swallowing; swelling of the parotid glands; croupy cough; measle- 
like eruption; red, raw shining tongue; or also covered with a thick yellow 
coating; deep-seated ulceration in the fauces; mucus streaked with blood; 
fetor from mouth; all symptoms worse after sleep. 

Kali mur. Sufficient in most cases; but when soft parts of the fauces 
are much swollen; Calc. sulph. (Schiissler.) 

Kali perma?ig. "Swelling within and without; oedema of the soft 
palate and uvula; thin, sanious, nasal discharge; excoriating upper lip; 
horrible offensive odor. Black gangrenous exudate; great prostration." 
Ivins {Diseases of the Nose and Throat.) Recommended in watery solution, 
every hour or less. 

Kali phosph. In malignant cases; offensive odor. (Schiissler.) 

Kreos. In malignant cases confined to the fauces with terrible foetor 
oris. 

Lac. can. The following proving by Dr. H. W. Taylor, is very sug- 
gestive: "Rolled and tossed about all night; could not sleep on account of 
uncontrollable feeling of restlessness; necessity to turn and shift about con- 
stantly. Palms of hands and soles of feet abnormally hot; sighing frequently; 
utter inability to lie half a minute in one position. Throat feels dry, husky, 
as if scalded by hot fluid. Dark red, angry streaks of capillaries in the 
fauces; the whole fauces dark red and tumin; round gray spot where the 
redness first began. Viscidity of saliva." Dr. Reissig, of New York, first 
used this remedy without divulging it. Dr. Dunham drew the secret from 
him, and since then Dr. Swan and several other physicians of good repute 
have published very severe cases cured by it. I consider the above proving 
as furnishing the best indications for its application. Dr. C. Iyippe gives the 
following characteristic indications: "The ulcers go from one side to the 
other and back again; the ulceration has a glistening, shining appearance 
{Apis); the swelling of the glands changes sides and is painfnl to the touch, 
and the nasal discharge excoriates the nostrils and upper lip {Arum- triph.). 
These characteristic ulcers, shining and glistening, may be found in any part 
of the body." If Laches, fails. 



934 THERAPEUTIC HINTS TO DIPHTHERIA. 

Laches. When the membrane develops first on the left and then on 
the right side; when there is more subjective suffering than the objective signs 
would warrant to suppose; when all the symptoms are worse after sleep. 
Livid, dark red hue of the swollen parts; fetid breath; tenderness of neck to 
slightest touch; sense of suffocation from anything pressing on throat and 
neck; external swelling of neck. Tendency towards the larynx with croupy 
cough and intolerance of any external pressure on the throat; badly smell- 
ing stools, even if formed; dark, scanty urine of strong odor; albuminous 
urine; purplish eruption on the body; delirium, with changes rapidly from 
one subject to another; somnolency; hard aching all over, which makes the 
patient constantly change his position. 

Lycop. The color of the fauces is of a brownish redness, the exudate 
commences on the right side and the pain is worse from swallowing warm 
drinks," or "worse from cold food or drinks, and better from warm food or 
drinks." (R. R. Gregg.) The nose is stopped up, and the patient cannot 
breathe with his mouth shut; he keeps his mouth constantly open, slightly 
projecting his tongue, which gives him a silly expression; the nostrils are 
spasmodically dilated with every inspiration; on awakening out of a short 
nap, he is very cross, kicks and behaves naught}', or jumps up in bed, stares 
about and knows nobody, seemingly dreaming with open eyes; frequent jerk- 
ing of the lower limbs, mostly with a groan, awake or slumbering; great fear 
of being left alone; cannot bear to be covered. All symptoms worse after 4 
o'clock, P. M. 

Merc. cyan. This remedy was first recommended by Dr. Beck to Von 
Villers in a hopeless case of diphtheria, because of its having produced in 
five persons poisoned with this drug, gangrene of the velum palatinum and 
fauces. It proved successful. Ever since Dr. Von Villers has used it in 
several epidemics under different latitudes with uniform success; higher 
dilutions operated better than lower. He began with the 6th and arrived at 
the 30th cent. Several physicians who never saw any result from it, gave 
the 2d or 3d trit. or dil. When an epidemic of diphtheritis prevails, he ad- 
ministers it in every case of inflammation of throat. Lately {Allgemeine 
Horn. Ztg., Vol. 99, p. 43, 1879) Dr. Grubenmann in St. Gallen confirms Dr. 
Von. Villers' observations by stating that in a late epidemic, he cured with 
this remedy in its 15th to 30th cent. dil. 50 cases, excluding all the light ca- 
tarrhal forms at that time, without ever seeing the disease spreading to the 
larynx or showing any paralytic sequelae. It has also cured cases where the 
disease had already invaded the larynx. Von Villers' indications are: "The 
presence of an exudate, which may be white, yellow, gray, or of any shade 
between. Adynamic fever and collapse already in the commencement. Fre- 
quentfy the exudate is in places where it cannot be seen." "Often indicated 
after Apis., when the exudate invades th'e nose, and there is excessive, 
debilitating perspiration even from slightest motion." T. F. Allen. 

Merc. bin. Left tonsil affected; velum elongated; gums and tongue 
more or less swollen and sensitive; constant collection of saliva and mucus in 



THERAPEUTIC HINTS TO DIPHTHERIA. 935 

the mouth necesitates swallowing; swallowing of fluids or solids is painful. 

Merc. prot. Worse on right side ; tongue coated thick on back part, of 
a buff-yellow color; worse from warm drinks. 

Naja trip. Suffocating spells on lying down, particularly when in bed; 
must be taken up and held erect in order to procure easy respiration; suffo- 
cative spells of cough after every sleep, however short. The cough is deep, 
hoarse; respiration wheezing, rasping, very tight and difficult, ameliorated 
during the morning from daylight ton a.m.; retention of urine; yellow 
watery stools. (M. Preston.) 

Natr. mur. Swelling of the submaxillary glands and lymphatics; map 
tongue; burning in throat; after application of caustics, especially of nitrate 
of silver. 

Nux vom. Feels better after a little sleep. (P. P. Wells.) 

Phytol. In cold weather, at the beginning with dryness and soreness 
of the throat, great headache, violent aching in the back and limbs; great 
prostration; cannot stand; gets faint and dizzy when rising up in bed. Sen- 
sation of a lump in throat, as if a red-hot ball of iron had lodged there; 
whole face inflamed, swollen, sore, sensative; deglutition almost impossible; 
cannot take hot fluids. ' ' Phytol. Is invaluable in the ulceration and pros- 
tration of diphtheria." (Aaron Walker.) 

Plum. met. and jod. Have been recommended and successfully used 
by Schussler; where there is inclination of the exudate to mortify and slough 
off; also in implication of the larynx. This was before the introduction of 
his tissue-remedfes. 

Rhus tox. When the child is restless, wants to be -carried about, wakes 
up every now and then complaining of pain in the throat; when a bloody 
saliva runs out of the mouth during sleep; when the parotid glands are 
greatly swollen; when there are transparent, jelly-like discharges from the 
bowels at stool or afterwards. 

Sulphur. Iyarge yellowish deposit all around the posterior wall of the 
pharynx, all posterior to the uvula and isthmus faucium. After exposure 
to the diphtheritic poison, dark redness of the fauces, very painful; sleepless 
nights. Drinks very hastily; delirious; miliary, scarlatina-like eruption. 
Quite recently, pulverized sulphur, blown upon the diseased surface, has been 
lauded as a universal cure for diphtheria. 

Vinca minor. Dr. Schier (Allgemeine Homoeopathische Zeitung, March, 
1894), highly recommends Vinca minor, and considers it with Mercurius 
cyanatus as the two most important remedies for diphtheria. 

To differentiate: Vinca minor affects most markably the mucous mem- 
brane of the pharynx, posterior nares, the nose and eyes. 

Mercurius cyanatus, where there is a tendency to extend into the larynx. 

Post-diphtheritic paralysis. 

Apis. Numbness of the extremities. 

Arg. met. Anaesthesia of the roof of the mouth and fauces. 



936 



DIGEST TO DIPHTHERIA, 



. Arnica. Paralysis of right side. 

Arsen, Paralysis of the lower extremities. 

Camphor a. Paralysis of the lungs. 

Caustic. Paralysis of one arm and the muscles of deglutition. 

Gelsem. Local tingling and incipient paralysis or anaesthesia; defec- 
tive or impaired vision. 

Kali brojn. Anaesthesia of fauces. 

Kali phosph. (Schiissler. ) 

Laches. Paralysis of left side. 

Nux vom. Hemiplegia, left side. 

Phosphor. Numbness of fingers and feet, with great weakness. 

Secale. Numbness of the extremities; paralysis of some parts; painful 
tingling (like crawling of ants) on the tongue. 

Tart. emet. Paralysis of the lungs. 

Besides compare: Arnica, Baryt., Coccul., Cuprum, Plumbum, Rhus 
tox., Sta?i?iu?n, Sulphur, Thuja, Zincum. 

Digest to Diphtheria. 



LOCAL SYMPTOMS. 

SENSATIONS. 

Absence of severe pain: Baptis., Card. 
ac, Ignat. 

Burning" : Arsen., Arum, triph., Xatr. 
mur. 

, with anguish from internal heat: 

Arnica. 

, like a red-hot ball of iron: Phytol. 

, scraping and blood}- expectoration: 

Canthar. 

, stinging and dryness: Apis. 

Dryness and constriction similar to 
Lachesis: Lac. ac. 

and husky as if scalded: Lac. can. 

and redness with painful swallowing: 

Bellad. 

and soreness in the beginning: Phy- 
tol. 

Painful sensations: Sulphur. 

, complains when waking up: Rhus 

tox. 

more so than the appearance of 

throat would suggest: Lac. can. 

Stitching posteriorly as of a hard sub- 
stance in pharynx: Arnica. 

APPEARANCE. 

Inflamed : Sal. ac. 

and swollen: Calc. sulph., Lac. can., 

Laches., Nitr. ac, Phytol. 



, cedematously with constant inclina- 
tion to swallow: Baptis. 

, livid: Ailanth., Laches. 

Redness, bright, puffy and glossy: Apis. 

, bright and swelling of tonsils: 

Sulph. ac. 

, brownish: Lycop. 

, dark: Sulphur. 

, angry streaks of capillaries: Lac. 

can. 

and dryness with painful swallow- 
ing: Bellad. 

Exudate, worse on right side: Merc, 
prot. 

, left side: Merc. bin. 

, commence on right side: Lycop- 

, left side: Laches. 

, goes from one side to the other and 

back again: Lac. can. 

, abundant: Card. ac. 

, covering the entire cavity of mouth : 

Arum, triph. 

and extends to lips and external au- 
ditory canal: Ars. jod. 

, white, extending down pharynx: 

A mm caust. 

, yellow, posteriorly to uvula and 

isthmus: Sulphur. 

gray: Lac. can. 

grayish, thick: Sulph. ac. 

greenish-yellow: Ignat. 



DIGEST TO DIPHTHERIA. 



937 



white, yellow, or any shade between: 

Merc. cyan. 
yellowish-white; lemon-colored 

strings of mucus hang from posterior 

naresdown: Sulph. ac. 

, soft: Sal. ac. 

, necrotic tendencj" Arnica, Kali 

phosph. 

gangrenous: Merc. cyan. 

mortifying and sloughing off: Plumb. 

met. and jod. 

putrid, seldom painful: Ignat. 

After expulsion absence of all erethism: 

Arnica. 
Ulceration, deep and angr} T -looking: 

Ail an th. 

, deep seated: Kali bichr. 

in the mouth: Nitr. ac. 

, glistening, shining like Apis: Lac. 

can. 

and prostration : Phytol. 

Gums and tongue swollen and sensitive : 

Merc. bin. 
Tongue red, raw shining: Kali bichr. 
coated thick, of buff-yellow color, on 

back part: Merc. prol. 

white: Bryon. 

map-tongue: Laches., Natr. mur. 

Speech thick, indistinct, difficult: Sulph. 

ac. 
Mouth sore, can't drink: Antm triph. 

dry without thirst: Bryon. 

Salivation, excessive: Nitr. ac, Sulph. 

ac. 
Saliva viscid: Lac. can. 
— — bloody, runs out of mouth during 

sleep: Rhus tox. 
MUCUS collects, must clear throat, makes 

burning and rawness worse: Arum 

triph. 
, necessitating swallowing: Merc. 

bin. 

streaked with blood: 

Sordes on teeth: Mur ac. 
Mouth constantly open, slightly project- 
ing tongue, causing a silly expression: 

Lycop. 
Fcetor oris: Arnica, Arsen., Ars. jod., 

Arum triph., Carb. ac, Kali bichr., 

Kali phosph., Kreos., Laches., Merc. 

cyan., Mur. ac, Nitr. ac, Sulph. ac 
Swallowing" difficult: Arnica, Apis, Sal. 

ac, Sulph. ac. 



, liquids run out of nose: Sulph. ac 

of solids: Lad. ac. 

or fluids: Merc. bin. 

almost impossible: Phytol., Sulph. 

ac 

painful : Nitr. ac 

painful in left ear: Kali bichr. 

in ears: Apis. 

, worse from cold food or drinks: 

Lycop. 
, worse from warm drinks: Lycop., 

Merc. prot. , Phytol. 
Nose stopped up: Amm. carbi, Nitr. ac 
, must breathe with mouth open: 

Arum triph., Lycop. 
Discharge from nose excoriating: Arum 

triph., Lac. can. Nitr. ac 

tough and stringy: Kali bichr. 

Nosebleed: Arum triph., Lgnat. 

blood dark and putrid: Mur. ac. 

Nostrils spasmodically dilated with every 

inspiration: Lycop. 
Picking" at nose and lips, making them 

bleed: Arum triph. 
Lips scabby and sore: Mur. ac 
sore and swollen, skin peeling off: 

Arum triph. 
Eruption or ulceration upon the border 

and anterior surface of lower lip: 

Bryon. 
Puffiness around eyes and cedematous 

swelling of face: Apis. 
Paleness of face: Sulph. ac. 
Bright redness of face: Acet. ac 
Submaxillary glands and lymphatics 

swollen: Natr. -mur. 

, changing sides: Lac. can. 

External swelling of neck: Apis, Bel- 
lad., Laches. 
Parotid glands swollen: Kali bichr., 

Rhus to A'. 
Tenderness of neck to touch: Apis., 

Laches. 
Larynx implicated: Bromium, Lodum, 

Laches., Merc, cyan., Plumb, met. and 

jod. 

, sensation of weakness in: Apis. 

and swelling of mucous membrane: 

Apis. 
Breathing labored: Apis., Ars. jod . 

, difficult: Sulph. ac. 

Suffocative sensation: Amm. caust., 

Apis, Laches., Naja trip. 
in sudden attacks: Bcllad. 



938 



DIGEST TO DIPHTHERIA. 



, worse after sleep: Laches., Naja 

trip. 

, on lying down in bed : Naja trip. 

, can't bear anything about throat: 

Apis, Laches. 
Croupy cough: A mm. canst., Ars. jod., 

Bromium, Lodum, Kali bichr., Laches. 
Hoarse cough: Apis, Ars. jod., Bro- 

mium, Xaja triph. 

SYSTEMIC SYMPTOMS. 

Stupefaction and drowsiness: Baptis. 
Delirium: Lgnat., Sulphur. 

, changes rapidly from one subject to 

another: Loaches. 
Low muttering : Baptis. 
Depression: Arnica.- 
Apathy : Sulph. ac. 

Fear of being left alone: I^ycop. 
Agony, jumps out of bed and gasps for 

breath: Arum, caust. 
Faint and dizzy when rising up in bed: 

Phytol. 



Headache: Apis, Lgnat , Phytol. 
Co-affection of brain and whole nervous 
system: Arnica. 



Impaired vision, objects appear a long 
way off, are seen double or inverted: 
Gelsem. 



No thirst, or desire for large draughts: 

Bryon. 
Constant desire for cold drink, takes 

little at a time: Arsen. 
Drinks hastily: Sulphur. 



Green vomiting : lgnat. 



Stools dark and blood-streaked: Baptis. 

, greeu : Lgnat. 

, jelly-like: Rhus to. v. 

, offensive, even if formed: Laches. 

, yellow watery: Naja trip. 



Micturition too copious, or scanty and 

difficult: Canthar. 

, painful, or suppressed: Apis. 

, suppressed: Lgnat. 

Retention : Naja trip. 

Urine dark, scanty, of strong odor: 

Laches. 



— albuminous: Apis, Arsen., Canthar., 
Laches. 

— with casts of the uriniferous tubuli: 
Canthar. 



Oppressed breathing from pulmonary 
congestion; must go to the window for 
fresh air: Baptis. 

Must be held up erect to procure easy 
respiration: Naja trip. 

The moment he falls asleep he is roused 
by want of breath: Amm. card. 

Respiration wheezing, rasping, tight 
difficult, better from daylight to n a. 
m. : Naja trip. 

Sighing frequently: Lac. can. 



Pulse intermitting: Nitr. ac. 

quick: Apis. 

small and rapid: Arnica. 

weak and small: Sulph. ac. 

and slow: Ars. jod. 

and pale face: Card. ac. 



Heaviness and paresis of right side: 

Arnica. 

, left side: Laches. 

Paralysis or anaesthesia; Gelsem. 

of lower extremities: Arsen. 

or only weakness of hands and feet: 

Apis. 
Abnormal heat of palms of hands and 

soles of feet: Lac. can. 
Jerking of lower limbs with a groan, 

awake or slumbering: Lycop. 
Violent aching in back and limbs: Lg- 
nat., Phytol. 
Aching all over, constantly changing 

position: Loaches. 
Darting, cutting pain in shoulders and 

neck, in periodical spells: Apis. 



Scarlatinal eruption: Apis, Sulphur. 

, purplish: Laches. 

Measle-like eruptions: Kali bichr. 
Eruption itchy, stinging: Apis. 
Irritable rash: Canthar. 
Ulcers, shining and glistening, may be 
found on any part of the body: Lac. 



Chilliness, sometimes: lgnat. 
Little or no fever: Sal. ac. 



TUSSIS CONVULSIVA. 



939 



High fever: Aeon , Apis, Be/lad., Ig- 
nat., Nitr. ac 

Inflammatory fever, rapid course: Ar- 
nica. 

Adynamic fever: Merc. cyan. 

Low fever with great prostration: Card, 
ac. 

Typhoid condition: Mur. ac. 

During fever local tingling of parts: 
Gelsem. 

Perspiration coming and drying up in 
starts: Apis. 



Drowsy with inability to fall asleep: 

Bellad. 
On awaking he is cross, kicks, behaves 

naughty, jumps up in bed, stares about 

and knows nobody, seemingly dreaming 

with open eyes: Lycop. 
Somnolency: Laches., Sulph. ac. 
Sleepless nights: Sulphur. 
on account of restlessness: Lac. can. 



Restlessness, nervous: Apis. 

, wants to change bed and room fre- 
quently: Arsen. 

, cries and throws himself about: 

Arum triph. 

, rolls and tosses about all night: 

Lac. can. 

, wants to be carried about: Rhus 

tox. 

Uneasiness : Nitr. ac 

Debility: Arnica. 

from the beginning: Apis. 



Decline of strength, small rapid pulse: 

Arnica. 

, cannot stand: Phytol. 

Prostration: Apis, Ars. jod., Bryon., 

Canthar., Mur. ac, Phytol. 
Weakness : Sal. ac 

and excessive paleness: Sulph. ac 

Adynamia: Arnica. 

Sinking, death -like turns: Canthar. 

Collapse early: Merc. cyan. 



Better from drinking hot water: Arsen 

warm tood or drinks: Lycop. 

after a little sleep: Nux vom. 

Worse from 4 p. m. : Lycop. 

after midnight: Arsen. 

after sleep: Kali bichr., Laches., 

Lycop. 

from motion: Bryon. 

from being covered: Lycop. 



At the beginning: Aeon., Bellad., 
Bryon , Gelsem. 

In the later stages: Arsen., Kali 
phosph., Plumb, met. and jod. 

After exposure to the diphtheritic poi- 
son: Sulphur. 

For lymphatic subjects with torpidity: 
Arnica. 

Syphilitic taint: Nitr. ac. 

In cold weather : Phytol. 

After the application of caustics, espe- 
cially Nitrate of Silver: Natr. mur. 

mercurial preparations: Nitr. ac. 

Citr. ac. is better than Lad. ac 

If Laches fails: Lac can. 



Tussis Oonvulsiva, Pertussis, Whooping-Cough. 

This affection is a species of bronchitis of an infectious and mostly epi- 
demic nature, and not a mere nervous complaint. For although in some 
cases the nervous vagus has been found softened, and the medulla oblongata 
and its membranes hyperaemic, these changes are not of a uniform occur- 
rence and must be considered as mere accidental complications. Post- 
mortem examinations invariably reveal hyperemia, and swelling of the 
mucous membranes of the larynx, trachea, and bronchial tubes. One at- 
tack gives immunity against another. In the beginning, whooping-cough 
cannot be distinguished from an ordinary bronchial catarrh; later, however, 
the fits of coughing assume that characteristic whoop, which consists in a 
long, crowing inspiration on account of a spasmodic closure of the glottis, 
and which is followed by several short expirations in quick succession, end- 



94° THERAPEUTIC HINTS TO TUSSIS CONVULSIYA. 

ing most frequently with vomiting of ingesta and large masses of tough, 
gelatinous phlegm from the bronchi. Such paroxysms come as often as the 
collection of phlegm is sufficiently abundant to excite them. The child feels 
their coining and dreads them; therefore it almost always strives to get hold 
of something whereby to support itself. During the paroxysm regular res- 
piration and the action of the heart are very much interfered with, and it ex- 
plains those cyanotic symptoms, which we so frequently observe in the face 
and on the neck (bluishness and swelling of veins), and also the general 
convulsions, in consequence of congestion to the brain. Hard paroxysms, 
by their violent convulsive straining, not unfrequently cause bleeding from 
mouth, nose and even ears. In rare cases children are seen to succumb sud- 
denly and unexpectedly during a coughing fit, either from severe and persis- 
tent .spasm of the glottis, causing suffocation, or from effusion of blood, or 
transudation of serum into the brain and its ventricles, or from paralysis of 
the heart, or a rapid development of a diffuse pneumothorax. 

Whooping-cough has been divided into three stages: the catarrhal, con- 
vulsive, and the critical. The first is like any other catarrh; the second is sui 
generis, characterized by its peculiar paroxysms, and in a majority of cases 
attended by an ulcer on one or both sides of the fraenulum linguae, less often 
on the upper surface of the tongue, said to be the consequence of wounds 
received by thrusting the tongue between the teeth during the paroxysms at 
a spot where they are either much inclined or very prominent; the third, like 
the first, is similar to an ordinary catarrhal affection, and gradually wears off. 
The popular belief in regard to whooping-cough is, "that it is six weeks 
coming, six weeks standing and six weeks going;" but, like all popular ob- 
servations, this ought to be taken with some discrimination. For, although 
obstinate cases last a long while, under careful homoeopathic treatment they 
never last that length of time. Its Physical Signs are precisely those of 
bronchitis. Whooping-cough ma}', when the inflammatory process spreads 
into the finest bronchial tubes and further combine with bronchitis capillaries, 
cause pneumonia and emphysema; or, by its disturbance of circulation, bring 
about hyperemia and even oedema of the brain and its membranes. It is 
also not unfrequently complicated with measles, scarlatina and small-pox. 
In these complications lies its danger. Ordinary, simple cases pass over with- 
out any difficulty, even without fever. 

Whooping-cough prevails mostly epidemically among children up to the 
• eighth year of age, and, as a rule, attacks them only once in their life, and is 
said to be broken off at once by vaccination. It is of rare occurrence in ad- 
vanced years, although it does occasionally occur. 

Therapeutic Hints. 

For first stage compare Bronchitis. 

A uibra gris. Severe paroxysms of hollow-sounding cough; oppression 
and rapid respiration; expectoration of large quantities of tough, grayish or 



THERAPEUTIC HINTS TO TUSSIS CONVUESIVA. 94 1 

yellow mucus, especially after waking in the morning. (M. Preston.) The 
paroxysm ends with belching. 

Ambrosia arte??i. Cough worse from 8-12 p. m., or about midnight 
wheezy, asthmatic with pain in the left chest; nosebleed; stuffed up feeling 
in nose, head and chest; e5 T es red, dry, smarting, or watery with profuse 
lachrymation. Given in the tincture. (E. K. Holman.) 

A?iac. Fits of vexation excite the paroxysms; dyspnoea during and 
after the coughing spells; for children who are ill-natured and of an uncon- 
trollable temper. ( Preston . ) 

Arnica. The child cries before the paroxysms; eyes are bloodshot; there 
is bleeding from the nose. 

Bellad. Congestion to the head with red face and eyes; crying when 
coughing; sneezing after coughing. 

Bryon. Worse after eating and drinking, with vomiting; involuntary 
loose stools during the coughing fits, involuntary discharge of urine. 

Calc. carb. Teething infants; convulsions. 

Cap sic. Pain in the ears when coughing; ears and tip of nose hot; 
bloody mucus from nose when coughing; eyes protrude with burning and 
lachrymation. 

Ca?'b. veg. Vomiting of food; bleeding at the nose; cough worse in the 
evening and in the open air. 

Cina. Spasms of the extensor muscles; the child becomes suddenly stiff ; 
clucking noise, as though water were poured out of a bottle, from the throat 
down to the abdomen; frequent sneezing after a paroxysm; bleeding from 
nose and mouth. For children who are inclined to frequently wet the bed, 
and pick at the nose, and who are obstinate and irascible. Fretting excites 
the cough. 

Cocc. cact. Expectoration of ropy mucus, causing gagging and vomit- 
ing of food. Feel better in the open air. 

Cor. rubr. Spasms of cough so violent that children lose their breath 
and grow purple and black in the face. 

Cuprum. Convulsive, long-continuing paroxysms of coughing, worse 
from eating solid food, better from drinking cold water; during the parox- 
ysms loss of breath and convulsive throwing up of tough, gelatinous mucus 
and afterwards constant rattling on the chest; bluish face and lips; convul- 
sions of the flexor muscles. 

Drosera. Worse after midnight; attended by gagging and frequent 
vomiting of ingesta; feeling of constriction in chest and hypochondria, so 
that the patient tries to support these parts by the hands; worse from tobacco 
smoke and drinking; bloody urine. 

Hepar. For third stage. 

Hyosc. Cough dry and worse at night in a recumbent position. 

Ipec. Spasm of the glottis before the paroxysm; bleeding from nose 
and mouth during the coughing fits; vomiting of mucus or food; convulsions 



942 THERAPEUTIC HINTS TO TISSUS CONVULSIVA. 

and stiffening of the body backwards; vomiting of food without coughing; 
rattling of mucus in the bronchial tubes; rash -eruption. 

Iodium. " Patients are weak, sallow, short of breath, emaciated and 
have enormous appetite." (M. Preston.) 

Kali card. Paroxysms worse after midnight, about 3 o'clock A. M.; 
bloated face, especially between upper eyelids and brows; dry skin, dry hair, 
and dry stools. 

Laches. Coughing spells always worse after sleep. 

Ledum. Dizziness and staggering after paroxysm; moaning and groan- 
ing during sleep; spasmodic contractions of the diaphragm after the spell, so 
that inspiration becomes double, sobbing- like, as we observe after hard crying 
spells. 

Mephit. Spells day and night; the child must be raised, gets blue in 
the face and can't exhale. Convulsions; fetid diarrhoea. 

Natr. mur. ' ' When the tears stream down the face whenever he coughs. ' ' 
(Burnett.) 

Niccol. The cough is a dry hack, like the tick of a clock in its regular- 
ity, continuing for a long time. The child must be held straight up during 
the continuance of the cough, otherwise it is seized with spasms. The great- 
est possible degree of dyspoena, but no expectoration. (M. Preston.) 

Naphthal. Recommended by Von Grauvogl. 

Nux vom. Cough worse in the morning and after eating; attended by 
vomiting, gagging, constipation, choking spells with bluish face, and pain in 
the abdomen. After previous quackery with cough-mixtures, drops, etc. 

Phosphor. Third stage. 

Pulsat. First and third stage; disordered stomach. 

Sepia. Cough in rapid successions till breath is exhausted, then gagging 
and vomiting of mucus; cough worse in the night. (C. Wesselhoeft.) 

Squilla. Cough excited by drinking cold water; involuntary discharge 
of urine during the spell. 

Stramon. Barking, croup-like cough with suffocative contraction of the 
chest, rattling, palpitation of the heart; anxiety, congestion, blood -spitting; 
convulsions. When coughing while sitting, the lower extremities are 
jerked up. 

Sulphur. Frequent relapses; third stage. 

Tart. emet. Coughing and gaping consecutively; coughing excited by 
getting angry, and by eating; vomiting of food and mucus after coughing. 
Signs of carbonized blood. 

Veratr. Vomiting of tough thin mucus, with cold perspiration on the 
forehead, involuntary discharge of urine and great exhaustion; face pale and 
sunken; restlessness and anxiety. Spells brought on from entering a warm 
room or drinking cold water; cough better when lying, worse when rising 
from bed. Lingering fever with lassitude, weakness, constant chilliness and 
great thirst. Fall and spring epidemics. 



MENINGITIS CEREBRO-SPINALIS EPIDEMICA. 943 

Meningitis Cerebro-Spinalis Epidemica, Spotted Fever. 

This is an infectious disease, characterized by an acute inflammation of 
the membranes of the brain and cord. It is held by some that the exciting 
cause is the diplococcus pneumonia of Frankel, which has frequently been 
found in the inflammatory exudate, but this view may be considered to be 
still sub-judice. 

The inflammatory exudate is deposited ' ' both on the convexity and 
at the base, especially along the course of great vessels, in the folds and 
depressions of the surface of the brain, in the fissure of Sylvius, 
along the sulci, between the pons variolii and chiasma. and on the pons and 
cerebellum. In rare cases the whole surface of the brain is uniformly cov- 
ered." In the spinal cord the exudation is found "chiefly in the lumbar, 
less in the cervical region, and almost exclusively on the posterior surface of 
the cord," owing to the tendency of any fluid to flow to the dependent parts. 
' ' The brain substance is sometimes congested with puuctiform haemorrhage 
and secondary development of small spots of softening; at other times, when 
the disease has been hyperacute or very long -continued, it is juicy or ©edema- 
tous, with a smooth, level surface, and of a watery appearance on section. 
More rarely the substance is of a tough consistence." (Von Ziemssen.) 

Although this disease may have prevailed at times in previous centuries, 
the first epidemic ascertained with certainty, is that in Geneva, from Febru- 
ary to April, 1805. Since then many epidemics have been observed, and in 
all parts of the globe, with the exception of the tropical regions proper. 

It generally occurs during winter and spring, and especially when there 
is great moisture of the air and great variations of temperature. It selects 
not malarial regions, but rather sandy, dry plateaus, though malarial neigh- 
borhoods are not exempt. Childhood is most severely attacked, yet no age 
is spared. The disease-germ seems best to thrive where it finds a soil pre- 
pared by insufficient nourishment, damp, overcrowded, badly ventilated 
houses with unclean ground floors. 

Symptoms. — It most always sets in suddenly, commencing with a chill, 
followed by fever; violent headache; vomiting; extraordinary prostration of 
strength and great restlessness. The headache is usually severe, sometimes 
in front, sometimes in the back part of the head; its cessation is a very favor- 
able sign. Vomiting is especially excited by rising and rarely absent. The 
fever-temperature is very irregular, varying in the mean from 100.4 F. to 
104 F., with very irregular variations above and below these points, often 
interrupted by long-continued normal temperatures, while the other symp- 
toms continue unabated. The pulse is likewise irregular; its frequency does 
not always correspond to the height of the temperature, and varies some- 
times thirty or forty beats in a few hours. A slow pulse is less frequently 
found than in meningitis tuberculosa, and a continued rapidity is unfavorable. 
In severe cases there occur at the start loss of consciousness, coma or delirium, 
or at least somnolence, out of which the patient may be roused by being 



944 MENINGITIS CEREBRO-SPINALIS EPIDEMICA. 

spoken to, answering correctly, but soon relapsing into the same state again. 
Some cases commence with convulsions, and that characteristic stiffness of 
the neck which, in a few hours, may develop into a tonic contraction of all 
the extensors of the spinal column; orthotonous is frequent; opisthotonus is 
rare; rarest is pleurothotonus or the unilateral contraction of the spinal erec- 
tor muscles. In rare instances, however, the stiffness of the neck is entirely 
absent. There is great aching in all the limbs, and especially in the spine, 
a universal oversensitiveness of the skin; every touch and motion causes 
great pain. Now appear also cutaneous eruptions, herpes on the face, or on 
the extremities; then erythema, roseola, urticaria and petechise. The name 
of the spotted fever was suggested by those irregular purplish, ecchymosed 
spots, from the size of a pin's head to larger patches, which appear generally 
on the second day of the disease upon various parts of the body, usually first 
on the upper eyelids, gradually extending to other parts; they do not get 
white under pressure. In some cases they are absent. From the third to 
the fifth day the tongue becomes dry and cracked in comatose cases; in other 
cases it remains moist but heavily coated. There is sometimes diarrhoea, at 
other times constipation. In other cases the symptoms of irritation are fol- 
lowed by symptoms of depression; no reaction ensuing; unconsciousness is 
complete, stools and urine pass off involuntarily, pulse and temperature rise, 
convulsive movements, half -sided paresis, general convulsions, profound 
coma follow each other and death closes the scene. In favorable cases these 
symptoms of depression do not set in at all, or are not so marked nor lasting. 
The headache, the pains in the limbs and spine continue, but gradually grow 
milder and convalescence begins in from one to two weeks, though sometimes 
later. There are cases especial during the commencement of an epidemic, 
which terminate fatally in from twelve to thirty hours; and on the other 
hand, there are cases even during the height of an epidemic, which are so 
light as to allow the patient to continue work. 

As SEOUEEvE have been observed: "Deafness, derangement of vision, 
chronic hydrocephalus and chronic meningitis, with the consequent impair- 
ment of intelligence, and lesions of motility in the form of paralysis and 
paresis. ' ' 

The Diagnosis is difficult in isolated cases and when the disease occurs 
in complication with other acute diseases, especially croupous pneumonia. 
It differs, however, from Tuberculous meningitis by the suddenness of its at- 
tack, the irregularity of pulse and temperature, and its peculiar eruptions; 
from Typhoid by the same peculiarities. In the first days a distinction be- 
tween the two may not be possible, but a few days of observation of the 
temperature will decide. When in complication with pneumonia, its diagno- 
sis may remain doubtful for some time; however, the stiffness of the neck 
and the painfulness of the spine will lead us to suspect such complication. 

Its Prognosis is grave, especially in infancy and old age, and in all 
cases where the symptoms are * very violent and the state of depression con- 
tinues without any apparent reaction. Each single case has to be weighed 



THERAPEUTIC HINTS TO MENINGITIS CEREBROSPINAL^ EPIDEMICA. 945 

by its own peculiarities and even these doubtful cases may take a favorable 
turn, while others prove fatal even under careful treatment. 

Therapeutic Hints. 

Aeon. Chill; fever; restlessness; dry skin; great thirst. Still I have 
not seen, nor found mentioned great achievement from this remedy. 

Act. rac. Intense pain in the head, as though a bolt were driven from the 
neck to the vertex with every throb of the heart; pain at the base of the 
brain and up and down the whole length of the spine; stiffness of neck and 
back; intense pain in the eyeballs; tongue swollen, or raw and red; redness 
of fauces and palate; soreness and bruised feeling of the muscles generally, 
or sometimes confined to a circumscribed spot, and often changing location, 
and with a feeling as if an abscess were forming; great sensitiveness of the 
skin. Creeping chills in the back; profuse, sometimes cold perspiration all 
over; tonic and clonic spasms; delirium, like delirium tremens; sees cats and 
dogs, etc. 

Apis. Often indicated. Compare Meningitis. 

Agr. nitr. Recommended by Grauvogl, is undoubtedly of great im- 
portance. It has tremendous headache of all kinds; vertigo; photophobia; 
clouds before the eyes; double vision; eyeballs floating in mucus; deafness; 
pale and emaciated face; lips and nails blue; white coated tongue, or dry and 
hard tongue, like bark, and black; black-coated teeth; cannot talk; wants to 
drink sweet things, sugar water, the juice of boiled, sweet prunes; stool 
and urine unconsciously; oppressed breathing; wants to be covered all 
the time and yet wants fresh air, the windows open; cannot move himself. 
Soporous sleep, with constant murmuring; it is difficult to rouse him, and 
when half roused, the eyes, scarcely opened, fall shut again. The whole left 
side is weak. Emaciation; constant trembling of hands; jerking of single 
muscles. 

Arnica. Sopor; cringes when touched anywhere, even during uncon- 
sciousness; great soreness all over; diuresis; during stage of great weakness. 

Arsen. Great restlessness and prostration; arsenic thirst; intermittent 
type. 

Bellad. Often indicated by the violent headache, drowsy state, and 
delirium; dilated pupils; double sight. 

Bryon. Bursting headache; stiffness of neck; great pain in joints and 
limbs, all worse from motion. 

Camphora. Cold, deadly pale or blue, almost pulseless from first shock 
of chill without reaction. 

Cann. Ind. Vertigo on rising with stunning pain in the back part of 
the head; fixed gaze; dilated pupils; sensitive to sounds; cold face, with 
drowsy and stupid look; anguish in the chest with great oppression; pain 
across shoulders and spine; paralysis of lower extremities and the right arm; 
convulsions; emprosthotonus, with loss of consciousness; collapse; stupor; 
pale, clammy and insensible skin; feeble, irregular pulse. (Hale.) 
60 



946 DIGEST TO SPOTTED FEVER. 

Chin, sulph. Violent throbbing headache; vertigo; heat in the face; 
involuntary closing of the eyelids from sheer prostration; intermittent type. 

Cicuta. Insensibility; double sight; dilated pupils; staring look; jerk- 
ing of eyeballs, muscles of face, arms and hands; perfect deafness, dumb for 
several days; ash y paleness of face; head retracted; rigid spine; dysphagia; 
first diarrhoea then constipation; rapid pulse; insensibility to touch and pinch- 
ing; paralysis all over. 

Crotal. Horrid headache; delirium with open eyes; pain in all the 
limbs; ecchymosed spots everywhere; convulsion and paralysis. 

Gelsem. Feeling as of a tape around the head; great drowsiness; itch- 
ing of head, face and neck; loss of vision and speech; nausea; pulse feeble; 
respiration labored and feeble; trembling and complete loss of muscular 
power; sweating relieves. 

Glonoin. Violent throbbing headache with sense of expansion; blind- 
ness with faintness and nausea; pale face; pain through the whole length of 
spine. 

Hyos. Delirium, muttering or wild; double sight; convulsions. 

Lycop. Sopor; sinking of lower jaw; fan-like motion of nostrils; feel- 
ing of tension in chest and abdomen as of a hoop; don't want to be alone; 
jerkings of limbs and body. Compare under Meningitis. 

Opium. Stupor; spasms; drawing the body backwards and rolling from 
side to side; deep, slow breathing; very quick, or very slow pulse. After 
violent emotions, fear, grief, fright, which acted like a blow, stunning the 
whole nervous system. 

Rhus fox. Stupefaction and vertigo; various eruptions, eczema on face; 
nosebleed; dry cough, perhaps blood}- sputa; great aching pains all over with 
restlessness. 

Ver. vir. During first stage with coldness of surface; loss of conscious- 
ness; labored, slow and irregular pulse. Later: trembling as if frightened 
and on the verge of spasms; convulsions; retraction of head; rolling of head; 
rolling up of eyes; opisthotonus; very frequent and feeble pulse. 

Protracted recovery hints to: Calc. carb., Card, veg., Psorin., Silic, Sul- 
phur, Zincum. 

Digest to Spotted Fever. 

Unconsciousness: Arnica, Ver. vir. and stupefaction: Rhus tox. 

Insensibility : Cicuta. on rising with stunning pain in the 



Delirium: Bellad. 

, with open eyes: Crotal. 



back part of the head: Cann. Ind. 
— and heat in face, violent throbbing 



-, muttering or wild: Hyosc. headache: Chin, sulph. 

-, like delirium tremens; sees cats and Violent throbbing headache with sense 



dogs, etc. : Act. rac. 
Does not want to be alone: Lycop. 



of expansion: Glonoin. 
Intense pain in the head, as though a 



After violent emotions, fear, grief, bolt were driven from the neck to the 

fright, which acted like a blow, stun- vertex with every throb of the heart: 

ningthe whole nervous system: Opium. Act. rac. 

Pain at the base of the brain and up and 

Vertigo: Arg. nitr. 



DIGEST TO SPOTTED FEVER. 



947 



down the whole length of the spine: 

Act. rac. 
Tremendous headache of all kinds: 

Arg. nitr. 
Violent headache: Bellad. 
Bursting" headache: Bryon. 
Horrid headache: Crotal. 
Feeling" as of a tape around the head: 

Gelsem. 
Head retracted: Cicuta, Ver. vir. 
Rolling" of head: Ver. vir. 



Intense pain in the eyeballs: Act. rac. 
Involuntary closing of the eyelids from 

sheer prostration : Chin, sulph. 
Rolling up of eyes: Ver. vir. 
Eyeballs floating in mucus: Arg. nitr. 
Dilated pupils. Bellad., Cann. Ind., 

Cicuta. 
Fixed gaze : Cann. Ind. 
Staring look: Cicuta. 
Clouds before the eyes: Arg. nitr. 
Double sight: A rg. nitr., Bellad., Cicuta, 

Hyosc. 
Photophobia : Arg. nitr. 
Loss of vision and speech: Gelsem. 
Blindness with faintness and nausea: 

Glonoin. 



Sensitive to sounds: Cann. Ind. 
Deafness: Arg. nitr., Cicuta. 
Nosebleed: Rhus tox. 
Fan-like motion of nostrils: Lycop. 



Face cold, with drowsy and stupid look: 
Cann. Ind. 

pale: Glonoin. 

pale and emaciated: Arg. nitr. 

, ashy paleness of: Cicuta. 

Sinking of lower jaw: Lycop. 
Lips and nails blue: Arg. nitr. 



Black coated teeth: Arg. nitr. 
Tongue, dry and hard, like bark and 

black: Arg. nitr. 
Tongue, swollen, or raw and red: Act., 

rac. 

, white coated: Arg. nitr. 

Dumb, for several days: Cicuta. 
Cannot talk: Arg. nitr. 
Redness of fauces and palate: Act. rac. 
Dysphagia: Cicuta. 



Craves sweet things, sugar water, the 
juice of boiled, sweet prunes: Arg. nitr. 

Arsenic thirst: Arsen. 

Nausea: Gelsem. 

First diarrhoea then constipation -.Cicuta. 

Stools and urine unconsciously: Arg. 
nitr. 

Diuresis: Arsen. 



Dry Cough, perhaps bloody sputa: Rhus 

tox. 
Respiration labored and feeble: Gelsem. 
Breathing, oppressed: Arg, nitr. 

, great oppression: Cann. Ind. 

, deep, slow: Opium. 

Anguish in the chest: Cann. Ind 
Feeling of tension in chest and abdomen 

as of a hoop: Lycop. 
Pulse feeble: Gelsem. 

and irregular: Cann. Ind. 

and very freqent: Ver. vir. 

rapid: Cicuta. 

very quick or very slow: Opium. 

labored, slow and irregular: Ver. 

vir. 



Stiffness of neck: Bryon. 

and back: Act. rac. 

Rigid spine: Cicuta. 

Opisthotonus: Ver. vir. 

Drawing the body backwards and roll- 
ing: Opium. 

Emprosthotonus, with loss of conscious- 
ness: Cann. Ind. 

Pain through the whole length of spine: 
Act. rac, Glonoin. 

across shoulders and spine: Cann. 

Ind. 

in all the limbs: Crotal. 

Great pain in joints and limbs, all worse 
from motion: Bryon. 

aching all over, with restlessness: 

Rhus tox. 

soreness all over: Arnica. 

Soreness and bruised feeling of the mus- 
cles generally, or sometimes confined 
to circumscribed spot, and often chang- 
ing location, and with a feeling as if an 
abscess were forming: Act. rac. 

Left side is weak; cannot move himself: 
Arg. nitr. 



Trembling and complete loss of muscu- 
lar power: Gelsem. 



94 8 



ACUTE MILIARY TUBERCULOSIS. 



, constant, of hands: Arg. nitr. 

, as if frightened and on the verge of 

spasms: Ver. vir. 
JerkillgS of limbs and body: Lycop. 

of single muscles: Arg. nitr. 

of eyeballs, muscles of face, arms 

and hands: Cicuta. 
Spasms: Opium. 

, tonic and clonic: Act. rac. 

Convulsions: Cann. Ind., Hyosc, Ver. 

vir. 

and paralysis: Cicuta, Crotal. 

Paralysis of lower extremities and the 

right arm: Cann. Iftd. 



Chill, fever; restlessness; dry skin; great 

thirst: Aeon. • 
Pale, clammy skin: Cann. Ind. 
Profuse, sometimes cold perspiration all 

over: Act. rac. 
Sweating relieves: Gelsem. 



Drowsy state: Bellad. 

Great drowsiness: Gelsen. 

Difficult to rouse him, and when half 
roused, the eyes scarcely opened, fall 
shut again: Arg. ntr. 

Sopor: Arnica, Lycop. 

Soporous sleep, with constant murmur- 
ing: Arg. ntr. 

Stupor: Cann. Ind., Opium. 

Intermittent type: Arse?i., Chin, sulph. 

During" first stage, with coldness of sur- 
face: Ver. vir. 

Creeping" chills in the back: Act. rac. 

Wants to be covered all the time and 
yet wants fresh air, windows open: 
Arg. nitr. 



Great sensitiveness of the skin: Ad. 

rac. 
Cringes when touched anywhere '.Arnica. 
Insensible skin: Cann. Ind. 
Insensibility to touch and pinching: 

Cicuta. 
Itching of head, face and neck: Gelsem. 
Various eruptions, eczema on face: 

Rhus tox. 
Ecchymosed spots everywhere: Crotal. 



Collapse: Cann. Ind. 

Cold, deadly pale or blue, almost pulse- 
less from first shock of chill without re- 
action: Camphora. 

Emaciation: Arg. nitr. 

Great restlessness, prostration: Arsen. 

During stage of great weakness: Arnica. 

Often indicated: Apis. Compare Men- 
ingitis. 

Protracted recovery hints to: Calc.carb., 
Card, veg., Psorin, Silic, Sulphur, Zin- 



Acute Miliary Tuberculosis. 

Acute miliary tuberculosis is an acute infectious disease characterized 
by the formation of miliary tubercles most frequently in the lungs and brain. 
It is a secondary disease, being due to embolic infection from a primary tuber- 
cular lesion of any tissue or organ. The exciting cause is the bacillus tuber- 
culosis of Koch. 

Being due to embolic infection, the tubercular lesions develop inter- 
alveolar, in contradistinction to the lesions of primary pulmonary consump- 
tion which are intra-alveolar, the infection having taken place directly 
through the respiratory channels in the latter case. 

' ' Acute miliary tuberculosis attacks with characteristic symptoms of a 
typhoid type both lungs, and frequently also other parenchymatous organs 
and membranes; the tubercle is deposited either all at once or at repeated 
rapidly recurring times with periodical exacerbations of the symptoms, and 
in the form of the most delicate granulations, which have either a transparent 
vesicular appearance, and are scarcely as large as oat grains, or are gray, 
crude, and of the size of millet seeds. The tubercles always appear in great 
numbers; they are discrete, uniformly distributed throughout the pulmonary 



ACUTE MILIARY TUBERCULOSIS. 949 

parenchyma, and only in rare instances do they become aggregated and 
coalesce in particular places, but even then there is uniformity in their dis- 
tribution. The} r all exist in the same stage, viz., that of crudity. At the 
same time the lung is hypersemic and oedematous, while its tissue has lost its 
compactness as a result of emphysema. The hypersemia may here and there 
have advanced to pneumonia and hepatization." (Rokitansky.) Outside 
of the lungs the miliary tubercles are found also in the spleen, liver, kidneys, 
pia mater, serous membranes, and in the choroid. 

Its Symptoms are: Cough, which is never absent, but not characteristic, 
and expectoration may be wanting, or consist of simple, colorless, rather 
viscid mucus, sometimes mixed with streaks of blood. 

The respiration is in almost all cases greatly increased, amounting in 
grown persons to from fifty to sixty, and in children to eighty or ninety per 
minute; the pulse runs up to 120 in the morning, and during the latter part 
of the disease to from 130 to 150. The temperature is usually not very high, 
nor does it rise parallel with the increase of the pulse. Towards the end the 
temperature falls and the extremities become cool and the face cyanotic. 

Auscultation reveals a general accentuation of the vesicular murmur, 
whistling and sonorous ronchi from apex to base, and at a later period crack- 
ling rales, which become more and more abundant. 

The disease attacks persons who are already consumptive, or have suf- 
fered from serious morbid processes in other organs, as a sudden aggravation 
of their symptoms, or in cases of persons of apparent health as an acute 
affection, usually setting in with a chill and subsequent high fever; assum- 
ing greatly the appearance of a typhoid fever, with mental dullness, vertigo, 
slight delirium, apathy, muscular prostration and sopor. The spleen, as a 
rule, is moderately enlarged. 

It is most frequently complicated with phthisis, and typhoid fever. In 
the latter case the disease develops itself either during the height of the fever, 
or follows immediately after its termination. The differential symptoms 
between the two are: typhoid fever has a regular type in the rising and 
falling of its temperature; shows roseola on the epigastrium and hypochon- 
dria; and exhibits at times diarrhoea, meteorism, and soreness in the ileo-csecal 
region about the end of the second week and haemorrhages from the bowels 
in the third week; while miliary tuberculosis is characterized by the absence 
of these signs and the presence of a disproportionate frequency of pulse and 
respiration relative to the grade of temperature. 

From acute bronchitis it distinguishes itself by the rapid loss of 
strength. 

Miliary tuberculosis may be inferred, also, in all cases in which a diffused 
friction murmur can be heard without any pleuritic symptoms. Its course 
is rapid and fatal. 



950 ANTHRAX. 

Therapeutic Hints. 

At the commencement compare: Apis, Arsen., Bellad., Bryon., Calc. 
carb., Gelsem., Laches., Phosphor., Sulphur. 

At a later stage: A mm. carb., Arsen., Carb. veg., Laches., Opium, 
Tart, emet., Veratr. 

Anthrax, Malignant Pustule. 

This is an acute infectious disease characterized by the formation of the 
anthrax carbuncle, either primary to local infection, or secondary to systemic 
infection. 

In 1863 Davaine demonstrated that the blood of sheep suffering from 
anthrax and containing the bacilli would invariably reproduce the disease if 
injected into a healthy animal. Later Koch succeeded in isolating and mak- 
ing cultures of these bacilli. 

Anthrax has also been called Carbunculus Contagiosus, and is to be 
distinguished from the common Carbuncle, which has nothing in common 
with it. 

It is characterized by the appearance of an angry-looking pustule, associated 
with gangrenous destruction of the surrounding parts which owes its origin 
either to a direct inoculation of the poison from an animal affected with the 
disease, or to a transmission of the poison by flies, or to inoculation of the 
poison from man to man, or to the eating of the flesh of diseased animals. 
It is, therefore, most frequently found among persons who have to do with 
diseased animals, or w T ho work in manufacturing establishments where the 
products of such animals (hides, horsehair, wool) are prepared for different 
uses. The infection takes place principally on the uncovered parts of the 
body wmich are exposed to the entrance of the poison. The eating of diseased 
flesh first causes general malaise and intestinal troubles, after which, in about 
eight or ten days, anthrax carbuncles appear, by preference on the arm, fore- 
arm and head. 

After an incubation of from a few hours to several days, there is at first 
felt on the spot where the poison took hold, a slight burning and itching, as 
if from the bite of an insect, and one can see a little red speck with a black 
point in its centre. This soon becomes changed into an itching papule, 
capped with a small, generally reddish or bluish vesicle, which gradually 
enlarges. After bursting it discloses a dark red base, which becomes covered 
with a crust, while often, though not always, secondary vesicles spring up 
around it, which contain a yellowish, reddish or blackish fluid. At the same 
time the surrounding parts swell cedematously over a considerable area, the 
cellular tissue underneath also becomes infiltrated, and in many cases dis- 
colored lines mark the course of the veins, or red stripes the course of the 
lymphatic vessels in the cedematous region; the corresponding lymphatic 
glands also swell. The general symptoms correspond with the severity of 
the local affection; there is fever, great weakness, delirium, excitement, con- 
fusion; sweating, diarrhoea and pain in the extremities; in fatal cases col- 



HYDROPHOBIA. 95 1 

lapse : in favorable cases after the dead masses have been removed by slough- 
ing off, the wound gradually heals by healthy granulation. 

Therapeutic Hints. 

Laches. Bluish color of the pustule and red streaks along the lymphatic 
vessels. (Dunham.) 

Anthrac. Blood poisoning. 

Malandrinum. Blackish diarrhoea; pain in back and limbs; pustule 
similar to a badly- looking vaccine-pustule. (R. Straube.) 

Compare Carbuncle. 

Hydrophobia, Lyssa, Rabies. 

"Hydrophobia in the human subject is an acute infectious disease, pro- 
duced by a specific virus, which is inoculated almost without exception, by 
the bite of a rabid animal (dog, wolf, fox, cat, skunk, horse, ox, etc.), most 
frequently that of the dog. Infection from man to man may be said prac- 
tically never to occur." (Bollinger.) Neither is it known that the con- 
sumption of the meat or milk of rabid animals ever produced the disease; 
but numerous observations make it quite porbable "that dogs may, by their 
bite, produce hydrophobia in the human subject, even during the period of 
incubation of the disease." (Bollinger.) A wound from the bite of a dog 
should, therefore, always be considered with suspicion; but instead of killing 
the dog on the spot, as is frequently done by ignorant people, he should be 
put under strict surveillance until it is proved whether he is mad or not. 
This will remove, in many cases, the fear and anxiety of those concerned, 
for the bite of a mere vicious dog, cannot produce hydrophobia. 

And it ought also to be stated here, that not everyone who is bitten by 
a mad dog, must necessarily become ill and die of hydrophobia. " Out of 
855 human beings bitten by rabid dogs, 299 (or nearly one-half) cases ended 
fatally. But if we include also the bites of dogs suspected of being rabid, 
the proportion becomes decidedly more favorable, 8 per cent, only of those 
bitten becoming ill and dying. Out of 1,362 human beings that had been 
bitten by rabid dogs, and dogs suspected of being rapid, there occurred 105 
fatal cases. How great an influence is exerted upon this final result by indi- 
vidual predisposition, or by other factors which are accidentally brought into 
play at the time of the bite (clothing, deposit of the saliva upon the gar- 
ments, the extent of the haemorrhage, the nature and location of the wound), 
is difficult to determine. ' ' ( Bollinger. ) 

The nature of the wound may be very trifling: a mere abrasion of the 
skin, capable of absorbing the virus, may be sufficient, for a fatal termination. 
Large wounds have been considered less dangerous than small ones, because 
the virus, it is said, is more easily washed out by the flow of blood; but with 
this facts do not agree. In regard to their location, wounds in the face are 
the most dangerous, next, those on the hands and on the body, lastly, those 
on the lower and upper extremities. 



952 HYDROPHOBIA. 

The wounds usually heal readily, with a striking absence of any inflam- 
matory tendency, and then follows the period of Incubation which varies 
greatly in length. It seldom is less than two weeks, most frequently lasts 
from three to six months, and in extremely rare cases two years and more-. 
During all this time the persons bitten feel, for the most part, quite well, only 
of some it is said, that touching the scar produces peculiar sensations, such 
as shuddering, feeling of anxiety, and sighing. 

The Premonitory Symptoms are in many cases very little character- 
istic. The original wound usually is presented by a mere scar, and becomes 
in exceptional cases only inflamed and swollen, and of a reddish or bluish 
hue. At times tearing pains proceed from the wounded parts, or peculiar 
sensations, such as prickling, boring, or burning. In some cases little blis- 
ters have been observed under the tongue. The patient loses his appetite, 
complains of headache, and becomes depressed and gloomy, and then again 
ill-natured, apprehensive, excitable, and agitated by an indescribable feeling 
of anxiety, especially when he himself refers his bad feelings to the bite as 
the cause. He speaks of it and its impending fatal result in a remarkable 
quick and sharp manner. He now becomes sleepless and restless and the 
ominous symptom of aversion to fluids, and great sensitiveness to every breath 
of air and reflection of light, is the beginning of the 

Second stage, the stage of hydrophobic spasms. However, it should be 
stated that this stage in some cases sets in abruptly, without any precursory 
symptoms, with a sudden inability to drink, which is soon followed by gen- 
eral convulsions of a paroxysmal character, or brought on by an attempt to 
drink water, by a sudden fright, or by any agitation. 

The inability to drink depends upon peculiar spasms of the muscles of 
deglutition, induced by an attempt to drink, or by the mere sight of water or 
glistening objects, so that after a while, notwithstanding the most intense 
thirst, the patient will rather endure the latter, than be subjected to these 
agonizing spasms — hydrophobia. With it are associated spasms of the 
muscles of respiration, induced by a draught of air, or by the opening and 
closing of a door — aerophobia — which causes dyspnoea and a feeling of suf- 
focation, sighing and groaning respiration, and the utterance of shrill, in- 
articulate sounds, resembling almost the hoarse bark of a dog. The general 
convulsions appear with variable degrees of intensity, from slight muscular 
contractions, trembling of the limbs, to the most severe convulsions of a 
clonic character, less frequently amounting to tetanic convulsions. These 
paroxysms are sometimes associated with manaical raging and hallucinations, 
which the patient vents upon those around him, by abusing them and snap- 
ping at them. They are of variable duration, lasting from one-half to three- 
quarters of an hour. However in exceptional cases they are absent, and the 
patient is able to swallow fluids, although the act is accompanied by pain. 
In some cases drinking succeeds when the patient is lefL alone, or when he 
closes his eyes, and uses the aid of a straw. So also are warm drinks, such 



HYDROPHOBIA. 953 

as milk, soups, also wine, often more easily taken than water. But in most 
cases the swallowing is impossible for fluids as well as for solids. 

The paroxysms are followed by periods of rest of equally variable dura- 
tion, during which the patient recognizes his surroundings, and answers 
questions correctly; but his voice is suppressed, and he appears extremely 
apprehensive, or talkative, and is in most cases sleepless. At other times an 
intellectual disturbance continues even during the absence of the spasms, and 
the patient sees objects which are not present, or imagines that his sufferings 
are caused by these around him, and he consequently rages and de ends him- 
self against those imaginary attacks and insults. 

The face of the patient is red, and expresses the greatest mental and 
physical misery and the most horrible agony. The eyes are wild, rolling, 
staring and livid; the eyeballs are injected, the pupils dilated, and the retina 
exceedingly sensitive to light. In some cases the face is pallid and cyanotic 
and the expression stupid. 

The mouth is full of viscid saliva, which as it cannot be swallowed, is 
constantly discharged or incessantly ejected in all directions. The tongue 
usually is moist and clean, at times slightly coated, seldom dry and thickly 
coated. The thirst is excessive, and accompanied by burning pains in the 
throat. The appetite is usually not affected. There is constant distress in 
the precordial region and dyspnoea; the bowels are constipated, and the urine 
is scanty, dark colored, cloudy, and frequently contains sugar, but no albu- 
men. The temperature usually rises to 100.4 F., seldom to 105 or 106 F. 
The skin is generally moist, and even covered with perspiration. During 
the paroxysms the extremities are cold and livid. After this paroxysmal 
stage, which may last from one and a half to three days, follows 

The third stage, or the stage of paralysis, into which the patient sinks 
gradually, if he be not carried off suddenly during a hydrophobic paroxysm. 
Then the convulsions become more feeble and cease entirely; the muscles 
still continue to twitch; the pupils are contracted or are of unequal size; the 
e3 T es are fixed, and strabismus frequently appears; " the saliva is no longer 
ejected, but runs from the open mouth; the voice becomes harsh and weak, 
the breathing short and rattling, and "the pulse very small, irregular and 
rapid; the skin is covered with a clammy perspiration." (Bollinger.) In 
some cases priapism with frequent seminal emissions has been observed. 

Towards the last many patients are again enabled to drink without any 
difficulty, " and this was considered of old to be a sure sign of death. Death 
itself may take place amid convulsions, or from asphyxia. It may also ap- 
proach quietly, seldom with symptoms of coma or suffocation." (Bollinger.) 
This last stage lasts, as a rule, only from two to eighteen hours. 

The most prominent morbid anatomical changes found on post-mortem 
examination are: hyperemia of the brain and its membranes, also of the 
spine and its membranes, of the lungs, and of the kidneys. The sinuses and 
peripheral veins are generally distended with dark colored blood, only slightly 
coagulated. 



954 THERAPKUTIC HINTS TO HYDROPHOBIA. 

Upon microscopic examination, Klebs found: " In all the swollen por- 
tions of the lymphatic system, and particularly in the submaxillary gland, a 
deposit of finely granular, strongly refractive corpuscles of a faint brownish 
color, closely packed together in clusters, at some points in the form of a 
long row, and at others branching out so as to form large star-shaped figures, 
following in general the course of the blood-vessels. " Whether these corpu- 
scles will prove to be the vehicles for the transfer of the specific infecting 
material, is as yet undecided. 

We can now more easily form an opinion as to the value of the old, but 
frequently renewed view, that hydrophobia in man is simply an affection of 
the nerves, which may be induced by anxiety and excitement ; that it is a simple 
myth. This imaginary origin and essence of hydrophobia is sternly rebuked 
by the sad fact, that so many persons, among all nations, succumb to the 
dreadful malady every year. If these persons were only hysterical women 
or hypochondriacal men, there might be some show for such an assertion, 
but the virus, if once implanted, spares neither childhood nor age. 

That it is a simple neurosis, a traumatic tetanus, is contradicted by the 
fact that hydrophobia has nothing common with traumatic tetanus. Accord- 
ing to Rose, these are the diagnostic points of difference between the two: 
"In traumatic tetanus a continuous spasm is present, to which there is finally 
added an increased reflex excitability; consciousness remains clear until the 
death-struggle; the organs involved in the act of swallowing are generally 
unaffected; the tetanic spasm begins in the masseter muscles and in those of 
the cervical region; the disease is fatal only when it breaks out within a few 
weeks after the injur}*. In rabies, on the other hand, clonic convulsions 
occur; reflex convulsions are noticeable from the outset; loss of conscious- 
ness often ensues at an early stage; the masseter muscles and those of the 
neck are not affected by the spasms; the disease makes its appearance after 
a period of incubation, lasting often for months; its course is uniformly acute; 
its termination fatal; its prominent feature consists of an affection of the 
organs involved in the process of deglutition." 

The Prognosis is a grave one. 

Therapeutic Hints. 

Prophylaxis. 

" While in cases in which. Cauterization is resorted to, scarcely 33 per 
cent, of human beings bitten by rabid animals fall victims to the disease; in 
cases where this operation is not practiced, exactly 83 per cent, of those bitten 
encounter certain death. " (Bollinger.) Brefeld gives the following direc- 
tion: " After the wound has first been syringed out with warm water, it is to 
be gently and thoroughly bathed and cleansed by means of soap-suds and a 
sponge, or with a solution of potash. The wound is next to be cauterized 
by means of caustic potash, and for several succeeding weeks (from four to 
six) a suppuration of the cauterized wound is to be kept up; a simple oint- 
ment, like resin cerate, being used as a dressing, or compresses saturated with 



THERAPEUTIC HINTS TO HYDROPHOBIA. 955 

a two-grain solution of potassa. Whenever cicatrization proceeds too rapidly, 
the cauterization by means of a strong solution of potassa is to be repeated." 

' ' The application of suction to the wound, either by the mouth of the 
sufferer, if the position of the wound permits, or by some other person, con- 
stitutes decidely one of the most efficient measures, and one that can always 
be applied upon the spot." (Bollinger.) It is self-understood that the lips 
of the operator should be entirely free from any cracks or wounds. Instead 
of the mouth, the dry cupping-glass may be applied, where the seat of the 
wound permits it. 

' l The best remedy," says Hering, " is heat applied at a sufficient distance 
to prevent actual scorching of the wounded part." Take a hot iron, a live 
coal, or even a burning cigar, and hold it so near to the wonnd and its cir- 
cumference that the patient feels the heat strongly, and continue until he 
commences to shudder. It is well to apply oil or fat around the wound, and 
necessary that all moisture which oozes from the wound should be carefully 
wiped off. This ought to be repeated three or four times daily, for one hour, 
until the w T ound has healed. 

So ma} 7 also the Turkish bath be of great use. 

There are a number of remedies, and among them a number of secret 
preparations used as prophylactics. 

Hahnemann recommends Bellad. in the smallest doses, at first repeated 
ever} 7 third or fourth day, and later at longer intervals. William Gross, 
Hering and Hartmann have also recommended it. 

Hydrophobin. or Lyssin has been introduced by Hering, and its provings 
show its adaptedness to such cases. 

Ca?ithar lb . Has been found effective by Hartlaub and Trinks. 

Anagallis arvensis and Meloe majalis are popular remedies. 

The developed malady requires first of all ' ' the removal of every cause 
of excitement ; the separation of the patient from everything calculated to 
disturb or render him anxious ; the maintenance of the utmost quiet ; the 
employment of a friendly tone of address (in place of coercive measures) ; and 
the endeavor to calm the sufferer by kind treatment." (Bollinger.) 

Bellad. Congested face ; wild staring look ; pupils dilated ; sensitive- 
ness to sunlight or shining things ; throat sore ; spasms of throat ; hoarse, 
barking voice ; inability to swallow ; oppression ; anxiety ; hallucinations ; 
biting and snapping ; convulsions. 

Canthar. When swallowing is prevented by inflammation, and not only 
from spasms of the throat ; spasms follow the pain caused by swallowing ; 
also when there is priapismus. (Hartmann.) 

Hydrophobin. or Lyssin. When the skin becomes bluish-red, with 
edges hard and swollen. (Hering.) 

Hyosc. General convulsions more prominent than spasms of the throat; 
does not spit and snap at those around, but abuses them otherwise. Sleep is 
interrupted as if by a sudden fright, followed by convulsions. After the 
abuse of Bellad. in massive doses. 



956 TETANUS. 

Laches. In the worst state of the developed disease it may be better 
than any other remedy. (Hering.) 

Spircea ulmer. During a frantic paroxysm a patient devoured with 
eagerness a piece of the root of this plant. One-quarter of an hour after, 
he became conscious, vomiting gall and fell into a profound sleep for 24 
hours. He was .well afterwards. (Kuhner, in Med. Journal, Vol. VII, p. 
51, Russia.) 

Stramon. Hahnemann says "that according to the totality of the 
symptoms of a given case, it may be indicated as well as Bellad. or Hyosc." 
Characteristics appear to be the fear of imaginary objects, and the great 
mobility and restlessness, with screaming. 

Tetanus. 

Tetanus is an acute infectious disease, characterized by spasmodic con- 
tractions of a group or groups of voluntary muscles. 

The predisposing causes are: 1. Slight injuries of the extremities. 2. 
External injuries of peripheral nerves. 3. Parturition, abortion, and inflam- 
mation of the navel of new-born children. 

The exciting cause is the baccillus of tetanus isolated by Kitasato. 

It is seldom that the disease is at once fully developed. Several days 
before its outbreak, chilly sensations are occasionally felt, even shaking chills, 
and aura-like pains from the injured part of the body. There are at first 
drawing pains in the neck and stiffness in the nape of the neck, with some 
difficulty of swallowing. These symptoms increase; the head becomes im- 
movable and drawn backwards, the masseter muscles grow rigid, the lower 
jaw is set, and deglutition still more difficult, even impossible. This state 
of things is called trismus or lockjaw. But frequently the tonic spasm gradu- 
ally extends over all the dorsal muscles, down to the sacrum, and over the 
muscles of the chest and abdomen, so that the whole body becomes as hard 
and rigid as a piece of wood. The muscles of the extremities are not quite 
so severely affected, and sometime not at all. The muscles of the face are 
likewise less severely involved; but still they participate more or less. There 
is a peculiar tension and painful expression in them. The eyesballs are 
rigidly drawn towards the inner canthus, and during the convulsive exacer- 
bations the forehead becomes corrugated; the eyebrows frown, the eyes stare, 
the lips are drawn asunder, showing the teeth; the tongue is thrust between 
the teeth, and frequently severely bitten. There is often risus sardonicus. 
This is tetanus. 

The general tonic spasm of the voluntary museles, however, has its re- 
missions, that is, the rigidity of the muscles yields occasionally to a more re- 
laxed state, until either without any external cause, or by some external in- 
fluence under a sudden general convulsive concussion, the highest degree of 
rigidity again sets in. Sometimes these recurring concussive jerks are so vio- 
lent that the patient is thrown backwards and forwards, while in other cases 
they resemble only electric shocks. In this way the disease progresses, alter- 



TETANUS. 957 

nating with rigidity, partial relaxation and convulsive concussions. The 
contractions are so violent that in most of the cases single bundles of muscu- 
lar fibres are torn and extravasation of blood takes place. The following 
forms of these spasms have been recognized: Opisthotonus, a bending of the 
body backwards, even to such a degree that the patient lies upon his heels 
and the back of his head; emprosthotonus, a bending of body forwards; 
pleurothotonus, a bending of the body sideways; and orthotonus, being 
stretched out straight. The most frequent form is opisthotonus; all other 
forms are quite exceptional. 

As long as the spasm prevails, the will has not the slightest influence 
over the muscles. On the contrary, an effort to check the spasm only in- 
creases the rigidity of the muscles, and likewise do all reflex irritations, so 
that, as is well known, even the slightest touch, movement of the bed, or even 
a draught of air, is sufficient to instantly cause the most violent canvulsive con- 
cussion'. 

The respiratory action is, of course, greatly interfered with, inasmuch as 
all the respiratory muscles are involved in the affection; where the remissions 
are of but short duration, we find dyspnoea in a high degree, and sweat, 
sometimes even danger of suffocation. 

The pulse during the remissions usually is normal, or only slightly accel- 
erated; but during the paroxysms it may reach 180, and the heart may sud- 
denly cease acting during the attack. The temperature rises in many cases 
to 1 1 2. 73 F., while in others it does not increase, or only slightly towards 
evening. 

There is great pain in the muscles during their contractions, and espe- 
cially is there a painful sense of pressure in the pit of the stomach, with ex- 
treme anxiety and excitement. 

There is usually distressing thirst, and in some cases actual hunger, 
neither of which can be satisfied; the bowels, as a rule, are constipated, and 
micturition is often impossible; the urine has, in some cases, been found to 
contain albumen, and in others sugar. 

The skin is generally hot and covered with perspiration, as in violent 
muscular exertions, and is followed by sudamina. 

The functions of the brain seem entirely unmolested; the patient has to 
suffer all these tortures in full consciousness. 

Sleep is entirely absent, and if the patient loses himself for a moment in 
consequence of exhaustion, he is at once roused again by violent concussions. 
This is the character of all kinds of tetanus. 

Trismus or Tetanus neonatorum presents on the whole, the same 
features; commencing at first with stiffness of the jaws and consequent in- 
ability to suck and swallow, the tonic spasms extend gradually downward 
and also implicate the extremities. Signs of collapse soon appear, and re- 
covery is still more uncommon than in cases of adults. 



958 therapeutic hints to tetanus. 

Therapeutic Hints. 

Aeon. Trismus and tetanus; contorted eyes; face changing color, now 
red, now pale again; throat feels dry and stiff. 

Angust. Opisthotonus from external injury; tetanic pains from injured 
foot up to back and neck; jaw stiff; two weeks after a needle had been run 
in foot. "Tremulousness of the muscles of the neck in the beginning." 
(Gilchrist.) 

Aryiica. After bruises; hot head, cool body; longing for alcoholic 
drinks; internal chilliness with external heat. 

Bellad. At the commencement, when there is: extreme excitement and 
sensitiveness of the skin; sudden jerks and shrieks during sleep; twitching 
of the muscles of the face and limbs; squinting; inability to swallow; later: 
convulsive motions; spasmodic respiration; dilated pupils; staring, open eyes. 
Wound healed but left a dark, tender spot: foot and leg swollen. 

Calc. card. Inflamed umbilicus of infants. 

Camphor a. Antidote to strychnine. 

Cicuta. Suddenly becoming stiff and immovable; tetanic stiffness of the 
whole body; opisthotonus; face puffed and bluish, or deadly pale and cold; 
eyes fixed, staring at one point; foam at the mouth; spasm of the chest, after- 
wards trembling; cannot recollect; the spasms are renewed from slightest 
touch, even from opening the door, and from loud talking. 

Cupr. ac. 6 In a case of locked jaw, and severe substernal pain, after 
removal of a large submaxillary tumor in an old man. (Gilchrist.) 

Gelsem. "Irritable, cannot be spoken to; heat in head, fulness of the 
face and cold feet." (Gilchrist.) 

Hydr. ac. "Cyanotic appearance, cold; the heart beats slower and 
slower, until it almost ceases, then suddenly rises in frequency, with each re- 
turn of the paroxysm." (R. Hughes.) "The suddenness and rapid es- 
tablishment of the attack, with opisthotonus, would seem to be pathogno- 
monic. ' ' ( Gilchrist. ) 

Hyper. After running a pin in right foot, pain runs up the limb through 
spine to neck and face; muscles of neck and jaw become rigid, and also the 
muscles of chest and abdomen. (W. F.Hocking.) Piercing wounds from 
pointed instruments' should always be treated with Hyper, to prevent any 
untoward symptoms. (Hering.) 

Laches. Peculiar tetanic look, half closed eyes and stiffness of neck; 
partial lockjaw; rigidity and pain in muscles of back. After cutting off two 
outer phalanges of third right toe, by being run over by a carriage wheel; 
soft parts of toe looked gangrenous nine days after accident. (M. Iy. Sircar.) 

One week after frost-bitten toe which had ulcerated, rigors, shooting 
pains in back, opisthotonus and trismus; remission midnight till noon; after 
midnight profuse sweat and agitated sleep; throat sensitive to contact; swal- 
lowing fearful. (I. Heber Smith.) 

Ledum. "Peripheral cases, traumatic, in which the parts become cold 
as ice, and the spasms begin in the wound." (Gilchrist.) 



CHOLERA ASIATICA. 959 

Lycop. Drawing of the head towards the right side, with stiffness of the 
neck, face and jaw; dizziness; heaviness in the head; weak eyes; dry and 
stuffed- up nose; dry, difficult stool; restless sleep; full of anxious dreams; 
much depressed in spirits. 

Moschus. Stiffness of the body, with full consciousness; spasms in the 
abdominal muscles. 

Nux vom. Intermitting fits of spasms; disturbed respiration; conscious- 
ness not disturbed; renewal of spasms from slightest reflex irritation. 

Phytol. Has caused the following symptoms: extremities stiff; hands 
firmly shut; feet extending and toes flexed; pupils contracted; te£th clenched; 
lips everted and firm; general muscular rigidity, opisthotonus; respiration 
difficult and oppressed; convulsive action of the muscles of the face and 
neck, followed bj' partial relaxation, which again was succeeded by the same 
tetanic condition. 

Platina. Opisthotonus alternating with spasms, with full consciousness; 
profuse menses; overbearing, proud disposition. 

Rhus tox. In consequence of taking cold from getting wet. 

Secale. After abortus, spasms with full consciousness, afterwards great 
exhaustion; heaviness in the head and tingling in the legs. 

Stramoii. Opisthotonus and trismus, with congestion to the head; red 
face; heat of the body; profuse urine; deep, snoring sleep. During the at- 
tack singing and declaiming. 

Ver. vir. Opisthotonus. Other remedies: Amm. carb., Amyl nitr., 
Arsen., Cannab., Curare, Hyosc, Ignat., Lauroc., Nicotine, Opium, Phy- 
so stigma. 

Cholera Asiatica. 

Cholera is an acute infectious disease characterized by violent vomiting 
and purging, cramps, and collapse. The exciting cause is generally conceded 
to be the comma bacillus, which was discovered by Koch, who was sent to 
India by the German government in 1883 for the purpose of making a gov- 
ernment investigation of this disease. 

He invariably found a bacterium in the fceces and intestines of cholera 
patients, which he was unable to demonstrate in the healthy, and named the 
same from its appearance the " comma " bacillus. 

Pettenkoffer, however, does not consider the bacillus as being the sole 
and most important causative agent in the production of cholera, and strenu- 
ously opposes the enforcement of quarantine during epidemics; his followers 
are known as anti-contagionists. He considers the condition of the ground 
water as the most important factor, for it is only in localities where there is 
a permeable surface and where ground water is present that cholera occurs; 
in such a locality the amount of ground water is also an important factor, 
the danger increasing in a dry season and decreasing during continued rain- 
fall; this is seen in Calcutta, where cholera decreases when the rainy season 



960 CHOLERA ASIATICA. 

sets in. He cites examples where the fresh discharges of cholera patients 
have been in jested with impunity, as favoring his theory. 

A case of true cholera exhibits the following symptoms: Beginning in 
most cases with profuse diarrhceic stools the bowels are quickly emptied of 
their contents. The discharges change to a rice-water-like fluid, and are 
accompanied by profound prostration. Upon drinking follows vomiting, at 
first of the contents of the stomach and afterwards of mere watery substances, 
slightly tinged yellow. The weakness of the patient increases rapidly and 
his voice becomes husk}-. The discharges now take place involuntarily, the 
secretion of urine ceases. To the insatiable thirst associate great anguish 
and oppression of the chest and in the pit of the stomach, and the most pain- 
ful cramps in the calves of the legs and in the bowels. The aspect of the 
patient has by this time changed fearfully. The eyes have sunk into their 
orbits, the nose has become pointed and the cheeks fallen in. The skin on 
the fingers is wrinkled, like that of a washerwoman — and if a portion of the 
skin is pinched it remains as a fold. The lips, extremities, genitals, assume 
a bluish, cyanotic color. The pulse is so faint that it scarcely can be felt, 
and so is the impulse of the heart. The whole surface of the body becomes 
icy cold. 

There is no headache, but frequently the patient complains of darkness 
before the eyes, roaring in the ears and vertigo. 

All this may take place in a few hours and the patient be no more. If 
recovery takes place all the symptoms may, by a perfect reaction of the 
system, become speedily extinct, but in case of imperfect reaction the disease 
assumes a typhoid state, which is sometimes complicated with different local 
inflammatory symptoms, such as pneumonia, pleuritis, bronchitis, parotitis, 
splenitis, or diphtheritic exudation in the pharynx, intestines, vagina and 
bladder, so that even if the patient lives through an attack of cholera itself, 
he may be carried off by its consecutive symptoms. All this, however, rarely 
takes place under homoeopathic treatment. 

The pathological changes, so far as they belong to the small intestines, 
are as follows: The serous (peritoneal) covering of the small intestines is, in 
consequence of capillary hyperaemia, of a rosy color and dry, or covered with 
a layer of sticky fluid; its mucous membrane is injected, and the solitary as 
well as Peyer's glands are swollen, and filled w r rth serum or solid exudation. 
The villi — those minute projecting papillae which are so abundant as to give 
to the entire surface a beautiful velvety appearance — have lost their epithe- 
lium, and the surface of the mucous membrane appears smooth, or covered 
with extensive extravasations. The colon presents in some epidemics signs 
of diphtheritic or dysenteric inflammation; at others no signs whatever. 
All other changes found post-mortem have not yielded any characteristic 
signs of cholera; they must be considered merely as accidental lesions, from 
which to make deductions would be, according to Buhl, a wrong to science. 
Dr. Gaspard Guillot, of L,yons, draws attention to the fact, which he ob- 
served, that the teeth of patients who died suddenly of cholera, assume a 



CHOLERA ASIATICA. 96 1 

hrick-red, and of those who lingered several days, a bronze or cyanotic color. 

Niemeyer explains the whole row of fearful changes, which the entire 
system undergoes by this dreadful malady, in the following manner: 

Out of the villi, which are denuded of their natural protection, takes 
place a constant copious transudation of serum into the gut, therefore, the 
rice-water discharges upward and downward, by which cholera is character- 
ized; but being deprived of their epithelium, these villi lose their capability 
•of absorbing the fluid which the patient takes as a drink; consequently the 
patient constantly loses fluids, but gains none. The next natural consequence 
of this must be, that the blood becomes dark and thick, in later stages even 
black, tarry, ropy, semi-coagulated. Thus the blood, deprived of its natural 
amount of water, seeks for fresh fluid supply, and absorbs all the water con- 
tained everywhere in the tissues, in consequence of which all the tissues be- 
come dry and reduced in volume; the nose becomes pointed, the cheeks fall 
in, the eyeballs sink back into their orbits, the skin wrinkles on the fingers 
like washerwomen's, and remains, as a fold, wherever pinched, and even 
pathological exudations, which have resisted all medication — for example, 
serous exudations of the pleural cavities, or within the synovial membranes 
of the joints — are completely absorbed, and moist eruptions and ulcers be- 
come dry like parchment. And further, it explains the cessation of all natural 
secretions, such as saliva, tears, sweat, urine and bile, simply because there 
is nothing more contained in the blood to be secreted. 

Another consequence of the blood constantly losing its watery con- 
stituents is this: the circulation of the capillaries becomes impaired, if not 
entirely prevented. As soon, however, as this takes place in the capillaries 
of the heart muscle, it causes, according to physiological and pathological 
experience, a paresis of the heart, and thus that characteristic feebleness and 
faintness of the heart's impulses and sounds, and the small feeble, faint pulse 
of the radial and carotid arteries, in cholera; thus, also, the cyanotic symp- 
toms, the blueness of the skin everywhere, the blue tongue, by which severe 
cases of cholera are characterized. 

On the same condition of the blood, also, depends that anguish for 
breath and hunger for air — that deep inspiration and short moaning expira- 
tion — which is always present in severe cases of cholera; for, in order that 
free expiration be possible, it is necessary, not onty that there should be a 
free admission of air into the air-cells, but also that a corresponding change 
of blood in the capillaries of the lungs should constantly be going on. A 
retardation of this flow causes an imperfect purification of the blood from 
its carbon, which fact can be demonstrated by an analysis of the exhaled 
air, which contains less carbonic acid gas than it does normally. The air 
passes out nearly unchanged, causing thus the characteristic cold breath of 
cholera patients, and as the vocal organs partake of the universal drying 
process, they become rigid, and naturally cause the voice of the patient to 
become changed into the peculiar cholera voice, which is rough and coarse, 
with perfect articulation. 
61 



962 CHOLERA ASIATICA. 

The very distressing and painful spasms or cramps, which contract the 
muscles into round, hard knobs, are doubtless caused by central irritation, and 
it is quite probable that this irritation originates in the same drying-out 
process which pervades the whole system. During the algid stage the 
temperature sinks to 93. 5 , in rare cases to 88° F.; the pulse is from the 
start feeble, and little or not at all hurried; exceptionally, only, it is as high 
as 96 or 100; often it becomes thready and hardly perceptible; even the 
heart's diastole may, in bad cases, be no longer recognizable while its systole 
continues. 

Dr. Koch considers this complex of symptoms of the attack proper of 
cholera, and which has generally been looked upon as a consequence of 
loss of water and the insipissation of the blood, essentially as poisoning 
of a special poison, which he supposes is produced by the comma-bacilli. 
" For," he says, " it (this complex of symptoms) takes place also not un- 
frequently when comparatively very small quantities of fluid are lost during 
life, by vomiting and diarrhoea, and when, immediately after death, the in- 
testine contains also only a small quanity of liquid. If, now, death follow 
in the stage of cholera poisoning, then the phenomena met with in post- 
mortem examinations correspond to those cases in which the mucous mem- 
brane of the intestine is little changed, and the contents of the intestine con- 
sist of a pure cultivation of comma-bacilli. If, on the contrary, this stage 
be prolonged, or if it be got over, the consequences of the mortification of 
the epithelium and of the mucous membrane show themselves; capillary 
haemorrhage in the mucous membrane takes place, and some of the compo- 
nent parts of the blood mix, in more or less abundance, with the contents of 
the intestines. The albuminous fluid in the intestines begins to putrefy, 
and under the influence of putrefaction, bacteria, other poisonous products 
are formed which are also absorbed. But these have an effect differing from 
that of the cholera poison; the symptoms caused by them correspond to what 
is generally called cholera-typhoid." (Translated from the ''Deutsche 
Medizinische Wochenschrift," in New York Medical Abstract.*) "Minute 
observation of these bacilli," so says the report of Dr. Koch and his col- 
leagues, <c under our treatment, led to the discovery of some very character- 
istic qualities, as to their form and growth in gelatine, which enabled us with 
certainty to distinguish them from other bacilli. And now we had the means 
of definitely deciding the question whether these bacilli belonged to the 
regular inhabitants of the intestine, or whether they occurred exclusively in 
that of cholera patients. And first of all, with the help of our gelatine pre- 
parations, we demonstrated the existence of these bacilli in the evacuations 
of all the cholera patients we examined, as well as in the intestinal contents 
of those who had died from cholera in a similar manner. We then examined 
the intestines of other corpses, and in every case the bacilli in question were 
absent from the intestines. Thus far we have examined the bodies of eight 
persons who died of pneumonia, dysentery, phthisis, and kidney disease, as 
well as of several animals, and other substances abounding in bacteria; but 



CHOLERA ASIATICA. 963 

nowhere did we find in them anything like our cholera bacilli. Should this 
phenomenon prove constant in the course of the further investigation, a very 
important result will thus have been attained; for if bacilli of a specific 
character are exclusively incident to the process of cholera, the original con- 
nection between the appearance of these bacteria of the disease would 
scarcely admit of any doubt, even if the reproduction of the disease in 
animals did not succeed. But, even in the latter respect, things seem to be 
in our favor, as some of the experiments made on animals have yielded re- 
results which allow us to hope for further success. ' ' 

The spread of cholera. Seeing that drinking water had a most potent 
influence upon the dissemination of the disease, Pettenkofer commenced, in 
the year 1854, his extensive and careful investigations as to the conditions of 
climate, weather and ground water in their bearings to cholera. His re- 
searches established the fact that the conditions of climate and weather had 
little or no influence, but that porous soils, which permit the penetration of 
moisture and fluids, were the very breeding beds for the spread of cholera 
germs, especially if resting upon closely packed alluvial clay, which arrests 
the further escape of the ground water downward, and collects it all in no 
great depth under the surface. Any well-feeding of such ground water, must 
necessarily become contaminated and be the source from which cholera will 
be further disseminated; for when drinking from such wells, the cholera 
germs would be transmitted to the very spot, the stomach and bowels where 
they could at once multiply and cause the disease. This is in accordance 
with all the facts known. A large material of such observations has been 
collected by Frankland in his article ' ' on the water-supply of London and 
the cholera " in the Quarterly Journal of Science, 1867. But this ground 
water produces cholera only, when the disease exists already upon the soil: 
it does not originate the seeds of cholera, but carries merely what it had 
received from the surface, and probably gives it a more or less favorable 
chance to multiply. 

To this mode of propagation belong also the instances where wells and 
rivers become contaminated by privies or sewers containing cholera germs. 
Kven milk if diluted with contaminated water or served in cans cleansed by 
such water will have the same effect. 

The air, too, is to a certain extent a carrier of the cholera germs, especially 
in the immediate presence of a cholera patient, and when being long exposed 
to its influence. But that air can carry the poison over large tracts of land 
has never been proved, and Hahnemann already has refuted this idea. 

Much more mischief is done by the adherence of the poison to solid 
bodies. Old clothing, linen, bedclothes, anything that has been soiled by 
the vomits or stools of the patient will surely disseminate the disease. The 
instances where it has been imported to distant countries by old rags thus 
contaminated are not rare. 

The Prognosis is very bad under allopathic treatment, 50 per cent, and 
more, as the last epidemic of 1884 i n France and Italy, has again shown. 



964 THERAPEUTIC HINTS TO CHOLERA ASIATICA. 

The deaths under the homoeopathic treatment amounted, even under the most 
unfavorable circumstances to only from 8-12 per cent, at the highest! 
Four homoeopathic physicians in Naples, Dr. Rubini, Cigliano, Mucci and 
Orioli lost in the same epidemic but 0.15 to 1 per cent! See a direct report 
of Dr. Tommaso Cigliano to the Allg. Horn. Zeitung in Leipzig, Vol. 109, 
No. 20, on the cholera epidemic of 1884 in Naples. 

Therapeutic Hints. 

For disinfection. These same physicians discarded altogether Carbolic 
acid, Chloride of lime, Sulphate of iron or Green vitrol, Corrosive sublimate 
and all other by the allopathic school profusely employed disinfectants. 
They advised their patients to burn Sulphur in privies and dirty places and 
corners, in rooms where cholera patients had lived and articles remained 
which they had used. Persons who had been in contact with cholera patients 
were advised to remain for a while in the vapors of camphor which had been 
allowed to evaporate on a hot iron, according to Hahnemann's direction. 
The dejections of cholera patients were mixed with a few spoonfuls of spirits 
of camphor. 

As prophylaxis they recommended Rubini' s solution of Camphor, which 
is made of 100 parts of camphor to 100 parts of spirits of wine; they advised 
it in doses of five, three or two drops twice or three times a da}'. 

In treating cholera patients they relied almost exclusively on Rubini' s 
camphor solution, giving 4 or 5 drops on sugar, or more in bad cases, every 
10 to 15 minutes, until reaction set in, when the doses were decreased and 
given in longer intervals. They used also Ver. alb. and Ctiprum and 
other remedies with good results, but their mainstay was Camphor in all 
stages. 

As drink the}' allowed fresh water, a little at a time, sometimes with a 
few drops of rum or cognac. If water would not stay on the stomach, they 
ordered small pieces of ice, although this only rarely. 

As nourishment they allowed, after perspiration and vomiting had ceased, 
meat broth, or water soup, or bouillion soup, also a little of watered wine. 
Thev never allowed any interference with any other drug, nor baths of any 
xind, nor change of bed or clothing until after perspiration had ceased. 

For injections Camphor is best applied in oil, or in warm water with 
some alcohol. 

I must here put in a word of warning against overdosing with Camphor. 
Camphor in an overdose will do harm and may even kill as well as cholera, 
and in a very similar manner, and just herein lies its homoeopathicity to 
cholera. If, when taken as a preventive or during reconvalescence, it causes 
stupefaction, somnolence, precordial anxiety, coldness and bluishness of the 
skin, its use must be discontinued at once, or the dose greatly diminished. 
Coffea or Opium are its antidotes. 

The best way of administering Camphor is on pieces of sugar; in water 
it causes often nausea and loathing to such an extent, that patients refuse to 
take it. 



THERAPEUTIC HINTS TO CHOLERA ASIATICA. 96.5 

Another prophylactic remedy which Dr. Hering recommended years 
ago, and which has proved equally successful in the several cholera epidemics 
of this country, is this: Take pulverized or precipitated Sulphur and put a. 
pinch of it into each stocking or shoe you are wearing; renew about twice a 
week. The sulphur will be absorbed by the skin and disinfect the body of 
an}- cholera germs that might chance to enter it, just as burning sulphur 
will disinfect rooms and clothing. 

The linen, bed sheets, etc. , should always, before they are given to the 
washerwomen, be thoroughly disinfected by exposure to the fumes of burning 
sulphur in a suitable room. 

As regards public sanitary measures, such as: The removal of filth from 
the streets, the abatement of nuisances, the filling up of wells in the city which 
may become contaminated by privies, sewers or ground water, the purifying 
of our rivers from which we draw our drinking water, the prevention of 
importing the cholera germs from abroad, we must necessarily leave to the 
proper authorities. 

As, there is, before and during an epidemic of this kind, generally a 
prevalence of bowel complaints (cholerine), it is quite important that these 
incipient symptoms should at once be attended to. We shall frequently 
find indicated: 

Aloes. Constant rumbling in abdomen with a feeling as if he must have 
a stool, but no evacuation following. (C. C. Smith.) 

Asar. Eur. In nervous and timid persons, who constantly feel chilly, 
or complain of cold hands, feet, knees or abdomen, even the hottest room or 
warmest covering does not relieve this chilly feeling; constant nausea, with 
loss of appetite or loathing of food without any gastric derangement; per- 
fectly clear tongue; rumbling and gurgling in the abdomen, likewise at- 
tended with nausea. 

Bryo7i. Diarrhoea in the morning after getting up, with previous cut- 
ting pain in the bowels. 

Card. veg. After exposure to heat of sun or fire (cooks, blacksmiths, 
masons, etc.), ushered in by haemorrhage from bowels; associated with flatu- 
lence. 

Chin, sulph. Foi the following precursory symptoms: great sensitive- 
ness against external influences; general weakness; internal bad feeling as of 
coming illness; anxiety; down-heartedness, moroseness, despondency, laziness, 
and lassitude, alternating with flashes of heat; heaviness in head as from a cold; 
loss of appetite, loathing and nausea; pressure in stomach worse after drink- 
ing water; pressure in pit of stomach up into the throat; pain in the bowels, 
especially after eating; constipation or soft stools followed by weakness ; 
heaviness and aching in all the limbs, especially in the joints. For this 
precursory stage, which, in the different single persons, of course, consists 
only in part of these symptoms, I gave Chin. sutph. y 0.01 to 0.06, one dose 
every evening, for eight days. None of the persons thus treated were at- 
tacked by cholera. If I ever should live to see another cholera epidemic, I 



966 THERAPEUTIC HINTS TO CHOLERA ASIATICA. 

would give Chin, sulph. and ozonized water. (Aegidi, A. H. Z. , Band 85, 
S. 191. 

Coloc. Bloody diarrhoea, with violent pain in the bowels, extending 
down into the thighs. 

Ipec. Nausea and vomiting predominating without, or at least always 
previous to, an alvine discharge. 

Iris vers. Violent pain at the pit of the stomach or around the navel, 
or in some cases still lower down in the abdominal region, at or before* even- 
fit of vomiting and purging. 

Mercur. Blood}', slimy discharges, with tenesmus. 

Phosph ac. Especially in the summer season; painless, watery dis- 
charges; great rumbling in the abdomen; bloatedness; sticky tongue. 

Secale. Painless diarrhoea, with tingling and numbness in the limbs. 

Veratr. Diarrhoea, and vomiting of a turbid water, with cold perspira- 
ton on the forehead. 

The developed cholera may point to one of the following remedies. 

Camphora. Hahnemann's discover}-; he says: "When cholera first 
makes its appearance, it usually attacks in the following way: great prostra- 
tion at once; the patient cannot stand; his features become distorted; his 
eyes sunken; his face and hands bluish and icy cold, with coldness of the re- 
maining parts of the body; his features express despair, and his whole action 
anguish, as though he would suffocate; half- stupid and senseless, he moans 
and groans in a hoarse, husky voice, expressing nothing particular, unless 
questioned. He has burning in the stomach and oesophagus, and cramps in 
the calves of the legs and in other muscles; when touched in the pit of the 
stomach he screams out; he has no thirst, no nausea, no vomiting, no diar- 
rhoea. In such cases Camphora gives immediate relief; one drop of the tinc- 
ture on sugar every five minutes. ' ' These observations of Hahnemann have 
been verified since by hundreds of physicians, and in thousands of cases. 

As additional symptoms I might mention: vertigo, nausea, vomiting 
with cold perspiration, especially in the face; faintness, asphyxia; cramps 
ever}- where; the upper lip is drawn up. exposing the upper teeth. It is also 
recommended after previous use of allopathic medicine. Its beneficial action 
s seen in a gradual glow and warm perspiration all over the body; when of 
course its use must be discontinued. Overdosing calls for Coffea or Opium. 

Next to Camphora in frequency of its use stands — 

Ver. alb. Anguish; fear of death, or indifference; vertigo; eyes sunken: 
nose cold; face cold, pale, distorted, bluish, bloated; great thirst for cold 
water, and vomiting after drinking, with great debility or diarrhoea at the 
same time: the discharges are gushing, profuse, rice-water-like, with cramps 
and colic in the bowels; cold feeling in the abdomen; tongue pale or bluish; 
dry or yellow-coated; cold; voice feeble and husky; very anxious oppression 
and constriction of the chest; tonic cramps commencing in hands and feet, 
gradually spreading all over; pulse very small, thread-like; coldness all over ; 
cold perspiration. 



THERAPEUTIC HINTS TO CHOLERA AS1ATICA. 967 

Cuprum. Hahnemann says: "If, after Camphora, there should not 
soon be a change for the better, apply at Once Cuprum x." Its sphere of 
action is the following: very painful clonic spasms in different parts of the 
body, so that the patient cries out; great pressure in the pit of the stomach, 
worse from contact; constriction of the chest; great thirst; for a while after 
drinking cold water vomiting and diarrhoea not very prominent; anxiety; 
cold face; blue lips; coldness all over; skin inelastic; urine suppressed. 

Besides these compare the following remedies: 

Aeon. Restlessness: coldness externally, but to the patient a sense of 
burning heat through the whole system; excessive thirst, but cannot retain 
anything; vomiting and purging of green, watery fluid; collapse. Two 
drops of tinctnre in half a tumblerful of water, two teaspoonfuls every half 
hour. (W. Boyce.) 

Arg. nitr. During the height of the disease, when the respiratory 
muscles are attacked with spasms, so that the patient can scarcely breathe, 
neither speak; to drink a swallow of water, or the approach of a handker- 
chief to the nose causes a feeling of suffocation, with terrible anxiety and 
thoughts of self-destruction; during the oppression severe stitches in the pit 
of the stomach; after taking any fluid it appears as though it were running 
straight through the intestinal canal without stopping. 

Arsen. Great anguish, indescribable, with constant restlessness; fear 
of death: sudden prostration; eyes sunken; nose pointed; face pale, cold, 
distorted; tongue dry, brown, or black; excessive thirst for cold water, but 
drinking little at a time, which is immediately thrown up; violent burning 
in the stomach and bowels, worse after throwing up; urine suppressed; voice 
hoarse; great oppression and constriction of the chest; skin wrinkled, dry, 
cold, blue; cramps, clonic and tonic, in different localities; cold, sticky per- 
spiration. May be indicated in all stages of the disease; best sign of its 
proper choice is the reappearing of urinary secretion. 

Bryon. 3 ° A few globules each time after vomiting alone, or after vomit- 
ing and purging, it cured even the worst cases with loss of consciousness, 
inability to speak, icy-coldness of the skin, wrinkled skin; pulselessness. 
(Haynel.) 

Carb. ve%. In the last stage; when already the discharges up and 
down, the cramps, and general reaction have ceased; when the patient lies 
in a sopor, and is pulseless, with cold breath, cold tongue, or coldness all 
over, a picture of perfect collapse. 

Cicuta. Violent cramps; tonic spasms of the muscles of the chest; loud 
hiccough; eyes turned upwards; soporous condition. 

Laches. Vomiting renewed by the slightest motion, and nausea attended 
by a great flow of saliva. 

Crot. tigl. Gushing out of watery discharges mixed with whitish flakes 
with rumbling, griping in the bowels, and afterwards burning in the anus; 
discharges always brought on after drinking and motion; great exhaustion; 
faintness and dizziness. 



968 THERAPEUTIC HINTS TO CHOLERA ASIATICA. 

Hydr. ac. When there is a rapid progress of the disease towards as- 
phyxia; marble coldness of the whole body; pulselessness; cessation of diar- 
rhoea and vomiting; hiccough; paralysis of the oesophagus; when drinking, 
the fluid runs gurgling down the oesophagus; long fainting spells; trismus; 
tetanus. 

Jatropha. Violent vomiting of a whitish, jelly-like substance, resembing 
the white of an egg; discharges from the bowels in gushes; gurgling noise in 
the abdomen, sounding as if a bottle were being emptied; cramps in the 
calves of the legs, drawing them flat; at the same time the mind is in a kind 
of ecstacy and takes little notice of these painful spasms; or anxiety and fear, 
as though cramps in the calves would set in; burning of the abdomen; belly 
drawn in; marble coldness of the body; pulselessness; cold, sticky per- 
spiration. 

Ipec. In light cases, where the vomiting predominates over the alvine 
discharges; vomiting mostly of a sour fluid, without diarrhoea. 

Phosphor. Tongue coated white; excessive thirst; vomiting after the 
water has become hot in the stomach: hiccough after eating; belly bloated; 
rumbling and rolling in the abdomen; the rice-water evacuations contain 
grains like tallow; oppression; great sinking of strength. 

Secale. Dizziness, deafness; painful retching; profuse diarrhoea; un- 
successful urging to urinate; skin wrinkled; tingling in the limbs; cramps 
and coldness; aversion to heat and being covered. 

Sulphur. First recommended by Dr. Hering, because it corresponds to 
its commencement in the morning, its cramps in the calves of the legs, its 
indifference of mind, and lastly its red spots, furuncles, etc., during con- 
valescence. Diarrhoea and vomiting at the same time, wakens the patient 
after midnight; the body grows cold and blue, with intense cramps in the 
calves of the legs and soles of the feet; pain in the region of the liver. 

Tabac. Cold perspiration, with constant, deadly sickness and vomiting 
now and then; cramps and tearing in the limbs. 

Consecutive symptoms may call for — 

Aeon. If there be high, inflammatory fever; hard, strong pulse; con- 
gestion of the head or lungs; great restlessness; fear of death. 

Bellad. Congestion of the head with violent delirium; visions and 
illusions of senses. 

Bryon. Typhoid symptoms; pain in all the limbs on moving. 

Canthar. Excessive sensitiveness of the abdominal walls; burning in 
umbilical region and deep in the pelvic cavity; rumbling in the abdomen 
and tenesmus followed by bloody evacuation; urination drop by drop, with 
great burning; suppression and retention of urine. 

Mur. ac. Difficult speech; moaning and groaning during sleep; sliding 
down in bed. 

Phosph. ac. Indifferent; without pain; delirium; drowsiness; sopor. 

Rhus tox. Typhoid condition; red tip of tongue; pain in all the limbs 
on lying quiet. 



ERYSIPELAS. 969 

Tereb. if Canthar. has failed. 

Dr. J. Buchner's therapy is the following: Cholerine: Ipec, Phosph. 
ac, Veratr. Cholera: Amm. sulph., Camphora, Cuprum, Cupr. ac, Ipec y 
Veratr. Cholera paralytica : Nicot. Typhoid ex diphtheride : Nitr. 
ac Typhoid ex morbo Brightii : Arsen., Cupr. ac, Phosphor. Other 
remedies which may be indicated: Card, veg., Cicuta, Ox. ac, Jatropha. 
Crot. tigl., Opium, Plumbum, Secale, Tabac, Tart. emet. 

Dr. Schussler recommends : Kali phosplwricum. 

Erysipelas. 

Erysipelas is an acute .infectious disease characterized by a peculiar in- 
flammation of the skin and enlargement of the neighboring lymph glands, 
and is accompanied by more or less severe systemic disturbances. 

The micrococcus erysipelatis which is found in the lymphatics of the 
part effected is probably the exciting cause. 

It was formerly divided into two forms, the Idiopathic, and Traumatic, 
or medical and surgical respectively, this distinction is, however, no longer 
made, as the idiopathic form can generally be traced to infection through a 
slight abrasion of the skin. As the slightest scratch may be the recipient of 
the poison, the disease is often communicated to nurses and physicians. 
''Erysipelas, like phlegmonous inflammation, affects the skin in its whole 
thickness and the subcutaneous cellular tissues. All the layers of the corium 
and of the subcutaneous cellular tissue are cedematous, swollen, and pene- 
trated by large, finely granulated, white blood-corpuscles. The meshes of 
the connective tissue in which these cells are inbedded are very decidedly 
separated by them and by the fluid which uniformly permeates the tissues. 
The most important distinctive feature of erysipelas is its disposition to spread 
only by creeping uninterruptedly onwards without making jumps," or as 
Billroth has it, "it spreads like water in blotting paper." When on the 
.scalp or face it is limited mostly to a more or less extensive portion of the 
skin of the head and face, and seldom descends over the neck to the trunk; 
on other parts of the body it is apt to spread over larger surfaces. 

Its local Symptoms are frequently preceded a day or two by a feeling of 
general malaise, chilliness and feverishness. Then the part affected, usually 
the cheek, begins to feel hot and tense; the skin reddens and swells, and be- 
comes very sensensitive to the touch. At the same time the adjacent 
lymphatic glands commence to swell. The inflamed portion assumes a red, 
smooth and shiny appearance, which is, however, darker and duller on the 
scalp than on other parts, and to the touch it gives the impression of a hard, 
stiff, caked mass. 

On the second or third day, generally, the redness and swelling reach 
their height, and, at this stage, in some cases, the epidermis becomes raised 
and filled with a yellowish, limpid fluid, sometimes tinged with blood, in the 
shape of large blisters — Erysipelas bullosum — which either dry up, or burst 
and become covered with crusts. 



970 ERYSIPELAS. 

During the height of the disease, the patient has high fever, with evening 
aggravations; his sleep is restless and full of dreams; he sometimes becomes 
delirious. On the fourth day the redness and swelling gradually subside on the 
places first attacked, while those parts which were invaded later stand yet in 
full bloom. By and by, however, they grow paler, softer, and assume a 
wrinkled appearance, as the swelling leaves; the crusts dry off, and on the 
whole surface the epidermis peels off in large flakes; the entire process last- 
ing from about eight days to two weeks. 

But this is not invariably its course. Just in its very nature, to creep 
on, lies its danger. It may, by continuity of tissue, wander to the mucous 
membrane of the nasal and pharyngeal cavities, cause an oedema of the glot- 
tis, and affect the larynx, the bronchial tubes, and even produce pneumonia 
and pleuro-pericarditis. 

The most important complications, therefore, are pneumonia, purulent 
meningitis and oedema of the glottis. Peritonitis, pericarditis and pleurisy 
are of rarer occurrence. 

The tongue usually is covered with a white creamy coat, which dries 
gradually, becomes dirty yellow and, when the fever is protracted, blackish 
and crust-like; there is nausea and vomiting; sometimes diarrhoea and, what 
seems very remarkable, in rare cases profuse intestinal hsemorrage, in con- 
sequence of ulcers in the duodenum, which generally have proved fatal, and 
remind one of similar symptoms which are occasionally observed after severe 
burns of the skin. In almost all cases there is albuminuria. The fever, ac- 
companying erysipelas, is characterized by a sudden rise of the temperature 
to even 104 F. or higher often within from 8 to 12 hours, still rising to 
105. 8° and in some cases to 107. 6° F. Exceptionally, however, the tem- 
perature shows periods, even for the length of a whole day, of marked de- 
pression, after which again a sudden rise takes place. When recovery ap- 
proaches, it usually sinks as rapidly as it rose, and may attain its normal 
standard within a few hours, or in a single night; then desquamation of the 
epidermis, in the form of large or branny scales, and wrinkling of the skin 
terminate the local process. However, even after this in some cases a re- 
newed sudden rise of temperature has been observed. The hair usually falls 
out, but quickly grows again. The skin, too, recovers its normal state; only 
upon the eyelids, the scrotum, the prepuce and vulva, where it is naturally 
tender, it may in severe cases undergo a more or less extensive gangrenous 
destruction, and its duration be prolonged to several weeks, even months. 

Unlike to other infectious fevers, erysipelas leaves a very great suscep- 
tibility for renewed attacks. Not a few persons are subject to a periodically 
returning form — the so-called Habitual erysipelas, which mostly affects the 
face or lower extremities. 

The Prognosis of erysipelas is favorable, as long as it does not spread 
to internal organs. 



therapeutic hints to erysipelas. 97 1 

Therapeutic Hints. 

The external application of raw cotton to the inflamed parts, to keep off 
the air, as in burns, I have found decidedly beneficial. The terrible itching 
is sometimes alleviated by the application of rye-flour. 

Apis. Spreading down to the face with great cedematous swelling of 
the eyelids, forming reddish, watery bags under the eyes; stinging, pricking, 
burning; smooth or blistered; thirst or no thirst. 

Bellad. Especially right side; eruption smooth, shining, streaked, of 
bright red color; brain symptoms prominent; sometimes nausea, gagging, 
retching; or coughing; drowsy but cannot sleep. 

Borax. Mild form; left side; painful when laughing with sensation as 
if covered by cobwebs. (Bonninghausen.) Pale, red oedematous swelling 
from left lower eyelid down to cheek; anxiousness; childbed; "after Apis 
and Rhus tox. had failed." (Fellger. ) 

Euphorb. Highly prized by Dr. H. Boskowitz. "It helped after 
Graphit. had failed." (W. K. Payne.) 

Hydrast. Wandering from left side of nose to right over whole face 
and scalp; intense pain in the lumbar region; chills down the back; ex- 
tremely restless; disturbed by noise; delirium; urine suppressed. 

Laches. Purplish, leaden hue; tongue dry, glossy, tremulous; visions, 
and delirious talk as soon as he shuts his eyes; aggravation from noon till 
midnight. 

Pulsat. The ears are especially affected; during damp, wet weather. 

Rhus tox. Vesicular form; spreading from left to right; burning and 
itching; nasal and pharyngeal cavities inflamed; great restlessness; pain in 
back and limbs, worse in rest; after getting wet. 

Ver. vir. Right side of head and face much swollen and covered with 
large blisters; headache; high fever; no sleep; no appetite; intermitting 
attacks of nausea; occasional vomiting of the water drank. It was applied 
low, externally and internally. Still other remedies may be indicated. 

Arse?i. Irregular progress; disposition to internal organs; terrible 
restlessness and sinking of strength; fainting pain in the bowels and haemor- 
rhage, as sometimes occurs in large burns. 

Camphora. Great exhaustion; coldness of skin; breathing scarcely 
audible or visible. Bonninghausen has recommended it for the initial 
symptoms, low and frequently repeated. 

Canthar. Large blisters, irritable and burning; after Rhus tox. had 
failed. Post erysipelitic chronic pricking of the skin. 

Chamom. Suppuration of the cellular tissue; low externally and in- 
ternally. 

Crot. tigl. (Edematous swelling of eyelids; large and small blisters 
intermediate skin cracked and peeling off; violent burning. 

Cuprum. Sudden sinking of the swelling and changing into a bluish 
color; violent brain symptoms. 

Graphit. Tendency to repeated attacks of erysipelas bullosum; also 



972 THE PLAGUE. 

when new aggravations come on during the same attack; constrictive head- 
ache in occiput; perspiration does not relieve. Habitual erysipelas, often 
alternating with tetter}' eruptions. 

Ipec, Retrocession of eruption, with vomiting. 

Kali carb. From right to left side; oedematous swelling under the eye- 
brows. When touched ever so slightly on his feet, he jerks them up much 
frightened; he talks of pigeons flying in the room, which he tries to catch 
with his hands; he gets regularly worse about 3 o'clock A. M. After previous 
attacks. 

Sulphur. Psoric taint; helps often when all others fail; habitual form. 

Phosph. ac. Traumatic form, where the periosteum is affected. 

Ruta. In combination with wounds. 

Silk. When the bones are injured. 

Gangrenous destruction, hints to: A? sen., Carb. veg., Cinchona and 
Sec. cor. 

Schiissler recommends Natr. sulph. for the smooth form with or with- 
out vomiting of bile, and Kali mur. for erysipelas bullosum. 

The Plague, Pestilentia. 

Is an acute infectious disease characterized by a suppurative inflamma- 
tion of the lymphatic glands, and the development of typhoid symptoms. 

The nature of the plague-virus is as yet unknown. 

Its home is in the countries of the East. Europe has been free from it 
since 1841, although an epidemic on the Russian frontier as late as 1878-1879 
put Europe on its guard. The contagiousness is greatly enhanced by de- 
ficient ventilation of the streets and houses, by the crowding together of 
many individuals into a small space, and by uncleanliness. 

The stage of incubation is given at from two to seven days, but the capa- 
bility ot the plague poison to live outside of the human body seems under 
certain conditions to extend over several years. 

Its stage of invasion begins suddenly, with bodily and mental weakness, 
headache, dizziness, pale and flabby face, distorted features, languid eyes, 
awkward speech, staggering gait, without fever, exhibiting the picture of an 
intoxicated man. Sometimes it is attended with vomiting and diarrhoea, and 
lasts from a few hours to one or more days. 

The second stage is characterized by an intense fever, which is introduced 
by chilliness or by a well-marked chill; the pulse is very frequent and the 
respiration accelerated. The patient soon passes into a well-formed typhoid 
condition, with wild or mild delirium, stupor and coma, dry, cracked tongue, 
sordes on teeth and lips, soot-colored crusts in nostrils, cardiac weakness, 
feeble, small, irregular pulse, sometimes cyanosis of the lips. This stage may 
continue for two or three days, when 

The third stage commences with the appearance of buboes, usually at- 
tended with a diminution of the fever, the breaking forth of a sticky, strong^ 
smelling sweat, a lowering of the pulse and the returning of consciousness. 



EXANTHEMATA. 973 

The buboes occur oftenest in the inguinal regions, but also in the axillae or 
on the neck, but as a rule, onry in one of these regions at one time. They are 
sometimes quite small; in other cases they attain the size of a hen's egg or 
even larger. Their suppuration is considered as favorable; in other cases 
the tumors become resolved. 

Besides buboes there occur in some cases carbuncles, usually on the 
lower extremities, also on the buttock and on the back of the neck. Petechise, 
vibices, or extensive ecchymobes appear only in the severest cases shortly 
before death. 

"Convalescence begins generally between the sixth and tenth day, and 
is often protracted by continuous suppuration of the buboes. Among the 
Sequei^E should be enumerated parotitis, furuncle, abscesses of the skin and 
muscles, pneumonia, protracted fever with continued typhous condition, 
drops}*, partial paralysis, mental disturbances, etc. Genuine relapses may 
also take place. ' ' (Liebermeister. ) 

Death can occur during any stage of the disease. The mortality of the 
plague is greater than that of any other epidemic disease. But the different 
epidemics vary greatly in this respect. 

Therapeutic Hints. 
In the August number, 1879, of the North American Journal of Horace - 
opathy, page 63, Dr. Hering says; " L,orbacher proposes as the main remedies 
for the plague; Laches., Arsen., Carb. veg., Chin, sulph. and ars. , Phosphor., 
Secale and A?ithrac. We may mention here our proving of Badiaga, which 
might be considered a remedy against the plague. What Laches, will do is 
uncertain. Still more uncertain is Arsen. Chin. ars. not being proved, we 
may leave altogether. Secale is another drug only known by poisonings. 
Anthrac. very likely will be of great importance in the plague. Kali phosph., 
proposed by Raue, we permit ourselves to mention as very promising. 
Str anion, has more similarity to the plague symptoms than Bellad.; and Silic. 
more than Hepar. Lomine, a preparation of the pus of the plague, brought 
here by Dr. Theuille, has cured cases of the greatest importance; one with 
suppurating sw T ellings along both sides of the neck, and cured them perma- 
nently. ' ' 

EXANTHEMATA. 

The Exanthemata are acute infectious fevers, characterized by the de- 
velopment of an eruption on the surface of the body during their course. 

There is a large number of infectious diseases whose specific causitive 
micro-organisms have not yet been discovered, among them are the exanthe- 
mata, pertussis, mumps, yellow fever and others. Welch, (in Amer. Text- 
Book of Pi r actice) thinks it improbable that bacteria will be found to be the 
exciting cause of those infectious diseases in which bacterial investigations 
have hitherto been unsuccessful. He says: " They are more probably caused 
by some other class of micro-organisms, for the demonstration and study of 
which we have not at present the same satisfactor}* methods as for bacteria." 



974 MEASLES. 

Measles, Morbilli, Rubeola. 

Measles is an infectious disease in which coryza, bronchitis and an erup- 
tion are the distinguishing features. 

It is extremely contagious, and more so during the stadium prodromorum 
et eruptionis than at a later period. The nature of the poison is entirely 
unknown. Only this much is certain, that it regenerates itself in the infected 
persons, impregnates the surrounding atmosphere, and that it may be carried 
from there to other quarters. Measles prevail therefore mostly as epidemics, 
in preference, it seems, during those months which favor catarrhal affections. 
As a general rule they attack a person only once in life, and children more 
than grown persons, although there are many exceptions. Also relapses 
occur sometimes after a few days or few weeks. The time of incubation 
varies from one to two weeks. 

The eruption of measles consists of numerous, roundish, lentil-sized red 
spots, which are a little raised above the level of the surrounding skin and 
generally contain in their centre a little papule. The closer they appear the 
more they coalesce, and in this way form irregular-shaped plaques, while on 
places where they are scarce they stand isolated. Between these spots the 
skin retains its normal color; on the face, however, it is usually somewhat 
cedematously swollen. Even in cases where they appear so abundantly as to 
coalesce (morbilli confluentes) they do not present an evenly diffused redness, 
but always a spotted appearance. There are cases in which the hyperemia 
of the skin results in an extravasation of blood, causing the eruption to 
assume a dark, blood-red appearance, and petechial spots to appear between 
the eruption; this form is called morbilli petechiales or hsemorrhagici, or 
rubeolce nigrce. The measly redness disappears under the pressure of the 
finger and reappears again after removing the finger, from the middle towards 
the periphery, contrary to scarlet fever redness, which reappears from the 
periphery towards the centre. Measles are always more or less accompanied 
by catarrhal affections of the eyes, nose, larynx and bronchial tubes, even 
by pneumonic symptoms. The blood is, like in other infectious diseases, 
poor in fibrin and of a dark color. 

The course and progress of measles is as follows; 

The first stage, or the stadium prodromorum, consists in a seemingly 
simple cold in the head and chest. There is chilliness and feverishness, and 
the temperature increases rapidly to 102 ° or 104 F. , but lessens again con- 
siderably on the next day; there is headache, sensitiveness to light, watery 
eyes, watery discharge from the nose, sneezing, nosebleed, hoarseness and 
cough, which latter sometimes assumes a croupy nature. Only in exceptional 
cases these symptoms amount to any considerable severity, and may then be 
associated with vomiting, delirium and sopor; in the majority of cases, 
however, the little patients do not mind them, but run about. On inspection 
of the fauces we observe that about the third day of this premonitory stage 
the identical eruption of measles has already made its appearance in the 



MEASLES. 975 

form of single, lentil-sized red spots upon the roof of the mouth and the 
palatal mucous membrane, some twenty-four or twelve hours before there is 
am- sign of an eruption on the external skin. This accounts at once for all 
the catarrhal symptoms, and for the fact that measles are already transmitted 
at this early stage from child to child by the mere breath. 

The second stage, the stadium eruptionis, begins on the fourth or fifth 
da}' and is marked by an exacerbation of the fever; the temperature of the 
body rises again, averages during the height of the disease about 104 , and 
may, in severe cases, reach even 105.8 F. During this time it happens 
occasionally that convulsions set in. The eruption appears first on the face 
and spreads gradually downwards over the whole body. There is now a 
peculiar measle-smell, scenting the whole atmosphere of the patient. In 
anomalous cases the eruption appears at first on the arms; in others it stays 
confined to single portions of the body, and in still others there is no eruption 
at all (morbilli sine exanthemata), although all the other symptoms and the 
previous exposure to the contagion leaves no doubt as to the nature of the 
disease. The stadium eruptionis generally is completed in twenty-four to 
thirty-six hours, although in some cases it lasts three, even four days, in 
which cases the first spots already disappear when the last come out. During 
this stage diarrhoea often sets in, and the catarrhal affection generally reaches 
its acme, but in malignant epidemics death may ensue in consequence of 
general paralysis and adynamia already at this early stage. In such cases 
the pulse grows weaker and weaker; the cutaneous capillaries burst and 
cause haemorrhages within the cutis; the prostration of strength is excessive 
and the patient sinks into a typhoid condition. , 

The third stage, the stadium florescentiae, is blended with the eruptive 
stage. In usual cases, already twenty-four hours after its full development, 
the redness commences to grow paler, and with it all the other symptoms, 
heat and catarrh, gradually grow milder. Such normal cases are termed 
morbilli vulgares, simplices or erethici. 

In other cases the measle-spots grow darker, assume a purple color, and 
remain visible upon the skin for five or six days. The dark coloring of the 
eruption is owing to the rupture of the cutaneous capillaries, and for this 
reason the redness does not disappear under the pressure of the finger. The 
whole morbid process approaches that of other inflammatory processes. The 
heat rises above 104 F. ; there is throbbing of the carotid arteries, palpita- 
tion of the heart, and a full, strong pulse; the catarrhal cough not unfre- 
quently changes into a croupy cough, and there may exist a complication 
with lobular pneumonia, or the catarrhal affection extends upon the alimen- 
tary canal and causes vomiting and diarrhoea. This state of things may aug- 
ment to complete prostration and collapse; then the eruption disappears from 
the skin and such a condition is not without danger. This form of measles 
has been termed morbilli inflammatorii, synochales. 

Still another form is that which has already been alluded to in the sec- 
ond stage. It is characterized by general adynamia and torpor. The erup- 



976 THERAPEUTIC HINTS TO MEASLES. 

tion remains visible only a short time, is either pale-reddish or purple, and 
frequently interspersed with petechiae. It is often combined with profuse 
bleeding from the nose; the pulse is very frequent and scarcely perceptible, 
and the patient sinks into sopor and collapse. This form is called morbilli 
asthenici, nervosi, torpidi, or septici. 

The fourth stage, the stadium desquamations, commences in simple cases 
usually about the eighth or ninth day of the disease. The measle-spots have 
at this time entirely disappeared, and in their plaees we observe a gradual 
loosening of the epidermis, which is thrown off in the form of fine scales. 
This process can best be observed on the face and hands, while on the parts 
covered, the loosened skin is rubbed off before it is noticed. This stage is 
rarely interrupted by dangerous complications; still, it may become compli- 
cated by croupous laryngitis or pneumonia. Noma or mortification of the 
labia pudenda is of very rare occuirence. 

As Seouee.E of measles are mentioned as quite prominent, chronic ca- 
tarrhal cough, and chronic pneumonia, which may end in consumption. Be- 
sides these, a number of scrofulous affections, such as chronic inflammation 
of the eyes, otorrhoea, glandular swellings, and chronic inflammations of the 
periosteum and of the joints. It is but just to remark that under homoeo- 
pathic treatment sequelae are of very rare occurrence. 

Therapeutic Hints. 

The bedroom should be kept of an equal temperature at about 65 ° or 
66° F. It ought to be aired frequently with care. The light in the room 
should be, modified according to the patient's own desire. If he wants to 
drink, he may have cold water, he may eat fruit, provided his bowels are not 
disordered. When the fever, catarrhal irritation and desquamation have 
passed off, he should have a warm bath, and on the following day a cool 
w r ash all over, taking care that it be done quickly and that the patient be 
well rubbed and dried with flannel afterwards. From this time he may be 
allowed to go into the fresh air, provided the weather allows it. 

Aeon. Is the very remedy at the beginning, because it corresponds to 
all the symptoms of usual cases — full, quick pulse; dry, hot, burning skin; 
fever ; restlessness ; catarrhal irritation from the eyes down into the bronchial 
tubes; nose bleed; dry, hacking, or even croupy cough; stitching pains in the 
chest; restless sleep, with jerking and starting; grating of the teeth, moan- 
ing and groaning, or sleeplessness with great agitation and anxiety; pain in 
the stomach and bowels, with vomiting and diarrhoea. 

Ant. crud. Pain in the ears; white-coated tongue; gastric derange- 
ments. 

Apis. Confluent eruption and oedema tous swelling of the skin; greatly 
inflamed eyes; croupy cough; violent cough, similar to whooping-cough; 
catarrh of the bowels, with diarrhoea; prostration, muttering and delirium. 

Arscn. In adynamic cases. Persistent burning heat of the skin; fre- 
quent, quick and small pulse; great anxiety; restlessness; palpitation of the 



THERAPEUTIC HINTS TO MEASLES. 977 

heart; too early or sudden disappearance of the rash; pale, earthy color of 
the face; bloatedness of the face; thrush in the mouth and fauces; constant 
craving for cold water, with but little drinking at a time; vomiting and 
diarrhoea; great sinking of strength; all worse about midnight. 

Bellad. May be indicated as often as Aeon, in the commencement, if 
there be heat with moisture of the skin, quick, but soft pulse; constant drowsy 
sleep, or drowsiness with inability to go to sleep; congestion to the head; 
injected eyes; thick, white-coated tongue; sore throat, even diphtheritic; 
hollow, barking, croupy cough; jerkings of the limbs; convulsions. 

Bryon. By slowly forthcoming eruptions and inflammatory affections 
of the chest; dry, painful cough, constipation, etc. 

Camphor a. In those dangerous cases where the face grows pale and 
the skin cold, assuming a bluish, purple color, with utter prostration and 
spasmodic stiffness of the body. Also in different after-complaints, especially 
painful and difficult micturition. 

Card. veg. Persistent hoarseness after measles. 

Chamom. Painful, watery diarrhoea, in consequence of taking cold. 

Coffea. Nervous, restless agitation, preventing all sleep; short, dry, 
hacking cough. 

Cupr. ac. Measles, bronchitis, delirium, wants to go home; expectora- 
tion only during the night. (J. C. Morgan. ) On falling asleep, begins to 
talk, scold, turn, twist and scream; on being aroused, was perfectly rational, 
tongue and mouth red. (J. F. Miller.) 

Drosera. Cough, with drawing together of the epigastrium, similar to 
whooping-cough, also paroxysms of cough after measles, worse in afternoon 
and evening, even when attended with bloody and purulent expectoration. 

Euphras. Streaming of hot, burning tears from the eyes, with great 
photophobia; profuse running from the nose, without burning; cough only 
during the da} 7 . 

Gelsem. After Aeon, great deal of coryza; drowsy with fever heat, 
no thirst. When the eruption turns livid, with cerebral symptoms. 

Hepar. Croupy cough, with rattling in the chest, but without expec- 
toration; worse in the morning. 

Ipec. Tardily forthcoming eruption, with oppression of chest; tickling 
cough and vomiting. 

Kali bichr. Flowing of water from the eyes, with burning when open- 
ing them; pustules on the cornea; stitches in the left ear extending into neck 
and head, with swelling of the glands; watery discharges from the nose, with 
great sensitiveness and ulceration of the nostrils; thirst,- with dryness of 
mouth and tongue; watery diarrhoea, followed by tenesmus; loud, rattling 
cough, with stringy expectoration. 

Laches. Iyivid eruption, countenance almost black, tongue coated dark 
brown, sordes on teeth, inability to protrude the tongue. (J. F. Miller. ) 

Mercur. Diarrhoea, with pain in the bowels and tenesmus; moist bark- 
ing cough, without expectoration; the cough is almost convulsive and cannot 
62 



978 SCARLATINA, SCARLET FEVER. 

be controlled, occurring in frequent paroxysms, particularly from 9 A. M. 
till 5 or 6 p. m. (C. Wesselhoeft.) 

Nux vom. After previous use of drugs; nose stopped up; cough dry 
in the evening and loose in the morning. 

Phosphor. In complication with bronchitis and pneumonic symptoms; 
tightness across the chest, with a dry, tight cough; worse from evening until 
midnight; unpainful diarrhoea. 

Pulsat. Inflammation of the eyes and photophobia; thick, yellow dis- 
charge from the nose; dryness of the mouth, without thirst; nightly diarrhoea, 
after previous rumbling in the bowels; rattling, loose cough, with expectora- 
tion of thick, yellow mucus; increase ot all the symptoms towards evening; 
chronic, loose cough after measles. 

Stramon. Sometimes before the outbreak of the eruption, if there be 
frightful visions of rats, mice, etc., at which the patient is startled and from 
which he tries to hide; spasmodic affection of the oesophagus, hindering 
swallowing. 

Sulphur. Either during the first stage, when the eruption makes a tardy 
progress, or for after-complaints, such as chronic coughs, originating in rem- 
nants of partial pneumonia; chronic diarrhoea; hardness of hearing; chronic 
discharge from the ears. 

Veratr. Pale, livid color, and tardy appearance of the eruption; 
haemorrhages without amelioration; burning heat with alternate cold ex- 
tremities; very frequent, weak, intermitting pulse; delirium; restlessness; 
drowsiness; apathy. 

Ver. vir. During febrile stage, especially if pulmonary congestion is 
impending; red streak down the centre of tongue; convulsions before erup- 
tion. 

Scarlatina, Scarlet Fever. 

Scarlet fever is an acute infectious and contagious disease, characterized 
by the appearance on the body of a diffuse scarlet eruption. The specific 
virus is as yet unknown (see Exanthemata, page 973.) 

Scarlet fever is characterized by the following features: 
1. An eruption of the skin due to hyperaemia, with numerous and 
closely aggregated red points about the size of a pin's-head, in normal cases 
equally distributed over the whole surface of the body. These scarlet points 
are either flat or slightly elevated, and as the hyperaemia increases, the 
vividly red points, originally isolated, gradually become confluent, and the 
exanthem assumes a uniform, intense redness, with turgescence of the skin, 
which appears stretched and glistening (Scarlatina laevigata). In other 
cases the eruption is but partial, or it may assume the shape of large roseola 
spots, from the size of a lentil to that of a bean, and of various shades of 
color, when it is called " Scarlatina variegata." Or the oedema of the skin 
is more considerable, and marked by a punctate injection in the form of small 
but numerous papules, which can be better felt than seen — Scarlatina pa- 



SCARLATINA, SCARLET FKVER. 979 

pulosa. Or in the further development of the papular form, miliary vesi- 
cles, about as large as a millet seed, with turbid contents, may appear on all 
parts of the body, but chiefly on the trunk — Scarlatina miliaris. Or the 
hyperemia may be so intense, that under the influence of a haemorrhagic 
diathesis, exudation of blood into the superficial layers of the skin, into the 
subcutaneous cellular tissue, into the mililary vesicles, and even haemorrhages 
from internal organs and mucous membranes may occur — Scarlatina hemor- 
rhagica. The scarlatinous exanthem is sometimes accompanied or followed 
by other forms of cutaneous disease, such as herpes labiales, acne, urticaria, 
pemphigus, ecthyma, varicella-like and pustular eruptions, sudamina, boils, 
and in septic conditions even gangrene of the skin and the subcutaneous 
cellular tissue. 

2. An angina which consists in mild cases of a uniform redness of the 
fauces, associated in more intense forms with swelling of the mucous mem- 
brane, enlarged follicles and tonsils in variable degrees. In still graver forms 
the mucous membrane is of a dark, livid color, greatly swollen, with abun- 
dant secretion, at times making deglutition considerably difficult or impos- 
sible, the fluid taken regurgitating through the nose; the tonsils are also 
greatly enlarged and prone to suppurate. In the severest cases (angina 
maligna) there is parenchymatous inflammation of the tonsils, and infiltra- 
tion of the region of the parotid and submaxillary glands, frequently of the 
entire cellular tissue of the neck, of the retro-pharyngeal and laryngeal cel- 
lular tissue, which latter causes respiratory disturbances similar to those of 
oedema glottidis. There is great proneness of these swellings to suppurate 
and even gangrenous destruction of the same has occurred. 

Scarlatinous angina is often complicated with diphtheria, which may 
stay confined to the throat or spread to the nose, larynx and the contiguous 
portions of the respiratory mucous membrane; it can be a complication of 
the mildest, as well as of the severest cases. Some authors consider the 
diphtheritic inflammation as a direct effect of the contagion of scarlatina. 

3. An inflammation of the kidneys, which may be of a catarrhal or pa- 
renchymatous nature. In the catarrhal form we find large masses of epi- 
thelial elements in the urine; it occurs mostly in the early stages of scarlet 
fever. The parenchymatous form is attended by albuminuria and hema- 
turia, and occurs, as a rule, not before the end of the second or third week, 
but at times in the beginning; it is accompanied by dropsical effusion, 
mostly as anasarca, though hydrops of the serous sacs may also be asso- 
ciated with it. 

It should be understood that scarlatina is an exceedingly variable dis- 
ease. There are cases without eruption, which are sometimes followed by a 
more or less well-marked and extensive desquamation; there are rare cases 
without angina, yet decidedly marked by kidney disease, parotitis and infil- 
tration of the cervical connective tissue; there are cases where the eruption 
follows an attack of nephritis, or parotitis, or infiltration of the cervical con- 
nective tissue, with or without angina. And even these different varieties 
may be combined in the most complicated manner. 



9S0 SCARLATINA, SCARLET FEVER. 

Scarlatina is a contagious disease,, not only by contact and immediate 
exhalation, but also by transmission through persons who are not themselves 
affected. The nature of the virus is not known; it is destroyed by heat, 
steam or boiling. The stage of incubation lasts from four to seven days, or 
longer. The predisposition to take the disease seems to be not nearly as 
universal as that for taking measles, quite a number of persons escape it 
altogether. Infants less than six months of age are mostly exempt from its 
attacks; but children between the ages of one to fifteen years are most liable 
to catch it; in later years the disposition to it decreases greatly; scarcely any 
one gets it a second time, but there are exceptions. It generally appears as 
an epidemic, and the different epidemics vary much in character, severity, 
time of year and duration. Its normal progress has been divided into four 
stages: 

i. The stadium podromorum commences with repeated chills, followed 
by heat, nausea, vomiting, violent headache, and a feeling of prostration. 
The pulse ranges from one hundred and twenty to one hundred and thirty 
and more beats per minute, and the temperature often reaches on the evening 
of the first day the height of 104 to 105. 8° F. This is quite characteristic 
of normal cases, as no other disease shows such a rapid increase of pulsation 
and temperature. Besides these symptoms the patient commences to com- 
plain of sore throat, dryness and burning, and pain when swallowing. On 
inspection we find the throat red and swollen, and the tongue coated, but red 
on its edges. This condition lasts in some cases only a few hours; in others 
it is entirely absent, or so mild that it ma}' be overlooked, the eruption ap- 
pearing at once, while in a majority of cases it lasts one or two days, and 
quite exceptionally still longer. So, also, varies the intensity of the attack 
in different individuals; from a mere indisposition, which is scarcely noticed, 
it may at once be associated with stupor and convulsions. 

2. The stadium eruptionis is almost always accompanied by an exacer- 
bation of the fever. The eruption shows first on the neck, not, as in measles, 
on the face, which remains unchanged, presenting only feverish, reddened 
cheeks. From the neck it spreads further over the body, so that usually in 
twenty-four or thirty-six hours the whole body is covered. The deepest red- 
ness appears on the neck, on the extensor muscles, around the joints, and on 
the dorsum of the hands and feet. Pressure with the finger upon the skin 
causes, for a moment, a white spot, which speedily grows red again from the 
periphery to the centre, unlike that in measles, which spreads from the 
centre to the perphery. As the eruption grows and spreads, so, also, grows 
the angina faucium, and the thick, white coating of the tongue is now peel- 
ing off, leaving it red all over with highly inflamed papillae, constituting the 
so-called strawberry tongue. The skin itches intensely. All these symp- 
toms are, not, however, alike in all cases. In some the redness may spread 
almost simultaneously all over the body and be very intense; it may be either 
scarcely noticeable or of different aspects, as described above; the angina 
also may amount to scarcely anything, or be very intense: it may be com- 



SCARLATINA, SCARLET FEVER. 98 1 

plicated with diph thelitis, or be combined with catarrh of the larynx or 
bronchial tubes. 

3. The stadium florescentiae, the time during which the eruption re- 
mains upon the skin, lasts usually from four to five days; about the second 
day of this stage it is in its fullest bloom; at the same time the fever and 
throat symptoms reach their height. The urine contains considerable quan- 
tities of cast-off epithelial cells, and frequently traces of albumen; in gen- 
eral the patient is sickest at this stage. It is the climax of the disease. 
From this time all the symptoms grow milder; the eruption declines, the 
fever lessens, the angina gradually lessens, and the patient feels better 
altogether. Yet this is not uniformly the case. The fever may rise anew, 
because new complications set in. 

4. The stadium desquamations sets in usually on the fifth day after the 
eruption first appeared, and lasts from eight to fourteen days. At first we 
observe fine white scales peeling off on the neck, the desquamation extend- 
ing gradually over the whole body. On the hands and feet great flakes of 
skin are often loosened by the patient himself, as a wholesome pastime after 
so severe an illness; fever and angina lessen constantly, until finally, in 
about three or four weeks from the commencement, perfect recovery takes 
place. This is the normal course of a simple scarlatina case. 

The Scarlatina maligna typhbsa, is characterized in the following way: 
In the premonitory stage already the patient is greatly prostrated, apathic, 
only half -conscious or comatose; the pupils are mostly dilated; there are 
either simply slight twitchings and jerkings of the limbs, 01; general convul- 
sions; the tongue is dry; the pulse very small and scarcely countable; the 
body is burning hot, with cold extremities. The eruption is either intense, 
breaking forth suddenly all over, and peeling off very soon in large flakes, 
as though the skin had been scalded. Such patients die, and it seems to me, 
for this physiological reason, that life cannot be sustained if a certain amount 
of the surface of the skin becomes destroyed. In other cases the eruption 
does not come out regularly, looks purple, livid, and is mixed with ecchy- 
mose spots; diarrhoea with meteorism associate, and the tongue and gums 
become covered with a black coating. Also such patients die mostly in the 
second stage, or sink during the stage of desquamation. 

Another bad form is that of Angina maligna, a parenchymatous inflam- 
mation of the tonsils and fauces. We observe in such cases great difficulty, 
even impossibility, of swallowing, and a nasal twang when speaking. The 
tonsils are greatly swollen, closing up the fauces; all the parts appear dark 
red; there is an abundant secretion in the throat, in consequence of which 
the breathing becomes rattling; the fever rises high; the face is red and 
bloated, and the conjunctiva injected; there is great restlessness and anxiety. 
This condition terminates either in the formation of abscesses, or in gan- 
grenous destruction of the parts. The first is the more favorable of the two. 
In case of gangrene we see a blister forming which bursts, and then gangre- 
nous ulcers spreading rapidly in circumference, but less in depth, emitting a 



982 SCARLATINA, SCARLET FEVER. 

terrible stench. All this is attended with violent fever heat, very frequent 
pulse, coma with half-open eyes, great restlessness, sudden screamings, ob- 
struction of the nose, difficulty of breathing, cold extremities, and retention 
of feces and urine. If the gangrenous process comes to a halt, the patient 
may recover, though very slowly; if it continues the patient dies within two 
or three days. In the latter case the color of the eruption grows livid, and 
does not disappear under the pressure of the finger. 

Or the sore throat may be complicated with diphtheria and consequent 
infiltration of the parotid, submaxillary and lympathic glands. This diph- 
theritic process may extend up into the nose (compare Diphtheritis) and 
cause a virulent coryza, that much-dreaded symptom of scarlet fever, with 
fetid discharge from the nostrils and a terrible smell from the mouth. At 
the same time the cervical glands and the connective tissue around them 
tumefy; the patient lies in a stupid or comatose state, with his head bent 
backwards; the pulse ranges from one hundred and forty to one hundred 
and sixty per minute, and the temperature of the body 106 F. and over. 
Should this morbid process extend into the larynx, there are small chances 
left for recovery. In some cases the inflammation spreads along the Eus- 
tachian tubes into the tympanum, causing an otitis media, which may lead to 
perforation of the membrana t3 T mpani, and caries of the petrous portion of 
the temporal bone. 

In other cases the infiltrated cervical glands suppurate, accompanied by 
a new increase of fever, causing various meningeal symptoms. At this stage 
not very unfrequently the synovial membranes inflame also, or pleuritis or 
pericarditis may suddenly set in, followed by an abundant purulent exudation. 

During the period of desquamation most generally the third localization 
of the scarlatinal virus takes place, that into the kidneys, causing, parenchy- 
matous nephritis, with its subsequent'scarlatinal dropsy. There are epidemics 
where almost all patients show symptoms of it — albumen and blood in the 
urine and dropsical swellings, while in others they are only exceptionally ob- 
served. It usually sets in with renewed chilly sensations, which are followed 
by fever, nausea, vomiting, pain in the region of the kidneys extending along 
the course of the ureters, with frequent desire to pass a little dark, dirty, 
brownish-looking urine, which contains blood, albumen and epithelial cells. 

Still another sequel of scarlet fever is to be mentioned: dropsy without 
albuminuria, which generally creeps on slowly and may attain to a great 
height; it is generally not so dangerous as that caused by nephritis, seems to 
be the consequence of loss of solid constituents of the blood, or a weakness of 
the heart, and is characterized by great weakness of the muscles, great pale- 
ness of the skin, great acceleration of the pulse from slightest motion, and 
fainting fits. 

The chronic otorrhcea after scarlet fever is mostly the consequence of a 
catarrhal inflammation of the meatus auditorius externus, while deafness has 
its cause in an inflammation of the middle ear, which has spread there 
through the Eustachian tubes and caused perforation of the tympanum, or 
thickening" of the same. 



THERAPEUTIC HINTS TO SCARLATINA. 983 

Another sequel to scarlatina is oedema of the lungs, which usually is 
complicated with hydrothorax and anasarca. Under constantly increasing 
dyspnoea and cyanosis the patient dies from asphyxia. The same takes place 
if oedema glottidis should be added to pulmonary oedema. 

In our Prognosis we must consider as unfavorable symptoms: sudden 
disappearance of the eruption, which is always a sign of a dangerous com- 
plication; sudden change of the scarlet into a livid color, with rise of tempera- 
ture and great frequency of the pulse, delirium or coma; purplish color of 
the eruption with ecchymoses or petechise, bleeding of the gums, bloody alvine 
discharges, which denote a dissolution of the blood; intercurring diarrhoea or 
dysentery, with meteorism, great thirst and sudden loss of strength; dimin- 
ished secretion of urine, which contains albumen and blood; intercurring 
oedema of the lungs or glottis; gangrene of the tonsils and fauces, and diph- 
theritic inflammation of the throat. 



Therapeutic Hints. 

As a preventive I would still recommend the potentized Belladonna, one 
dose every night, until symptoms appear. If it cannot prevent the attack, 
it has seemed at least to mitigate its violence. The clumsy imitation by the 
old school — drop-doses of the tincture or extract — could not possibly pro- 
duce any beneficial results. 

The terrible burning and itching of the skin is best relieved by rubbing 
the body all over with bacon (fat part of ham), olive-oil, or cocoa-butter, 
once or twice a day; always if the skin is dry, glands swollen, and there is a 
scrofulous diathesis. 

When the the temperature of the body rises to 106 F. and over, it has 
been found beneficial to envelop the whole body in a wet sheet; I would 
prefer warm to cold water. The room should be well ventilated and kept at 
a comfortable temperature. 

Where there are several children in a family the rest should be kept 
away from the sick-room. 

For complications with diphtheria compare the corresponding chapter. 

Aeon. Rarely, and only in the very beginning of the attack, if charac- 
terized by the following symptoms: great dry heat and congestion of the 
skin; thirst; rapid and hard pulse; great restlessness; headache; peevish- 
ness, which revolts against all interference; or at a later period: sudden ex- 
cruciating pain in the stomach, gagging, retching, vomiting of blood and 
stoppage of breath; distressed face, anguish; cold sweat on forehead; gasping. 

Ailanth. "Violent vomiting; severe headache; intolerance of light; 
dizziness; hot, red face; inability to sit up; small, rapid pulse; drowsy, at 
the same time very restless; great anxiety; two hours after the first invasion 
the drowsiness had increased to insensibility, with constant muttering de- 
lirium; did not recognize the members of the family; she was now covered, 
in patches, with an eruption of miliary rash, with efflorescence between the 



984 THERAPEUTIC HINTS TO SCARLATINA. 

points of the rash of a dark, almost livid color; the patches between the 
points of the eruption were of a dingy, dull, opaque appearance; the eruption 
was more profuse on the forehead and face than elsewhere, and especially on 
the forehead; the pulse was now small, and so rapid as hardly to be counted; 
the surface had become cold and dry; the livid color of the skin, when 
pressed out by the finger, returned very slowly; the whole was a most com- 
plete picture of torpor." These toxical symptoms, caused by Ailanthus and 
observed by Dr. Wells, of Brooklyn, simulate so strikingly adynamic forms 
of scarlatina that it must be a curative agent in such cases. Has since been 
confirmed by Dr. Chalmers and others. 

Amm. Card. Hard swelling of the right parotid and lymphatic glands 
of the neck; putrid sore throat; miliary form of eruption. 

Apis is, according to Wolf, indicated in usual as well as in those grave 
cases where the blood is thoroughly poisoned by the virus, and the whole 
nervous system under its paralyzing influence; the fever assumes a typhoid 
character; the tongue is of a deep-red color and covered with blisters, which 
become converted into sores and ulcers, with stinging pains; the nose dis- 
charges a thick, white, bloody, fetid mucus; the tonsils are swollen and hard, 
and the swallowing difficult; the whole abdomen is sore to the touch; the 
discharges from the bowels are diarrhoeic, slimy and bloody; nephritis; the 
urine is scanty, and of a dirty-red color; micturition frequent and sometimes 
painful; the breathing is accelerated and labored; there is loss of conscious- 
ness, delirium, sopor, convulsions, trembling of the limbs; the skin is either 
burning hot all over, or gradually growing cool, or hot in some and cool in 
other places; the fever rises constantly, and the pulse changes frequently in 
character; dropsical symptoms during desquamation. — Cerebral irritation; 
piercing shrieks; rolling of the head; grating of teeth ; irregular, slow, pulse. 
— ''Apis is never indicated in the coryza form, only with a dry nose, dryness 
of the throat and hydrocephalic symptoms." — (Hering. ) 

Arsen. When the eruption delays or grows pale suddenly, livid, or is 
intermixed with petechise; malignant sore throat; different dropsical affec- 
tions; dyspnoea: extreme restlessness and anxiety; prostration; typhoid 
symptoms; cold hands; burning heat internally, with a cold external sur- 
face; cold perspiration; quick, small pulse. Nephritis albuminosa. 

Arum triph. Great soreness of the mouth; redness of the tongue, with 
elevated papillae; cracked corners of the mouth and lips; stoppage of the 
nose, without or with profuse yellow discharge, filling the whole nasal cavity 
and throat; putrid sore throat; diphtheria; submaxillary glands swollen; 
urine abundant and pale; eruption all over the body, with much itching 
and restlessness; picking at the nose, lips and finger-nails. 

Asclep. Syr. Is recommended for dropsy in consequence of nephritis. 

Bar. carb. Swelling of the parotids, tonsils and submaxillary glands, 
with much saliva, or else dryness in the throat, with pressing, stinging pain 
on swallowing. During and after desquamation. 

Bellad. Congestion of the brain, with delirium; on closing the eyes he 



THERAPEUTIC HINTS TO SCARLATINA. 985 

sees horrible things; wants to sleep, but cannot sleep; anxious dreams; 
starts in sleep; suddenly springs up in bed, or attempts to; throbbing of the 
carotid arteries; involuntary moving of the hands to the head; bending the 
head backwards; head hotter than the remainder of the body; eyes injected; 
face fiery red, or pale and puffed, or sunken; tongue white, with red edges, 
or else red all over, with raised papillae; fauces inflamed, swollen; cannot 
swallow, or only with greatest difficulty; external swelling of the neck; 
vomiting. (Bellad. is only indicated in the smooth form of eruption with 
vascular and nervous excitement; it does no good in adynamic cases. The 
miliary form of eruption is much more adapted to Amm. carb., Laches., or 
Rhus fox. ) 

Bromium. When the parotids became involved, especially the left, it 
did better than any other remedy. (W. Payne.) 

Bryon. When the eruption delays or suddenly disappears; beginning 
dropsical symptoms; pleuritis or meningitis. Crimson-red face; dry lips; 
dry, brownish tongue; great thirst, and drinking much at a time and hastily , 
obstruction of the bowels; sleep with eyes half open; disinclined to move; 
pain on moving. 

Calc. carb. After Bellad., about the third day; great, hard swelling 
of all the glands about the neck; greatly inflamed throat, with aphthae on 
the tonsils and roof of the mouth; the pale, bloated face shows no signs of 
eruption; great anxiety and oppression, threatening paralysis of the lungs; 
scrofulous individuals; longing for boiled eggs. Otorrhoea as a sequel. 

Camphora. In desperate cases, with rattling in the throat; hot breath, 
hot forehead, with hot perspiration; limbs cold and purple. 

Carbol. ac. A case by Dr. Rouht; sleeping uneasily with half-open 
eyes; twitching of hands and limbs; starting from sleep; delirious talking; 
moaning; tossing; pulse 160; tongue thickly coated in centre, afterwards 
clearing and leaving it of a glossy, red color; throat swollen inside and out- 
side; difficult swallowing and breathing; nose stopped up; lips dry and 
cracked; odor of breath almost unbearable; fauces fiery red and swollen; 
diphtheritic patches on the tonsils and pharynx; urine scanty and red; 
bowels moved every hour; eruption of a dark-red color; miliary vesicles 
over the entire body. 

Carb veg. In last stage; rattling in the throat; complete sinking of 
vitality; cold breath; cool extremities; sticky, cold perspiration; wants to 
be fanned all the time. 

Coffea. As an intermediate remedy for excessive nervous excitement, 
sleeplessness and palpitation of the heart. 

Colchic. Nephritis; bloody urine, looking almost like ink and contain- 
ing albumen; dropsy. 

Cuprum. When the eruption quickly disappears, with subsequent con- 
vulsions, rolling of the eyes, distortions of the face, mouth and all the flexor 
muscles; great restlessness, tossing about; sopor; delirium. (No eruption, 
but terrible sore throat; delirious, fearing the bedclothes would catch fire, 



986 THERAPEUTIC HIXTS TO SCARLATINA. 

etc.; afraid of every one who approaches; afraid of falling; clinging tightly 
to the nurse; afraid of being injured by any one else; conscious, knows other 
people; won't stay in bed, but on the lap. (R. Gardiner.) 

Digit. Nephritis after desquamation, with anasarca and oedema of the 
lungs. 

Ge/sem. Has been given in large doses to " control the pulse, calm the 
nervous erethism, determine the eruption toward the surface, relieve pain 
and lessen the cerebral congestion." I believe its proper homoeopathic 
sphere of action will be found rather in those asthenic forms of scarlet 
fever, which from the commencement show marked signs of a general toxi- 
cation of the blood by the scarlatinal virus, viz. : profound and intense pros- 
tration of the whole muscular power; cerebral intoxication; pulse frequent, 
soft, weak and so feeble as sometimes to be imperceptible; impaired vision; 
spasms and paralysis. Dr. Morgan gives the following hints: Chilliness, or 
at least cold hands and feet; heat with languor and drowsiness; when sleep- 
ing, the patient talks in delirious muttering, or half wakes at times; crimson 
flush of the whole face in all positions; suffusion of eyes, heavy looking; 
throat feels as if swelkd or filled up, is diffusely red; tonsils red and slightly 
swollen; when the eruption recedes, all the viscera are threatened. 

Helleb. Dropsical symptoms, in consequence of nephritis; urine with 
sediment like coffee-grounds; squinting; pupils dilated; face pale and puffed. 

Hepar. After previous abuse of mercury. Best remedy for commenc- 
ing nephritis. (Kafka.) 

Hydr. ac. Has been suggested by Dr. Wells, when the eruption in its 
earl}' appearance is dark colored and soon becomes livid, only slowly regain- 
ing its color when this is expelled by the pressure of the end of the finger; 
rapid, feeble pulse. 

Hyosc. Stupid drowsiness, or else great nervous excitability and sleep- 
lessness; utter stupidity, or else illusions of the imagination and senses; 
vacant staring at things, or else sparkling red, prominent eyes; embarrassed 
indistinct speech; answers no questions, or else indistinct muttering loquacity; 
mouth and throat dry and red; inability to swallow; abdomen distended, 
tympanitic; water}*, involuntary and unnoticed stools in bed. "Its sphere 
seems to be limited to cases with acute inflammatory affections of the brain, 
or to that state between erethism and torpor, which places it in relation to 
Bellad. and Stramo?i., as in typhoid fever, below Stramon." (P. P. Wells.) 

Iodium. After mercury; ulcers in the throat; glands swollen, suppu- 
rating; everything appears bright blue to him in the distance; worse from 
warmth and from warm things of all kinds. 

Kali bichr. Diphtheritic inflammation; discharge from nose is tough 
and stringy; pain in left ear; swelling of parotid glands; croupy cough; 
measle-like eruption; red, raw, glistening tongue, deep ulcers in the fauces. 

Kali carb. Swelling of the right parotid gland; fever and restlessness; 
always worse about three o'clock in the morning; smell from the mouth like 
that of old cheese; great dryness of the skin; oedematous swelling, like little 
bags, between the eyebrows and upper eyelids. 



THERAPEUTIC HINTS TO SCARLATINA. 987 

Laches. Miliary form of eruption; also when the eruption turns purple 
at a late stage; in malignant cases with threatening gangrene or sloughing 
ulceration; acrid, foul secretions; low grade of inflammatory action; ap- 
proaching to a condition of torpor. Diphtheritic inflammation of the throat; 
fluids regurgitate through the nose; ulcers on the tongue; suppuration of 
the glands of the neck; pleuritic, pericarditic and general dropsy in delayed 
desquamation, with great oppression; nephritis with urine almost black; 
badly smelling stool; fever worse in the afternoon. 

Lycop. Diphtheritic sore throat; stoppage of the nose; rattling in the 
throat; comatose state; deafness and purulent discharge from the ears; great 
peevishness; crossness on getting awake; worse from being covered too much; 
scanty, dark red and albuminous urine, with strangury; oedema of the face, 
hands and feet; ascites; secondary eruption of dark red blotches on hands, 
thighs, back or face; colic during desquamation, with costiveness. Is some- 
times indicated at the onset. 

Mercur. Consecutive anasarca and ascites; soreness and inflammation 
of the genital organs. 

Merc. jod. After Laches. ; loss of voice, hoarseness, can only lisp; 
fauces bluish-red, ulcerated. 

Mur. ac. Intense redness rapidly breaking out all over the body in 
the first hours of the attack with coma; or scanty eruption, which is inter- 
spersed by petechise; dark redness of the face; purplish color of the skin; 
burning heat of the body; great anxiety and restlessness, constantly com- 
pelling the patient to uncover himself; aggravation in the evening; pulse 
intermitting at regular intervals; severe angina; dark, bluish-red fauces, 
aphthae; foul breath; discharge of thin, acrid pus from the nose and lips; 
sighing, groaning respiration; sliding down in bed. 

Nitr. ac. Diphtheritic sore throat extending up into the nose, from 
which a profuse, thin, purulent matter discharges; tonsils swollen; tongue 
dry, fissured; difficult deglutition; indistinct speech; sometimes deafness; 
intermitting breathing; eruption of a fine, miliary nature; skin burning hot. 
"Remarkable bad smell of all se- and ex-cretions: stool, urine, sweat and ex- 
halation of skin; bad smell from mouth with dark red, swollen gums, easily 
bleeding; nosebleed, often exhausting, with dark red blood; vomiting, etc. 
Fauces somewhat more dark red than usual, but no swelling." (Kunkel.) 

Opium. Convulsions, delirium and a soporous condition, with snoring, 
which were not relieved by Bellad. 

Phosphor. After Mur. ac. , although, on the whole, the patient seems 
improving, a suspicious rattle commences in the throat; also by prevailing 
chest symptoms; likewise in case of oversensitiveness of all the senses, and 
yet an apathetic quietness and " don't-care " disposition appears; burning in 
different parts of the body, which compels change of position. Copious 
coryza; alarming weakness and increasing frequency of pulse; during night, 
hands cold and bluish; congestion to the head. 

Phosph. ac. Complete apathy and indifference; don't want to talk; 



THERAPEUTIC HINTS TO SCARLATINA. 

answers slowly and reluctantly, or short, incorrectly; stupor; stupid ex- 
pression of the face; bleeding from the nose; meteoristic distention of the 
abdomen, with a great deal of rumbling and gurgling, and unpainful, watery, 
grayish diarrhoea; involuntary stools; great debility; ecchymosed spots; 
bluish spots on the parts which the patient lies upon; pulse weak, frequent, 
intermitting; profuse stick}- sweat. 

Phytol. Eruption dry, of a shriveled appearance; in passing the hand 
over the skin it feels like brown paper; urine suppressed; hands and feet 
burning hot; cannot keep them covered; restless and sleepless; tongue dry 
in centre; sides coated brown; throat covered with a diphtheritic deposit of 
an ash color. (C. A. Sibly.) 

Rhus fox. When after Belladonna, about the third day the fever is 
still rising; when the eruption of the miliar}^ kind looks dark; when the 
eyes appear swimming, as if intoxicated; when the tongue grows red and 
smooth, and a drowsy state, with delirium, sets in; great restlessness; bleed- 
ing from the nose at night; rheumatism of the joints, worse in rest; oedema 
of the scrotum and penis; the swollen parotid glands break open and dis- 
charge ichor copiously; impure, deep cavity, as if one could see into the 
throat; first the left, then the right. Often indicated at the onset of the 
miliary form. 

Secale. Watery discharge from the nose, and yet a stoppage of the 
nose; bloody and albuminous urine; cannot bear the heat of the stove, or 
remain covered. 

Senega. Oppression; rattling in the chest; loose, but feeble cough, 
with little expectoration; hydrothorax. 

Silic. Fever worse at night; sleep disturbed by pain in the ears; child 
wakes up throwing the arms about and screams; puts the hands behind the 
ears; otitis media; if sickly after vaccination, or soon after, scarlet fever 
follows; likes to be covered, wrapped up. 

Stramon. Similar to Belladonna cases, but "the eruption is less 
bright, shows a disposition to fade or recede, and the urine is small in 
quantity or its secretion suppressed." (P. P. Wells.) Parenchymatous 
nephritis; delirium, hallucinations, convulsions. Great dryness of the 
throat, compelling frequent drinking; swelling of the tongue, so that it 
hangs out of the mouth; paralysis of the tongue. 

Sulphur. Rapidly growing red all over, and intensely so, with follow- 
ing sopor soon after the first vomiting; burning heat of the skin; eruption 
at first bright, soon growing purple, attended with diarrhoea, worse in the 
morning. Cerebral disturbances, with sopor, starting, etc. ; bloated, shin- 
ing-red face with white circle around the mouth; dry nose; dry, cracked and 
red tongue. 

Tereb. Especially when the kidneys become involved with parenchy- 
matous inflammation and its smoky, bloody urine. "Albuminuria and 
dropsy after scarlet fever; urine greenish, scanty, loaded with albumen; 
much thirst, drinking often and much at a time." (J. B. Bell.) 



DIGEST TO SCARLATINA. 



989 



Verair. In hot summers; burning heat changing with coldness of the 
extremities; small, frequent pulse. 

Ver. vir. According to western physicians, in large doses, rather anti- 
pathically, to subdue arterial excitement. Convulsions, with greatly dilated 
pupils, perfect sleeplessness. Red streak down the centre of the tongue. 

Zincum. Especially in threatening paralysis of the brain complete un- 
consciousness; the child lies perfectly motionless; jerking of the whole 
body, or twitchings of single limbs; grating of the teeth; shrill, frightful 
screams, with altered voice; cannot speak any more; occiput very hot; fore- 
head cold, covered with cold perspiration; white, pale, distorted face; breath- 
ing short and quick, but no rattling; discharge from the bowels and bladder 
involuntary; limbs icy cold, and the whole body cool; bluish-red all over; 
pulse thread-like, scarcely countable. ''Convulsions, followed by stupor; 
•occiput hotter than forehead; screams before the spasms; trembling of the 
muscles; constant motion of the feet between attacks; urine scanty, 
bloody." 

Digest to Scarlatina. 



SKIN SYMPTONS. 

Smooth form : Bellad. 

Jffiliary form: Ailanth., Amm. card., 

Laches., Nitr. ac. 

, at the commencement: Rhus tox. 

,in patches with dark, almost livid 

color: Ailanth. 

, dark looking: Rhus tox. 

, vesicles over entire body: Carbol. 

ac. 
Measle-like eruption: Kali, bichr. 
JEmption wanting, but terribly sore 

throat: Cuprum. 

wanting in face: Calc. carb. 

scanty, with interspersed petechiae: 

Arsen., Mur. ac. 

growing rapid and intense all over 

body with sopor: Mur.ac, Sulphur. 

Uruption all over with much itching and 
restlessness: Arum triph. 

profuse on forehead and face: 

Ailanth. 

at first bright, soon growing purple: 

Sulphur. 

dark-red: Carbol. ac. 

bluish-red all over: Zincum. 

■ dry, of a shriveled appearance: Phy- 

tol. 

livid, returning slowly when ex- 
pelled by pressure: Ailanth., Hydr. ac. 

purplish: Mur. ac. 

purplish at a later stage: Laches. 



, livid, interspersed petechiae: Arsen., 

Mur. ac. 
, patches between the rash of a dingy, 

opaque appearance: Ailanth. 
Eruption, ecchymosed spots: Phosph. ac. 
, secondary of dark-red blotches on 

hands, back and face : Lycop. 
, bluish spot on parts where he lies 

upon: Phosph. ac. 

, when delaying: Arsen., Bryon. 

, when receding: Arsen., Bryon. 

, , all viscera threatened: 



Gelsem. 



convulsions: Cuprum. 
-, suppression of 



urine: 
Stramon. 

Skin, very dry: Kali carb. 

, burning hot: Nitr. ac. 

, feels like brown paper: Phytol. 

During desquamation: Bar. carb., Sul- 
phur. 

THROAT AND NECK SYMPTOMS. 

Fauces, inflamed and swollen: Bellad. 

, bluish-red, ulcerated: Merc.jod. 

, , dark, apathae: Calc. carb., 

Mur. ac. 

, dark-red, but not swollen: Nitr. ac. 

, fiery red and swollen: Carbol. ac. 

, diffusely red, and feels filled up: 

Gelsem. 
, swollen inside and outside: Carbol. 

ac. 



99Q 



DIGEST TO SCARLATINA. 



Tonsils, swollen: Bar. card., Nitr. ac. 

, and red: Gelsem. 

, and hard, with difficult swal- 
lowing: Apis. 
Throat dry and red: Hyosc. 
dry, with frequent drinking: Stra- 



mon . 

— dry 
Apis. 

— dry, 



and hydrocephalic symptoms: 



with pressing, stinging pain on 
swallowing: Bar. carb. 

, difficult swallowing: Apis, Bar. 

carb., Bell ad., Hyosc, Nitr. ac. 

, , fluid regurgitates through 

nose: Laches. 

, and breathing: Carbol. ac. 

, rattling in throat: Camphora, Carb. 

veg., Lycop. 

, diphtheric inflammation: Arum 

triph . , Carbol. ac. , Kali bichr. , Laches. , 
Lycop., Phytol. 

Throat, diphtheritic inflammation, ex- 
tending into the nose with profuse, 
thin, purulent discharge: Nitr. ac. 

ulcerated: Lodum, Kali, bichr., 

Merc. jod. 

, putrid, sore: Amm. carb., Arum 

triph. 

, malignant: Arsen, 

, with threatening gangrene and 

sloughing: Laches. 
Glands about neck swollen: Bellad., Calc. 

carb., Carbol. ac. 
about neck swollen and suppurating: 

Lodum, Laches. 
Parotid glands swollen: Bromium, Kali 

bichr. 
first left and then right, break- 
ing, with deep cavity: Rhus tox. 

, right side: Kali carb. 

swollen and lymphatic glands: Amm. 

carb. 

swollen and submaxillary : Bar. carb. 

Submaxillary glands swollen: Arum 

triph. 

KIDNEY AND URINE SYMPTOMS. 

Nephritis : Ascelp., Apis, Arsen., Can- 
thar., Colchic, Digit., Helleb., Hepar, 
Laches., Stramon., Tereb. 

with dropsy: Asclep., Canthar., 

Digit., Helleb., Tereb. 

, with urine always black : Laches. 

, with bloody, smoky urine: Tereb, 



Urine bloody, almost like ink: Colchic. 

, almost black: Laches. 

, smoky: Tereb. 

, albuminous: Apis, Colchic, 

Lycop., Secale, Tereb. 

and scanty: Zincttm. 

scanty, dirty-red: Apis. 

, red: Carbol. ac. 

, dark-red: Lycop. 

, greenish: Tereb. 

suppressed: Phytol. 

, sediment like coffee-grounds: Helleb. 

fetid: Nitr. ac. 

abundant and pale; Arum triph. 

Micturition painful and frequent: Apis. 

Micturition with strangury: Lycop. 

Dropsy : Apis, Arsen., Bryon., Canthar., 
Colchic, etc. ; see Nephritis. 

Puffed face : Bellad. , Helleb. 

(Edema between eyebrows and upper 
lids: Kali carb. 

Bloated face, without a sign of eruption: 
Calc carb. 

Ascites: Lycop., Mercur. 

(Edema of scrotum and penis: Rhus tox. 

Pleuritic and pericarditic dropsy: La- 
ches. 

Hydrothorax : Senega. 

(Edema of lungs: Digit. 

of hands and feet: Lycop. 

Anasarca: Digit., Laches.. Mercur. 



ACCOMPANYING SYMPTOMS. 

Conscious, knows every one: Cnprum. 

Unconsciousness : Apis, Zincum. 

Insensibility, with constant muttering: 
Ailanlh. 

Over sensitiveness of all the senses: 
Phosphor. 

Stupor : Phosph. ac. 

Stupidity: Hyosc 

Does not recognize anybody: Ailanth. 

Answers no questions: Hyosc. 

slow and reluctantly, or short, incor- 
rectly: Phosph. ac. 

Illusions : Hyosc 

, sees horrible things on closing the 

eyes, Bellad. 

Hallucinations : Stramon. 

, fearing the bedclothes would catch 

fire: Cuprum. 

Delirium: Apis, Cuprum., Opium., Stra- 
mon. 



DIGEST TO SCARLATINA. 



991 



, with congestion of the brain: Bel- 
lad. 

Delirious talking, moaning: farbol. ac. 

muttering when sleeping: Gelsem. 

, with drowsiness: Ailanth., 

Rhus tox. 



Loquacity, indistinct, muttering: Hyosc. 

Shrieks, piercing: Apis. 

Screams, shrill, with altered voice: Zin- 
cum. 

Spring's up in bed, or attempts to: Bel- 
lad. 

Don't Want to talk: Phosph. ac. 

Won't stay in bed, but on the lap: Cup- 



Apathy, indifference, "don't care": Phos- 
phor., Phosph. ac. 

Anxiety : Ailanth. 

and restlessness: Arsen., Mur. ac. 

and oppression, threatening paraly- 
sis of lungs: Calc. carb. 

Afraid of falling, clinging to the nurse, 
afraid of every one, of being injured: 
Cuprum. 

Anguish: Aeon. 

Peevish, revolts against all interference : 
Aco?i. 

on getting awake: Lycop. 



Dizziness : Ailanth. 

Cerebral irritation: Apis, Gelsem. 

disturbances, with sopor, startling: 

Sulphur. 

inflammation: Hyosc. 

Meningitis : Apis, Bryon. 

Paralysis of brain threatened: Zincum. 

Congestion to head: Bellad., Phosphor. 

Headache: Aeon., Ailanth. 

Head hotter than remaining body: Bel- 
lad. 

Occiput hotter than forehead: Zincum. 

Forehead hot, with hot perspiration: 
Camphora. 

, cold sweat on: Aeon., Zincum. 

Head bending backwards: Bellad. 

rolling: Apis. 



Eyes appear swimming, as if intoxicated: 
Rhus tox. 

, suffusion of, heavy-looking: Gel- 
sem. 

staring, or sparkling red, prominent: 

Hyosc. 

, rolling of: Cuprum. 

Everything appears bright blue in the 
distance: lodum. 

Vision impaired: Gelsetn. 

Intolerance of light: Ailanth. 



Eyes injected: Bellad. 

Pupils dilated, squinting: Helleb. 



Ear, pain in left: Kali bichr. 

Otitis media, puts hands behind the 

ears: Silic. 
Otorrhea a as a sequel: Calc. carb. 
Deafness : Nitr. ac. 
and purulent discharge from ears: 

Lycop. 



Nose stopped up: Carbol. ac, Lycop. 
, with or without profuse yellow 

discharge: Arum triph. 

with watery discharge: Secale. 

, discharges thick, white, bloody, 

fetid mucus: Apis. 
, profuse, thin, purulent matter: 

Nitr. ac. 
, tough and stringy mucus: Kali 

bichr. 

, acrid fluid: Mur. ac. 

Coryza, profuse: Phosphor. 
Nose dry: Apis, Sulphur. 

bleeding: Phosph. ac. 

at night: Rhus tox. 

, dark blood, exhausting: Nitr. 

ac. 
Picking at nose lips and finger-nails: 

Arum triph. 



Face fiery -red: Bellad. 

hot-red: Ailanth. 

dark-red : Mur. ac. 

crimson -red: Bryon. 

, flush of whole face in all posi- 
tions: Gelsem. 

shining-red, with white circle around 

mouth: Sulphur. 

pale and puffed: Bellad., Helleb. 

pale and bloated, without eruptions: 

Calc. carb. 

pale and white: Zincum. 



992 



DIGEST TO SCARLATINA. 



— cedematous, and hands and feet, and 
ascites: Lycop. 

— , swelling, like little bags be- 
tween eyebrows and upper lids: Kali 
card. 

— stupid: Phosph. ac. 

— distressed: Aeon. 

— distorted : Zincu m . 

— , and mouth, and all flexor 

muscles: Cuprum. 



Lips dry: Bryo?i. 

dry and cracked: Carbol. ac. 

and corners of mouth cracked: Arum 

triph. 



Tongue red, with raised papillae: Arum 
triph., Be Had. 

red and smooth: Rhus tox. 

red, raw and glistening: Kali bichr. 

, red streak down the centre: Ver. vir. 

, deep red, covered with blisters, ul- 
cerated, stinging: Apis. 

thickly coated in centre, aftewards 

glossy red: Carbol. ac. 

dry and brownish: Br yon. 

dry, red and cracked: Nitr. ac, Sul- 
phur. 

dry in centre and sides coated brown: 

Phytol. 

, ulcers on: Laches. 

, swelling of, that it hangs out of 

mouth: Stramon. 

, paralysis of: Stramon. 



Speech indistinct: Nitr. ac. 

, loss of: Zincum. 

Teeth grating: Cuprum, Zincum. 

Gums bleeding and swollen, dark red: 
Nitr. ac. 

Bad smell from mouth: Carbol. ac.,Mur. 
ac., Nitr. ac. 

, like old cheese: Kali carb. 

Hlouth., soreness of: Arum triph. 

and throat dry and red: Hyosc. 

Thirst: Aeon. 

great, and drinking much at a time 

and hastily: Bryon., Sulph., Tereb. 

, frequent drinking: Stramon. 

Longing for boiled eggs: Calc. carb. 

Vomiting: Ailanth., Bellad., Nitr. ac. 

• of blood at a later period, with ex- 
cruciating pain in the stomach, gagging, 
retching and stoppage of breath: Aeon. 



Colic during desquamation: Lycop. 
Abdomen distended, tympanitic: Hyosc. 

distended, meteorism, gurgling, un- 

painful diarrhoea: Phosph. ac. 

sore to the touch: Apis. 

hot to the touch: Laches. 

Ascites: Lycop., Mercur. 
and anasarca : Mercur. 



Diarrhoea worse in early morning: Sul- 
phur. 

every hour: Carbol. ac. 

, slimy and bloody: Apis. 

, unpainful, watery, grayish: Phosph. 

ac. 

, involuntary: Phosph. ac. 

, , watery, unnoticed: Hyosc. 

, and involuntary micturition: 

Zincum. 

Constipation: Bry 'on., Lycop. 

Stools fetid: Laches., Nitr. ac. 



Genital organs sore and inflamed: 

Mercur. 
(Edema of scrotum and penis: Rhus tox. 



Voice, loss of, hoarseness, can only lisp: 
Merc. jod. 

Rattling in throat: Camphora, Carb. 
veg., Lycop. 

Breath cold: Carb. veg. 

hot: Camphora. 

Breathing short and labored: Apis. 

and quick, but not rattling: 

Zincum. 

difficult: Carbol. ac. 

intermitting: Nitr. ac. 

sighing, groaning: Mur. ac. 

Dyspnoea : Arsen., Calc. carb., Laches. 

Oppression, and rattling in chest: Senega. 

Stoppage of breath, gasping: Aeon. 

Cough loose, but feeble, with little ex- 
pectoration: Senega. 

croupy: Kali bichr. 

Chest symptoms prevailing: Phosphor. 

Paralysis of lungs threatening: Calc. 
carb. 

(Edema and anasarca: Digit. 

Peluritis: Bryon. 

Hydrothorax: Senega. 

Pleuritic dropsy: Laches. 

Heart, palpitation: Coffea. 

Pericarditic effusion : Laches. 



DIGEST TO SCARLATINA. 



993 



Pulse rapid and small: Ailanth., Ver. 
alb. 

and hard: Aeon. 

and feeble: Hydr. ac. 

as hardly to be counted: Ail- 
ant h. 

, 160 per minute: 

quick and small: Arsen. 

thread-like, scarcely countable: Zin- 
cum. 

, soft, weak and feeble, sometimes 

imperceptible: Gelsem. 

weak and frequent: 

Phosph. ac. 

irregular, slow: Apis. 

intermitting: Phosph. ac. 

at regular intervals: 

changes frequently in 

Apis. 

Carotid arteries throbbing: Bellad. 



Phosphor 



Mur. ac. 
character: 



Hands cold: Arsen. 

and bluish during night: Phos- 
phor. 

and feet burning hot, cannot keep 

them covered: Phytol. 

Limbs cold and purple: Camphor. 

Rheumatism of joints, worse in rest: 
Rhus tox. 

Bluish spots on the parts upon which he 
lies: Phosph. ac. 



Debility : Phosph. ac. 

Prostration "• Arsen., Card, veg., Gelsem. 

Inability to sit up: Ailanth. 

Lies perfectly motionless: Zincum. 

Sliding down in bed: Mur. ac. 

Torpor: Ailanth., Laches. 



Trembling" of limbs: Apis, Zincum. 
Twitching of hands and limbs: Carbol. 

ac. 
of single limbs and jerkings of 

whole body: Zincum. 
Involuntary moving of hands to the 

head: Bellad. 
Constant motion of feet: Zincum. 
Convulsions: Apis, Cuprum, Stramon. 

, screams before: Zincum. 

, with dilated pupils: Ver. vir. 

, with snoring: Opium. 

, followed by stupor: Zincum. 

and paralysis: Gelsem. 

63 



Distortions of face, mouth and flexor 
muscles: Cuprum. 



Thorough blood-poisoning by the scar- 
latinal virus: Ailanth., Apis, Gelsem. 
Acrid, foul secretions: Laches. 



Drowsiness: Ailanth., Bellad., Hyosc, 

Rhus. tox. 

and very restless: Ailanth. 

and cannot sleep: Bellad. 

with the heat: Gelsem. 

Sopor: Ailanth., Cuprtim, Opitim. 

Comatose: Lycop. 

Sleeps with eyes half open: Bryon., 

Carbol. ac. 
with starting: Bellad., Carbol. ac, 

Sulphur. 

half awake: Gelsem. 

Sleepless and nervous excitability: Cof- 

fea., Hyosc, Ver. vir. 

and restless: Phytol. 

Restlessness : Aeon., Arsen., Rhus tox. 

, tossing about: Cuprum. 

, constantly uncovering himself: 

Mur. ac 
On getting awake, cross: Lycop. 
, throws arms about and screams: 

Silic 

, scratches his head: Calc carb. 

Sleep disturbed by pain in the ears: Silic. 
Chilliness, at least cold hands and feet: 

Gelsem. 
Cold and dry surface: Ailanth. 
hands and cool body: Zincum. 

surface, burning heat internally: 

Arsen. 

Cool in some and hot in other places: 
Apis. 

Coldness of extremities changing with 
burning heat: Ver. alb. 

Heat, great and dry, congested skin: 
Aeon. 

, burning of body: Mur. ac, Sulphur. 

, with languor and drowsiness: Gel- 
sem. 

of occiput greater than that of fore- 
head: Zincum. 

of head greater than that of remain- 
ing body : Bellad. 

Burning heat changes with coldness of 
extremities: Ver. alb. 

heat internally with cold surface: 

Arsen. 



994 



RUBELLA. 



gradually growing cool, or hot 

in some and cool in other places: Apis. 

in different parts of body, compelling 

to change position: Phosphor. 

Fever and restlessness: Kali card. 

, worse in afternoon: Laches. 

, worse in night: Silic. 

Typhoid character : Apis, Arsen. 

Low grade of fever: Laches. 

Sweat profuse and sticky: Phosph. ac. 

sticky and cold: Card. veg. 

cold: Arsen. 

cold on forehead: Aeon., Zincinn. 

and exhalation fetid: Nitr. ac. 



Better from fanning: Card. veg. 

from being wrapped up: Silic. 

from changing position: Phosphor. 

Worse in evening: Mur. ac. 

in morning 3 o'clock: Kali carb. 

from being covered: Lycop., Secale. 

from warmth and warm things: Io- 

dium, Secale. 



from moving: Bryon. 

from rest: Rhus tox. 

OTHER REMEDIES AND CONDI- 
TIONS. 
Calc. carb. after Bellad., about the third 

da}-. 
Hyosc, similar to Bellad. and Slramon. 
Hepar and Iodium after the abuse of 

mercury. 
Merc. jod. after Laches. 
Opium, if Bellad. does not relieve. 
Phosphor, after Jlur.ac, when suspicious 

rattle in the throat commences. 
Rhus tox. after Bel lad. } if fever still rises 

about the third dav. 



Lycop. sometimes at the onset, when 
there is drowsiness and crossness after 
sleep. 

Carb. veg. in last stage. 

Ver. alb. in hot summer. 

Silic. after vaccination. 

Calc. carb. in scrofulous individuals. 



Rubella, Roetheln. 



The many different views as to the nature of this disease, whether it be 
a hybrid affection of scarlet fever and measles, or an affection distinct from 
either of the two, seem now to settle down in favor of the latter view. For 
an attack of rubella protects neither against measles nor scarlet fever, and 
vice versa. 

Rubella is contagious and appears in epidemics. Its stage of incubation 
lasts probably from two and a half to three weeks; prodoma are scarcely 
ever observed. The breaking out of an exanthem is the first, or, at least, 
among the first symptoms of the disease. It commences on the face and 
spreads gradually in a downward course all over the bod)'. With it there 
may be an increase of temperature from 2 to 4 F. above the normal, though 
usually it amounts only to about 1.5 F., or there is none at all. The rash 
has great similarity with that of measles, but the rubella spots are smaller, 
rounder in form and paler in color. Sometimes it is accompanied with some 
sneezing, coughing, slight photophobia, sore throat, and some slight transitory 
disturbance of the appetite. Affections of the kidneys do not occur. Des- 
quamation is absent in most cases. The duration of the exanthem is often 
scarcely two, but sometimes four days. Recovery takes place undisturbed 
after its disappearance. The whole process seldom needs medicinal inter- 
ference. For the catarrhal symptoms either Aeon., Bellad., or some other 
remedies may be indicated. 



variola. 995 

Variola, Small-Pox ; Variolois, Varioloid. 

Variola is a highly contagious infectious disease, characterized by severe 
prodromic manifestations, a peculiar eruption and fever of a- distinct type. 

The nature of the variola virus we do not know, except by its effect upon 
the organism. (Seep. 973.) It is regenerated while it develops its effects, 
and thus propagated from organism to organism. The infectious matter is 
-contained in the variola pustules as well as in the exhalations from the small- 
pox patient. Infection takes place, therefore, not only by inocculation or 
immediate contact with the patient, but also by a more remote means. The 
poison can be carried by other persons in their clothes, or by things 
which have been in the atmosphere of the patient. It is very per- 
sistent in its nature, and may retain its property for years if ex- 
cluded from the atmosphere, and not exposed to great heat. There 
is no difference between the virus of small-pox and that of varioloid; 
either may cause the one or the other disease. This seems to depend 
entirely upon the susceptibility of the organism, and its adaptation for 
a greater or less development of its effects. Small-pox and varioloid differ, 
therefore, only in the intensity of their symptoms. The individual predis- 
position for taking the disease is wide-spread; no sex, no age, not even the 
foetus is exempt; some persons, however, are never affected by it. Those who 
once lived through an attack are, almost without exception, safe from any 
further infection, at least for a long time. Vaccination seems likewise to de- 
stroy the predisposition to the disease; if not in toto, at least partially. For, 
ever since vaccination has become generally introduced, the epidemics have 
grown decidedly milder, the majority of cases being varioloids, while previous 
to the discovery of vaccination, the reverse was the rule. Nevertheless, there 
are epidemics which are still characterized by great malignancy, while others 
again are exceedingly mild. It has not been possible to trace out any cause 
for this difference. This is one view of the vaccination question. Of late 
years, however, not only great doubt of the correctness of this view, but 
direct accusations of its falsity have been propagated by men as able as its 
defenders. The lively agitation in England and Germany against the 
coercion law of vaccination has produced a whole library on this subject, and 
will make itself felt more and more every year. The statistic assertion that 
small-pox epidemics have become milder since the general introduction of 
vaccination, is flatly contradicted by the researches of the foremost statis- 
tician of Germany, Dr. Hngel, in Berlin, who already in the year 1862, had 
to confess, " there has no change occurred in the coming and going of small- 
pox epidemics, nor in general in the number of small-pox patients since the 
introduction of vaccination." (Zeitschrift des Kbnigl. Preussischen Statist. 
Bureaus, February, 1862.) But it does not lie in the sphere of this work, 
to reproduce the details of this contention; my belief is, that vaccination 
after a few generations will be as obsolete in medical therapeutics as inocula- 
tion, blood-letting and kindred barbarisms of old are to-day. 



996 VARIOLA. 

Its Course and Symptoms. After the lapse of nine or ten, sometimes 
more days of incubation, the initial stage, or the stadium invasionis, begins 
with a shaking chill, or repeated chilliness, which is followed by a violent 
fever. The temperature rises on the first day to 103 or 104 F., and on the 
second or third day to 105 or 105.5 , and even 107 F. This high fever is 
accompanied with a number of painful symptoms of the head, throat, stom- 
ach, and general body; in some cases with delirium and convulsions. No 
other, however, is so characteristic of the disease as the dreadful backache, 
with which it is in most cases associated. The fever rises continually during 
the first three days, showing slight remissions only in the morning. On the 
evening of the third day it reaches its height. Only in rare cases is this 
premonitory stage absent. In some epidemics the initial stage is marked by 
an erythematous eruption, either diffuse or measly; or by a haemorrhagic ex- 
anthem, which consists of extremely small punctate, often pin-head sized, 
haemorrhages in the epidermis, at times so closely crowded together that the 
impression of a diffuse redness is produced. Sometimes both forms are com- 
bined and we see, then, petechise upon an erythematous base. The petechial 
eruption has its favorite seat on the lower region of the abdomen, on the 
genitals and the inner surface of the thighs, also on the lateral surfaces of 
the trunk up to the axillae, the contiguous portions of the arms and the pecto- 
ralis major muscles. This eruption generally appears on the second day and 
lasts from twelve to twenty-four hours. As a rule the petechial form lasts 
longer. 

The second stage, the stadium eruptionis, commences on the evening of 
the third day. There appear little red spots first on the face. If very 
numerous, they coalesce like measle-spots, with which they might be con- 
founded if it were not for the granulated feel which they present to the sense 
of touch (like shot.) On the second day the eruption appears on the neck, 
chest and back; and on the third day it spreads over the extremities. The 
granulated feel of the eruption is due to the formation of papules in conse- 
quence of an enlargement of the cells of the rete Malpighii, which pushes 
the epidermis up. Soon an exudation of clear fluid from the papillary layer 
converts the papules into vesicles, and separating the cells into small groups, 
a reticulated cavity is formed, which contains pus-corpuscles and the epithe- 
lial framework. This is the reason why a pock never discharges fully if 
opened only in one place. After the formation in vesicles, most pocks show 
a central depression or umbilicus, which some think to be due to the pres- 
ence of a hair follicle or the duct of a sweat gland in or over its centre; others 
teach that the periphery of the pock swells more rapidly than its centre, and 
thus becomes more prominent. This umbilicus disappears when the pustule 
is fully ripe, but re-appears again from the earlier drying of the centre. It 
requires about six days for the ripening of the pustules; or counting from 
the time of invasion, nine or ten days. Simultaneously with this eruption 
on the skin, an eruption of the same character appears upon the different 
mucous membranes. On the conjunctiva it causes a flow of tears, photo- 



variola. 997 

phobia, and in severe cases total closure of the eyes for many days; in the 
mouth it causes salivation; in the pharynx, difficulty of swallowing; in the 
larynx, hoarseness and cough; and in the genitals, itching and burning pain; 
Even the external portion of the dura mater has been found studded with 
pustules filled with matter. In several instances the suppuration was of 
such a character as to destroy the membrane where the pustules existed. 
(Report of Drs. Howell and Johnson, Small-pox Hospital, San Francisco, 
Epidemic of 1868. North American Journal, February, 1869, p. 443.) 

The full development of the eruption is generally attended with great 
relief to the patient; all the pain lessens and the fever decreases consider- 
ably. In cases of variola confluentes only, the relief is not so marked. This 
is, however, not the end of the trouble. 

On the ninth or tenth day the fever commences to rise again; it is the 
beginning of the stadium suppurationis s. maturationis. At this time the 
pustules enlarge still more, the surrounding skin commences to inflame and 
to swell, and a red areola forms around each pustule. Redness and swelling 
coalesce from all sides, and constitute a diffused, erysipelatous appearance of 
the whole face, greatly disfiguring the patient. This process gradually 
spreads over the whole body, in the same order in which the eruption com- 
menced to appear. The patient complains of great tension and burning of 
the skin, and the affections of the eyes, mouth, throat, larynx and genitals 
increase in corresponding order. The temperature rises again from 102 and 
103 to 104 F. , frequently attended with chilly sensations; it rises accord- 
ing to the intensity of the inflammation of the skin; and does not abate until 
the dermatitis reaches its acme. This renewal of heat is called the secondary 
or suppurative fever. It may be attended with delirium and symptoms of 
adynamia and general paralysis, in consequence of the absorption of pus 
into the blood. In other cases it combines with a hemorrhagic diathesis, 
when the contents of the pustules become bloody, and bloody extravasation 
within the skin or haemorrhages from different mucous membranes take place, 
haemorrhagic small pox ; or, though only in rare cases, portions of the inflam- 
mation mortify and discharge a badly-looking ichor, gangrenous small-pox. 
Besides all this, as the variola-poison is apt to localize during this stage in 
serous membranes and parenchymatous organs, we meet with a number of 
different complications, such as: dyspnoea, stitching pains in the chest, cough, 
bloody expectoration, pneumonia, pleuritis, pericarditis, meningitis, suppura- 
tive inflammation of the joints, periostitis, subcutaneous and intermuscular 
abscesses, inflammation and suppuration of lymphatic glands, suppuration 
of the eyes with hypopion, and croupous exudations in the larynx and 
trachea. 

The last stage, or the stadium exsiccationis, usually commences about the 
eleventh or twelfth day. The pustules burst and discharge their contents, or 
dry up, and become covered with hard, brownish crusts. There is still some 
fever at first; it lessens, however, continually, and with it gradually disap- 
pear all the painful symptoms which arise from the eruption on the different 



99^ VARIOLA. 

mucous membranes. The crusts now gradually drop off, at first those which 
cover the most superficial pustules; they leave dark-red, somewhat elevated 
spots, which, however, after some time, entirely disappear. Not so those 
which form upon deep-seated ulceration. They adhere a long time, and 
leave, after dropping off, an uneven scar, which looks at first red, but by de- 
grees grows conspicuously white, to remain so for life. In confluent small- 
pox the destructive process is of a still greater extent, in circumference as 
well as in depth, and frequently the remaining scars greatly disfigure the 
face, similar to scars of deep burns. This is the course and progress of 
variola. 

Varioloid runs a similar but much milder course; all its stages are 
milder and shorter; its secondarj^ fever is much less intense, or wanting alto- 
gether; and its suppurative process does not destroy the cutis, so as to leave 
scars. 

The Piu'piira variolosa represent the worst course which small-pox 
can take in the initial stage. It attacks young and robust persons by prefer- 
ence, begins with rigor, headache, very intense pain in the back, and great 
prostration. Within eighteen to thirty-six hours a scarlet-like erythema ap- 
pears over the entire body, which is mingled with petechise and larger cuta- 
neous haemorrhages, varying in size up to that of a silver dollar, which usu- 
ally become confluent upon the chest and abdomen. The face is rendered 
red and puffy, the conjunctiva bloodshot, and large black rings are formed 
around the eyes, through haemorrhage into the cellular tissue of the lids and 
their contiguous parts. The tongue is swollen and covered with a whitish- 
yellow coating, and the throat is affected with diphtheritic exudation, from 
which issues a terrible odor. There is pain in the pit of the stomach, nausea 
and vomiting of bile and blood, bloody diarrhoea and offensive urine. In 
some cases we meet a troublesome cough, with bloody expectoration, and in 
women, haemorrhages from the womb. The temperature rises to about 104 
F.; the intelligence is usually unimpaired until a short time before death, 
when the body, particularly the trunk, assumes a blackish or leaden-gray 
hue. Some patients die within three days after the beginning, or even 
earlier, some survive the sixth day. (Curschmann.) 

Prognosis. — The fewer the pustules, the lighter the case; confluent pus- 
tules are much more severe. Haemorrhagic, septic and gangrenous small- 
pox are not absolutely fatal, but very dangerous. 

When typhoid symptoms are added, the prognosis must be very guarded. 

The younger the individual the greater the danger. Very young in- 
fants are always in great danger. 

In pregnant females it brings on abortus. 

Inebriates are liable to be taken with delirium tremens. 

Any of the complications mentioned makes the diagnosis doubtful. 

Preventives. 

Vaccination is lauded and equally condemned. The humanized virus 
and the lancet have given place to the ivory point and the cow-pox virus. 



THERAPEUTIC HINTS TO VARIOLA. 999 

This is an improvement. Syphilis at least is thus prevented from being; 
propagated any longer by vaccination. 

Internal vaccination is recommended and practiced by Dr. Kaczkowsky, 
and consists in the administration of one dose of Sulphur™ which is left to 
act for fourteen days, and is followed by the administration of Vaccininutn, 4 
or Variolinum. 4 About the seventh or eighth day febrile symptoms occur, 
and on the eighth, ninth or tenth day a granular eruption, of the size of poppy 
seeds, appears under the skin, which soon ripens and heals. This process has 
never been carried out to a sufficient extent so as to enable us to judge of its 
efficacy. 

Dr. H. Boskowitz, of Brooklyn, recommends the virus of the malanders 
or grease of the horse either for inoculation, instead of cow-pox virus, or for 
internal use in a high triturition. The successful internal application of 
Malandrinum as a preventive has been confirmed this season (1880-81) by 
Dr. R. Straube and myself. Dr. Hering has advised the sprinkling of a 
w T eak solution of Cyanide of potassium about the house, because such me- 
chanics as use it in their manipulation, have been observed by Dr. Korn- 
dcerfer to be exempt from the disease in small-pox epidemics, because the 
sulpho-cyanide of potassium, which is present in the saliva of the healthy, 
disappears from there in small-pox patients, and appears instead in the con- 
tents of the pock. This has been demonstrated by me about the year 1850. 
Still others have used Baptis., or Sarracenia, as preventives, with great 
success. Who shall gainsay it ? They all were trustworthy observers, and 
epidemics of small-pox change as much in their peculiarities as epidemics of 
scarlet fever or any other disease. 



Therapeutic Hints. 

Apis. Where there is an erysipelatous redness and swelling, with sting- 
ing, burning pains; stinging, burning pain in the throat; dyspnoea; sup- 
pression of urine. 

Arsen. In the asthenic cases, with great sinking of strength, burning 
heat, frequent small pulse, great thirst, great restlessness, and when the 
pustules sink in, and their areolae grow livid. 

Baptis. Typhoid symptoms; pustules appear more thickly in throat 
than on skin. It proved exceedingly effective during an epidemic, prevent- 
ing even the offensive effluvium. (B. Williams, B. J. H., 1873, p. 344.) 

Bellad. During the first stage; high fever; congestion to the head; sleep- 
lessness, with desire to sleep; convulsions. Later, sore throat and cough. 

Bryoyi. At the commencement, and also when the chest symptoms in- 
dicate it. 

Calc. carb. Very important during dentition. 

Camphor a. In those dangerous cases where the swelling suddenly sinks 
in and the pustules suddenly dry up, showing a complete giving out of the 
life-forces. 



IOOO THERAPEUTIC HINTS TO VARIOLA. 

Carb. veg. When the eruption seems to recede, with cold extremities, 
small, empty pulse, oppression of chest and harrassing cough. 

Canthar. Dysuria and bloody urine; the eruption assuming a haemor- 
rhagic tendency. 

Hepar. Croupy cough; suppuration. 

Hydrast. ca?i. Has been given successfully when there was great 
swelling, redness and itching, and great soreness of the throat. Is said to 
prevent the pitting to a considerable degree. 

Malandrinum.™ Has been given during the last epidemic (i 880-81) 
by Dr. R. Straube, several others and myself with great success as a pre- 
ventive as well as a curative agent. It prevented the suppurative fever, or 
lessened it at least to a considerable degree, and took away all offensive ex- 
halation. Cerebral symptoms, such as delirium and hallucinations necessi- 
tated the interpositition of Stramon., while great soreness of the throat and 
cough required Bellad. An article on Melandrinum by Dr. R. Straube, 
Avhich contains a partial proving of this remedy, can be found in the North 
American Journal of Homceopathy ■, August number, 1881. 

Mercnr. Especially during the suppurative stage; great flow of saliva; 
dysenteric discharges from the bowels; syphilitic taint. 

Phosphor. Hemorrhagic diathesis; blood}* contents of the pustules; 
hard, dry cough; bronchitis; haemorrhage from the lungs. Typhoid form. 

Phosph. ac. Typhoid conditions subsultus teudinum; great restlessness; 
great fear of death; the pustules don't fill with matter; some degenerate 
into large blisters, which burst and discharge a watery fluid, leaving the sur- 
face excoriated; water}* diarrhoea. 

Rhus tox. Typhoid symptoms, dry, cracked tongue; sordes on the lips 
and teeth; great debility and restlessness; the eruption shrinks and looks 
livid. 

Sarracenia. Has been used empirically, and is said by some to shorten 
and to ameliorate the progress of the disease; others deny it. The fact of it 
is, we do not know any characteristic indications of the remedy as yet. 

Sulphur. Is indicated where there is any tendency of metastasis to the 
brain during the suppuration; is indispensable occasionally as an intercur- 
rent remedy when others seem to fail; and Goullon advises its uniform use 
in the stadium exsiccationis. 

Tart. emet. Has been found by some to ameliorate the progress of the 
disease. 

Thuja. Recommend by von Bcenninghausen as a preventive as well 
as a curative agent. He states that it shortened in the epidemic of 1849, in 
his neighborhood, all cases, and prevented all scars. 

Vacci?ii?ium. Has been used undoubtedly with great benefit in small- 
pox; its use has shortened and ameliorated all stages quite considerably. 
Sulphur was given afterwards. 

Variolimim. Makes the progress of the disease much milder; quickly 
removes all dangerous symptoms; changes imperfect pustules into regular 



VARICELLA. IOOI 

ones, which soon afterwards dry up; promotes suppuration on the third day, 
and exsiccation on the fifth, sixth and ninth day, and prevents all scars. 
This is the unanimous testimony of ten physicians who have used it in dif- 
ferent epidemics. 

Varicella, Ohicken-Pox. 

Some pathologists consider chicken-pox as the lightest form of variola. 
This cannot be, for experience teaches that varicella does not extinguish the 
liability to either cow-pox or small-pox, and that an infection with varicella 
causes the identical varicella and not variola or varioloid. 

Varicella often prevails epidemically, and we also find sporadic cases. 
It frequently precedes, accompanies, or succeeds epidemics of small-pox, 
measles and scarlet fever. 

It consists at first, of little red spots, like flea-bites, which in the course 
of a few hours develop themselves into vesicles, filled with a transparent, 
straw-colored fluid. The form of these vesicles varies, and according to the 
different forms which they occasionally assume, they have been divided into 
varicellae ovales, lenticulares, coniformes, cuminatae. Some of them often 
fill with pus and become varicellse pustulosse, leaving, after desiccation, a 
scar. Their appearance, in most cases, is the first symptom of the disease, 
without any previous ailment. They spread irregularly over the body, and 
continue to appear in crops for several days, so that, when the first crop is 
already in a state of dessication, a new crop shoots up, thus differing from 
variola. In this way the whole process may last fourteen days, and even 
longer. A similar eruption occasionally takes place upon the mucous mem- 
branes, and forms little ulcers in the fauces; but that is not always the case. 
The generel feeling of the patient is not very often materially disturbed, though 
some cases are attended with fever, headache, cough, want of appetite and 
general indisposition. Great care must be exercised to differentiate it from 
small-pox, as serious mistakes have been made, cases of varicella having 
been sent to small-pox hospitals. 

Therapeutic Hints. 

It seldom needs particular treatment. The occasionally attending symp- 
toms may be met by Aeon., Ant. cried., Bellad., Hyosc, Mercur., Pulsat:, 
Rhustox., Tart. emet. Compare Variola. 



SKIN. 



The skin, as the exterior investment of the body, serves to protect it; 
at the same time it is the medium by which a continued exchange goes on 
between the interior organs and the outer world. It is the connecting link 
between them, the last and lowest of the human frame. Its affections are 
almost always tokens of some internal derangements, hence their suppression 
is almost always followed by an aggravation of internal troubles. On the 
other hand internal complaints get better in the same degree as the morbid 
process passes outwardly to the skin. This we might state in brief as the 
essence of Hahnemann's psora-theory, which has been thrown aside by the 
would-be- wise, who never understood it. According to Nunez the suppres- 
sion of cutaneous eruptions on the anus is followed by liver complaints; on 
the legs, by digestive derangements; on the scrotum and penis, by impotence 
and seminal emissions; behind the ears, by cough and affections of the eyes; 
on the scalp, by pulmonary phthisis; on the arms and hands, by laryngeal 
phthisis; in the palms of the hands, by nervous asthma; on the nose and 
nostrils, by discharges from the ears; on the face (acne rosacea), b}^ heart 
diseases. The skin being easily accessible to ocular inspection and micro- 
scopical investigation, its affections have been thoroughly searched and min- 
utely arranged and described, especially by Hebra. It would alone fill a 
large volume were I to give a minute investigation of this subject. For such 
there is no room in a work of this kind. I shall confine myself to a cursory 
exposition. Besides, several of these affections have been treated of in pre- 
vious chapters. 

1. HYPERTROPHY OF THE SKIN. 

A hypertrophy of the entire structure of the skin we often find in single, 
confined places, constituting so-called moles, or motner's marks, and soft warts. 
They appear raised above the level of the skin, and, from large deposits of 
pigment within the rete Malpighii, they are of a dark-brown color and cov- 
ered b}^ a luxuriant growth of hair. 

A hypertophy of the epidermis, hard and horny constitutes callosities, 
w T hich form on such places as are exposed to external pressure, especially on 
the hands and feet. Corns, or clavi, are callosities, which grow on small, cir- 
cumscribed places of the feet in consequence of the pressure of tight shoes. 
Horns, or cornua cutanea, consist either in an excessive, circumscribed hyper- 
trophy of the epidermis or in enlarged hair-follicles. 

An abundant formation of pigment in the rete Malpighii causes a more 
or less dark color of the skin; when accumulating in confined spots, without 
rising above the level of the skin, it constitutes naevi spili (mother's marks); 



ICHTHYOSIS, OR FISH-SKIN. IOO3 

lentigines (liver spots); ephelides (freckles); chlosmata uterina, that is, brown- 
ish spots on the forehead and upper lip during pregnancy, or in consequence 
of uterine disorders; and the peculiar darkening around the nipples and the 
darkening of the linea alba during pregnancy. 

A hypertrophy of the papillary layer of the cutis constitutes ichthyosis. 

Ichthyosis, or Fish-skin, 

Is, according to Hebra, always of a congenital or hereditary nature. The 
skin appears dry and rough, and covered with thickened and exfoliating cu- 
ticle, like scales, all over, with the exception of the face, the inner side of the 
joints and the scrotum. In light cases the skin presents merely a rough ap- 
pearance, being covered with fine, white scales, without any sign of congestion 
or inflammation underneath. These light cases are called by some authors 
pityriasis, while other writers class under pityriasis also those cases where 
such small, whitish patches of unhealthy cuticle form upon a red, inflamed 
surface, calling it pityriasis ruba. It seems that the latter is a superficial 
dermatitis, and has nothing to do with a diffused hypertophy of the papillary 
layer of the cutis. 

Compare A rsen., Calc. carb., Clemat., Graphite Hepar, Lycop., Petrol. , 
Phosphor., Plumbum, Sepia, Silic, Sulphur, Thuja. Rubbing with oil, and 
afterwards taking a warm bath, is best suited to remove the hard scales. 

Hypertrophy of single papillae causes warts (verrucse vulgares) and fig- 
warts (condylomata). For common warts: Ant. crud., Calc. carb., Caustic., 
Dulcam., Natr. mur., Nitr. ac, Phytol., Rhus tox., Sepia, Sulphur, Thuja. 
For fig-warts compare venereal diseases. 

A circumscribed hypertrophy of the cutis constitutes co-called polypi of 
the skin, and the molluscum simplex, a hard, sometimes pediculated tumor. 

A hypertrophy of the cutaneous capillaries causes telangiectasias. Some 
of them remain stationary through life, while others enlarge continually, and 
may give rise to profuse haemorrhages. 

Compare Bellad., Fe??. phosph., Lycop., Phosphor., Plati?ia, Sulphur, 
and to which may be added Calc. carb., Carb. veg., Fluor ac, Pulsat., Thuja. 

H. ATROPHY OF THE SKIN. 

Atrophy of the entire skin takes place in consequence of general maras- 
mus, either senilis or praematurus, induced b3^ exhausting diseases. 

A want of pigment throughout the whole skin is congenital to albinos or 
kakerlakes. A disappearance of pigment in single places of the skin, vitiligo 
or achroma, gives, especially to dark persons, a white-spotted appearance. 

An atrophy of the hair- follicles causes baldness, calvities, or, as it happens 
mostly to aged persons, alopecia senilis. The falling out of the hair after se- 
vere illness depends merely upon a nutritive disturbance of the hair-follicles, 
not upon a wasting away of the same. Therefore the hair grows again as 
soon as these nutritive disturbances cease. 

A want of pigment in the hair makes it gray and white. 



1004 HYPEREMIA AND ANEMIA OF THE SKIN. 

m. HYPEREMIA AND ANEMIA OF THE SKIN. 

A stagnation of blood in the cutaneous capillaries, in consequence of 
heart disease, causes cyanosis. 

Hyperemia, or congestion of the skin, characterized by redness of the 
skin, is caused by exposure to heat; by the application of different irritating 
substances, such as mustard, cantharides, mezereum, etc., by a blow or fall; 
by the different exanthematic diseases and fevers of different descriptions. 

Anaemia of the skin, characterized by great paleness of the skin, is al- 
ways associated with a general anaemic state of the system; moreover, it is 
induced by exposure to cold; and is quite a characteristic sign of chills. 

IV. DERMATITIS, INFLAMMATION OF THE SKIN. 

Erythema. 

Erythema is characterized by a diffused redness of the skin, which, under 
the pressure of the finger, disappears, and leaves not a white, but a yellowish 
spot, which at once grows red again. It gradually disappears and is followed 
by desquamation; it is always attended with more or less burning pain. 
Erythema is caused by exposure to heat, the rays of the sun, and by different 
irritating substances. When it occurs in small children between the folds of 
the skin around the neck, behind the ears, between the thighs, etc., or in fat 
women under the dependent breasts, and becomes raw, it is called Intertrigo. 
It is found also between the buttocks, in consequence of friction from walking 
in hot weather. When erythema is the consequence of pressure from lying 
long in one position, as in severe illness upon the os sacrum, trochanters, or 
other prominent parts of the body, it is called Decubitus. So, also, do we 
observe erythema, in consequence of acrid discharges from the eyes, nose, 
bowels and genitals upon the adjacent parts. 

Besides all this there is an erythema, which, without any apparent cause, 
appears spontaneously upon the back of the hands and feet: in rare cases it 
spreads over the face and trunk, but never without, at the same time, show- 
ing itself upon the back of the hands and feet. It appears in these localities 
as an evenly diffused redness and swelling, which, after a short time, be- 
comes covered with smaller, or larger, dark-red, or even purplish-colored 
papulae, Erythema papulatum seu tuberculosum. It is always attended with 
an annoying burning pain, and in some cases with feverishness. After a few 
days the redness, swelling and papulae disappear, and the whole morbid 
process winds up with desquamation of the cuticle in the coure of eight or 
fourteen days. In some cases it lasts longer; when repeated crops of papular 
eruptions follow each other in succession and on different localities. 

The Erythema nodosum appears almost exclusively on the lower ex- 
tremities of young persons. Upon the reddened skin lumps of the size of 
hazelnuts or walnuts appear, which are painful to the touch and have a great 
similarity to bruises, changing their color from red to purple, then to blue, 



HERPES. IOO5 

and lastly to green and yellow. This form is always attended with feverish- 
ness and ends with desquamation after eight or fourteen days; only in rare 
cases new crops follow. 

Therapeutic Hints. 

Intertigo of infants between the thighs, when attended with acrid diar- 
rhoea, compare Borax, Chamon., Lycop., Mercur., Rhus tox., Sulphur. 

When behind the ears: Graphit., Petrol., Sulphur. 

In general: Lycop. 

Erythema from exposure to the rays of the sun: Aeon., Camphora, 
Canthar. 

Decubitus: Arnica, Carb. veg., China, Fluor, ac, Sulph. ac, etc. Com- 
pare the corresponding chapters. 

Erythema from acrid discharges, compare the corresponding chapters. 

Papulous erythema, compare Aeon., Bellad., Laches., Mercur., Rhus tox., 
Sulphur. 

Erythema nodosum, compare Arnica, Laches., Ledum, Lycop., Mezer., 
Ptelea inf., Rhus ve?i., Sulph. ac., Sulphur. 

Herpes. 

The different forms of herpes are characterized by an exudation, usually 
of a watery substance, beneath the epidermis, forming globular vesicles which 
are arranged in clusters upon an inflamed patch of the skin, and terminate 
frequently in the formation of a thin incrustation without leaving scars. 

The Herpes facialis appears on the face; when on the cheeks and upon 
the eyelids it is called Herpes phlyctaenoides, when upon the lips, Herpes 
labialis, or Hydroa febrilis (fever- blisters). This latter form is a frequent at- 
tendant upon croupous pneumonia, intermittent fevers and other febrile 
diseases. It scarcely ever occurs in typhus. 

A special treatment is not required, but its presence may suggest Bryon., 
Graphit., Hepar, Natr. mur. (especially in intermittent fevers), Rhus tox., 
Sulphur. 

The Herpes prseputialis appears by preference on the prepuce, but 
also on the scrotum, penis and on the outer parts of the female organs. Its 
appearance in clusters of globular vesicles, which are soon covered with a 
thin crust, distinguishes it at once from chancre. 

Hepar or Mercur. are almost always sufficient for its removal, and in 
case of violent itching and burning in females, Calad. seguinum. 

The Herpes Zoster, or Zona, or Shingles, is characterized by its peculiar 
way of spreading along the course of certain cutaneous nerves. When 
it appears on the thorax, the cluster of vesicles occupy the space in which 
one of the spinal nerves takes its course, commencing near one of the 
vertebrae and running around on one side of the trunk towards the 
sternum, thus forming a kind of belt around one-half of the thorax. When 



1006 THERAPEUTIC HINTS TO HERPES. 

it appears on the neck, it forms not only a ring around one side of the 
neck, but it appears likewise upon the trunk and the upper arm, corresponding 
to the course of the cervical nerves and the brachal plexus. In cases where 
it starts from the lower lumbar vertebrae, it spreads in a similar manner 
upon the thigh. Quite seldom is zoster found in the face, and then it occupies 
one-half of the face in the shape of a belt. Zoster is almost always preceded 
by rheumatic pains in the parts affected, by fever and debility. There is 
burning in the parts, then follows redness, upon which gradually clusters of 
vesicles appear, which often coalesce. In the course of four or six days they 
form into crusts. This terminates the attack, unless new and fresh crops of 
vesicles should break forth. The burning pain usually commences to leave 
when the eruption is full}' out, and disappears entirely with the falling off of 
the crusts. Not unfrequently, however — and this is quite a peculiar feature 
of zoster — there is developed, after all seems well, an intercostal neuralgia, 
which is very painful and often quite obstinate. Sometimes the vesicles are 
converted into deep-seated pustules, leaving scars behind them; or they be- 
come infiltrated with blood}' serum. The duration of zoster is from 12, 14 
to 30 days, according to the degree of the inflammation and the general con- 
dition of the patient. 

Therapeutic Hints. 

Arsen. Severe, burning pain, worse at night, and great restlessness. 

Canthar. On right side. 

Cistus. On back. 

Comocladia. On legs. 

Crot. tigl. Itching and painful burning and redness of the skin; forma- 
tion of vesicles and pustules; desiccation, desquamation and falling off of the 
pustules — a close picture of zoster. 

Euphorb. Burning in the face; inflamed cheeks, w T ith boring, gnawing 
and digging from gums to ears, and itching and tingling in the cheeks. 

Graphit. Especially on the left side. 

Iris. vers. On right side, with following gastric derangement. 

Kalm. lat. Facial neuralgia after zoeter. 

Laches. In spring and fall. 

Mercur. Is said by some to be a specific for relieving the burning, and 
preventing the appearance of new crops. Right side, extending across the 
abdomen. 

Mezer. Is strongly recommended, and said to prevent and cure the suc- 
ceeding neuralgia intercostalis. 

Pulsat. Where there is gastric derangement; evening aggravation, and 
a mild, yielding, tearful disposition. 

Ranunc. bulb. Preceding neuralgia intercostalis. 

Rhus tox. Where there is fever, restlessness and burning-itching. 

Thuja. Suppressed gonorrhoea; burning after scratching. 

Zincum. With lancinating pains; suppurating herpes. 



URTICARIA. * IOO7 

Herpes circinnatus (ringworm) is characterized by its circular form. 
The vesicles, usually much smaller than in other forms of herpes, appear in 
the form of a circle, the centre of which is fading, while on the periphery 
the vesicles are spreading. Sometimes, however, there is one larger vesicle, 
which not unfrequently is filled with a bloody fluid, right in the centre of 
the ring, and around the ring appears still another larger ring. This form 
is called Herpes his, and is usually found upon the back of the hands or 
feet, on the fingers or toes, less frequently on the arms, thighs or face. Many 
forms of these eruptions are caused by vegetable parasites. 

Therapeutic Hints. 

Compare Calc. carb., Hydrast., Natr. carb., Natr. mur., Sepia, Tellur. 
" Chrysophanic acid, ringworm." (C. E. Fisher.) 

Urticaria, Nettle-rash. 

This affection is characterized by prominent and perfectly smooth 
patches upon the skin, the color of which is either redder or whiter than the 
surrounding skin. They are formed by a serous infiltration of the papillary 
layer of the cutis. The causes of these eruptions are numerous. As such 
we may mention — 1. Various external irritations, such as contact with net- 
tles, or with some kinds of caterpillars and mollusks; the sting of fleas, 
bed-bugs, mosquitoes, bees; scratching with the finger-nails. 2. Intestinal 
irritations from eating strawberries, crabs, clams, mushrooms; from taking 
copaiva-balsam. 3. Uterine irritations, during pregnancy; menstruation; 
different uterine diseases, and after the introduction of pessaries. 

Entirely unknown are the causes of Urticaria febrilis, which is chiefly 
attended by digestive disturbances, and has in its course and progress great 
similarity to other exanthematic fevers. I have often observed that symp- 
toms which simulated croup, asthma or different other complaints, all at once 
disappeared as soon as nettle-rash made its appearance upon the skin. We 
also find it associated with chills and fever, and other febrile complaints. 
In some cases it assumes a chronic form, when it is quite difficult to get 
rid of it. 

Therapeutic Hints. 

Anac. From emotional causes. 

Ant. crud. White lumps with red areolae and itching; thick, white- 
coated tongue; gastric derangement. 

Apis. Stinging, burning; croupy cough; uterine catarrh. 

Arsen. Burning; chills and fever; alternating with croup and asthma. 

Bellad. During profuse menstruation; after eating cabbage or sour- 
kraut. 

Berber. Heartburn, with soap-sud taste in mouth. 

Bryon. Fever and rheumatic pains, worse from motion. 



1008 ECZEMA. 

Calc. carb. Fat, plump children; teething period; chronic form; rash 
disappears in the fresh air. 

Dulcam. Itching; after scratching, burning; after taking cold; grip- 
ing pain in the bowels, with nausea and diarrhoea. 

Hepar. Chronic cases; eruption on hands and fingers, during intermit- 
tent fever; disguised croup. 

Ignat. During the chill)'' stage of intermittent fevers. 

Kali carb. During menstruation; swelling of parotid glands. 

Lycop. Chronic cases. 

Pulsat. During delayed and scanty menses; rheumatic tendency. 

Psorin. After suppressed itch, frequently repeated attacks of urticaria, 
with fine vesicles on the top, which dry and peel off in fine scales; appearing 
regularly after an)' exertion. 

Rhus tox. Itching, burning; skin swollen and red; after getting wet; 
worse in the cold air; rheumatic pains, worse during rest; fever; thirst. 

Sepia. Chronic; breaks out during a w T alk in the cold air and disap- 
pears again in the warm room; especially on the face, arms and thorax; 
uterine troubles. 

Sulphur. Chronic cases; worm symptoms; rheumatism; frequently in- 
dicated after Pulsat. 

Urtica urens. Without any concomitant symptoms. 

Ustil. Itching at night; ovarian irritation, with menstrual irregularities. 

Eczema. 

Eczema consists of a diffuse, superficial dermatitis, which causes numer- 
ous little vesicles upon an inflamed, irregular surface; sometimes these ves- 
icles are intermingled with pustules (impetiginous variety), at other times 
the exudation may not be abundant enough to raise the epidermis into ves- 
icles, but only loosens it, so that it dies off and forms a scaly surface; or the 
epidermis is actually thrown off, leaving a raw, moist surface behind (inter- 
trigo), which, in some cases, becomes covered with a thin scurf, in others 
w T ith a thick crust. 

Its Causes are — i. Direct irritation of the skin by too high a tempera- 
ture (baker's itch); hot baths; the application of wet bandages; the rubbing 
jng in of mercurial salve or croton oil; and by various other irritating sub- 
stances. 

2. Stagnation of the venous blood within the capillaries. As this takes 
place most frequently on the lower extremities, we find the consecutive eczema 
there also, in the form of salt rheum. 

3. A dyscratic diathesis of scrofulous or rachitic individuals; in overfed, 
plump children. 

4. In many cases we cannot trace it to any cause. 

It chooses as favorite localities: the scalp, where it is called tinea fur- 
furacea, if it causes merely a separation of the epidermis in fine scales; or 



ECZEMA. IOO9 

tinea amiantacea, if the dried exudate and the loosened epidermis form a 
kind of asbestos-like layer upon the inflamed surface. Dandruff is a seborrhoea 
(dry) of the scalp, and is distinguished from eczema by being a functional, 
non-inflammator3 T disorder. But it may also form thick crusts, matting the 
hair together (tinea capitis). Facial eczema (see Crusta Lactea, p. 231). 

When the eruption commences with vesicles and violent itching: Rhus 
/ox., Merc, sol., Lycop., Arsen., Crot. tig I. 

When attended with swelling of the glands of neck and nape of neck: 
Bar. card., Sulphur, Calc. carb., Conium. 

In rachitic individuals: Silic, Sulphur. 

When forming out of nodes and pustules with thick crusts: Hepar, 
Calc. carb., Graphit. 

In scrofulous subjects: Bar. carb., Calc. carb., Sulphur, Silic, Phos- 
phor. (Kafka.) 

The face. Here it occurs in all forms and has received many different 
names: eczema impetiginosum, when intermingled with pustules; and rubrum, 
when growing upon an inflamed, red surface; porrigo larvalis, when forming 
thick crusts; tinea faciei, crusta lactea, when appearing during lactation; 
crusta serpiginosa, etc. 

The genital organs, in males the penis and scrotum, and in females the 
labia majora. It is either acute or chronic; the latter especially when on the 
scrotum. By its terrible itching it drives one almost to madness. It may 
appear also upon the perineum and around the anus. 

The inner side of the thigh, just where the scrotum touches it. This is 
called eczema marginatum, and has been observed especially in shoemakers 
and cavalrymen. It commences on the inner side of the thighs, just where 
the scrotum touches it, but soon appears also on the corresponding place of 
the other thigh. 

The legs. Here it forms a large, red, raw, constantly secreting surface, 
sometimes ulcers covered with thick crusts. This is called salt rheum. 
When the ulcers heal the skin appears thickened and is usually of a darker 
color from alteration of the pigment. 

The bends of the extremities. The scanty exudate generally dries with 
the loosened epidermis, and forms a brittle covering which, on motion of the 
limbs, cracks in different directions. Sometimes the secretion is more pro- 
fuse, and keeps the affected parts constantly moist. 

Hands and feet. It is a peculiar fact, that the hands and feet are at- 
tacked almost always simultaneously. When it appears on the dorsal side, 
it generally assumes the form of simple eczema or vesicles, and may be con- 
founded with itch. On the palms of the hands or soles of the feet it scarcely 
ever occasions vesicles, but causes the epidermis to peel off in the form of 
white scales, for which reason it has been called psoriasis or pityriasis palma- 
ris or plantaris. It is also found on the external ears, on the eyelids, on the 
trunk, on the nipples of nursing women (" sore nipples "), on the navel, in 
the axillae, in the inguinal region of children, between the toes in conse- 
64 



IOIO THERAPEUTIC HINTS TO ECZEMA. 

quence of sweating. The progress of the disease is seldom acute; all forms 
are characterized by great itching; scratching is apt to spread the affection 
further. 

Therapeutic Hints. 

In selecting the remedy for such affections, the constitutional symptoms 
must never be lost sight of. I can give hints only to local symptoms, as the 
other would lead too far, and still could not meet all the possible complications. 

Eczema on the scalp, compare: 

Arsen. Generally dry, scaly eruption, sometimes fetid, purulent secre- 
tion, with nightly burning or terrible itching; better from external warmth. 

Bar. carb. Moist crusts, with falling off of the hair; glandular swell- 
ings on the neck and under the lower jaw. 

Calc. carb. Thick crust, moist or dry, with scrofulous diathesis. 

Chrysoph. ac. Especially for the squamous variety. (C. E. Fisher.) 

Clemat. The eruption inflames during the increasing, and dries up 
during the decreasing moon. 

Cicuta. With itching, or burning, or both; the secretion from the vesi- 
cles forms a yellow ; thick crust, which mats together. Also on chin. (C. 
Wesselhoeft. ) 

Graphit. Impetiginous eruption; soreness after scratching; worse on 
left side, and in the evening; sticky secretion. 

Hepar. Purulent secretion, itching and sore; worse in the morning, 
and on the right side; unhealthy skin, even slight wounds suppurate. 

Lycop. Thick crusts, with fetid secretion underneath; bleeds easily 
after scratching. 

Mercur. Yellow crusts, stinging, burning; the surroundings inflame 
easily after scratching. 

Natr. mur. Raw, inflamed surface, continually discharging a corroding 
fluid, which eats away the hair; on the boundaries of the hair. 

Rhus tox. Thick, moist crusts; tingling, stinging, burning, especially 
at night. 

Staphis. Yellow, acrid moisture oozes from under the crusts; upon the 
denuded surface new vesicles form at once which burst. By scratching one 
place the itching ceases, but appears in another place. 

Sulphur. Crusts and pimples itch spontaneously, especially at night; 
bleed easily. 

Besides, compare Anacard., Aiit. crud., Borax, Bromium, Cicuta, 
Cyclam., Dulcam., Kali bichr., Lappa, Nitr. ac, Oleander, Phosphor., Sepia, 
Si lie, Thuja, Viola trie. 

Eczema on the face, compare Arsen., Bellad., Borax, Calc. carb., Clemat., 
Cicuta, Crot. tigl., Cylam., Dulcam., Graphit., Hepar, Iris, Lycop., Mercur., 
Mezer., Natr. mur., Rhus tox., Sarsap., Sepia, Staphis, Sulphur, Viola trie. 

Eczema on the genital organs, compare Arg. nitr., Arsen., Calad., Crot. 
tigl., Graphit., Hepar, Lycop., Natr. mur., Nitr. ac, Petrol., Rhus tox., 
Sepia, Sulphur, Thuja. 



ULCUS VARICOSUM. IOII 

Eczema marginatum, compare Natr. mur., Sepia, Sulphur. 

Eczema on the legs, salt rheum. As this affection is the result of stagna- 
tion in the venous circulation, it will be a great service to bandage the limbs 
tightly. Among the remedies compare Arsen., Calc. carb., Carb. veg., 
Graphit., Laches., Lycop., Mercur., Natr. mur., Pidsat., Rhus fox., Sarsap., 
Sepia, Silic, Sulphur. 

Eczema in the bends of the extremities, compare Amm. carb., Bryon., 
Calc. carb., Graphit., Ledum, Mercur., Sepia, Sulphur. 

Psoriasis, or pityriasis palmarum, or plantaris point to Magn. carb., 
Ran. bulb., Rhus fox., Sepia, Sulphur. 

Ulcus Varicosum, Varicose Ulcers on the Legs. 

Carduus maria?ius. Five drops of tincture 3X a day, or first dilution. 
(Dr. Windelband, of Berlin, Zeitschr. des Berliner Ver. Horn. Gerzte.) 

Clematis vital ba. 3d trit. Dr. P. Jousset. (Allgm. Jour. Ztg., 127 
Band, November, 1893, Nos. 21 and 22, page 171.) 

Impetigo, Pustular Eruption. 

It differs from eczema in being a purely pustular disease. As, however, 
the contents of eczema vesicles frequently become milky and purulent, no 
distinct line of demarcation can be drawn between these two skin affections. 
In fact, many of the eruptions cited under eczema of the scalp and face are 
often confounded with eczema. Its causes are not well understood, although 
it is probably a superficial pus infection. In addition, we find this form 
especially in scrofulous subjects, in whom there is a great vulnerability of 
the skin, so that any little irritation or wound of the skin at once begins to 
fester. We also find it sometimes after vaccination sprouting forth over the 
body. 

Impetigo contagiosa. — The eruption is attended with fever; a part of 
the skin reddens, burns and itches, and now little vesico-pustules appear, 
which in five or six days reach the size of a split pea or a hazelnut; they 
are generally umbilicated, and form after a while yellowish, straw-colored 
crusts, which look as if stuck on. The eruption may remain confined to the 
forehead and cheeks, but frequently extends further. The scratching with 
the nails is especially apt to spread the affection, and it may, in this manner, 
be transmitted to other persons. 

Therapeutic Hints. 

All that has been said under eczema is applicable here. All the con- 
stitutional symptoms must be considered. If Hebra and his echoes assert 
that it be pure imagination of an erroneous idea of the natural processes in 
the human body to suppose that eczema, if cured by external means {id est, 
by being suppressed by green soap, Kali caustiacm, Tar, etc.), could ever do 



IOI2 ECTHYMA. 

any harm, we leave them to grow wiser by closer observation, and stick to 
old Hahnemann and our own experience. There is no distinct line of de- 
marcation between eczema and impetigo. The latter is admitted by Hebra 
himself to be in connection with a scrofulous diathesis; why not the eczema ? 
If the one be the expression of a general contamination of the system, why 
not the other ? But it is so much easier to cut off the fruit of a tree than to 
root out the tree itself. 

For Impetigo contagiosa, Dr. Kippax in his hand-book of skin diseases 
gives the following hints: 

Ant. cried. Is the main remedy. 

Aeon. If there is much febrile disturbance. , 

Euphorb. When there is an irritable skin, with swelling of the face 
and pea-sized yellow vesicles, 

Kali bichr. Stands next to Ant. cried. 

Tart. emet. When the disease is exceedingly pustular. 

Thuja. After vaccination. 

Silic. and Kali nitr. Are at times indicated. 

Ecthyma ; Isolated, Large Pustules. 

Upon a red and swollen surface single pustules appear, of the size of a 
pea, which contain a yellow, purulent, or dark-colored fluid, if there be 
blood mixed with it. They are surrounded by a red areola, and appear most 
frequently upon the extremities, on the seat, on the chest, and on the neck, less 
often on the face. Ecthyma is almost always attended with stinging pains, 
and in irritable persons with slight fever. In the course of a few da3 T s the 
pustules dry up and form round, brownish crusts which when being removed, 
leave more or less extensive excoriations, resulting in temporary scars and 
pigmentation. In chronic cases the disease is protracted by successive crops 
of pustules for a long time. 

We meet it at any time of life, and especially in consequence of pro- 
tracted diseases, poor living and cachectic conditions. 

Therapeutic Hints. 

Compare Ant. crud., Arsen., Calc. carb., Cicuta, Cyclam., Kali bichr., 
Laches., Lycop., Merc, sol., Nitr. ac, Piper nigr., Secale., Sulphur, Tart, 
emet. 

The general constitutional symptoms must never be lost sight of. 

Pemphigus, Pompholyx, Isolated Large Bullae or Blisters. 

Upon a red, inflamed, but not, infiltrated surface, pretty large blisters 
appear, which are filled with clear serum and greatly resemble those occa- 
sioned by burns or fly-blisters. About their causes nothing is known, ex- 
cept that if they occur in newborn children they are of syphilitic origin, and 
in grown persons they are symptoms of some general dyscrasia or cachexia. 



RUPIA OR RHYPIA. IOI3, 

The acute form of this affection is extremely rare. It is always at- 
tended with pretty high fever and general indisposition, and lasts about four- 
teen days, Renewed outbreaks may prolong it much longer. The chronic form 
of pemphigus, which may grow out of an acute attack, lasts months and 
even years. One crop after another appears upon the skin, showing the 
bullae in all the phases of their development; the youngest are transparent, 
the older have a milky appearance; they burst and leave an excoriated sur- 
face. This raw surface still continues to secrete serum, and is finally covered 
with a thin crust. The worst form is Pemphigus foliaceus. It begins with a 
single blister, which is continually increasing, until the whole surface of the 
bod}' is literally skinned and then covered by a brownish crust. It often 
takes a fatal termination. 

Therapeutic Hints. 

Compare Arsen., Bellad., Canfhar., Caustic, China, Dulcam., Kreos. t 
laches., Mercur., Phosphor., Kan. buib., Rhus tox., Sepia., Sulphur, Thuja. 

Rupia or Rhypia, Isolated Blisters, which form thick Orusts. 

The bullae contain a purulent, reddish matter, which gradually dries 
and forms a thick dark crust. Underneath this crust matter continues to 
form, which again dries and consequently raises the centre of the crust, 
while on the periphery it becomes encircled by a vesicated border, which 
also dries up into a crust. And as this latter is much thinner than the first, 
which has been successively heaped up, the whole assumes a great similarity 
to an oyster-shell. On removing the crust we find a deep, foul, excoriating 
ulcer. Rupia is a late and malignant manifestation of syphilis. 

Therapeutic Hints. 

Compare syphilis. Berjeau gives the following hints: 

Clemat. Growing worse during the increasing moon; discharge of a 
sanious pus, yellow and corrosive; burning and tingling in the ulcer; itching 
worse at night in bed. 

Mercur. Violent itching, worse in bed; ulcerating pimples; desquama- 
tion of the skin; excoriations of a tettery nature, which are oozing constantly 
and bleed easily when scratched. 

Nitr. ac. After mercury; copper-colored spots; watery, blood} 7 secre- 
tion. 

Sarsap. Also after the abuse of mercur} 7 ; purulent vesicles, itching; 
depression of spirits. Especially in the spring. 

Sulphur. Scabious eruptions with burning, itching, surrounded by a 
yellow or brownish areola; secretion a sanious, fetid or thick and yellow pus; 
spots covered with small vesicles, discharging serous lymph. 

Thuja, brown or red mottled spots, with itching shootings in the even- 
ing; purulent pimples, containing fluid-like varnish. 



IOI4 FURUNCULUS. 

Furunculus, Boil. 

A furuncle commences as an inflammation of. one or several closely- 
grouped cutaneous glands, or hair-follicles, which become infiltrated. By- 
and-by the inflammation spreads to the surrounding cellular tissue, and 
through the entire skin, suppuration takes place, and, accompanied by acute 
pains, and at times fever, the boil breaks and discharges a bloody matter; 
the core (which consists of destroyed cellular tissue), however, is not dis- 
charged until all of it has been loosened from its surroundings. Large boils 
generally occur singly; small ones, so-called blind boils, which discharge 
very little, or nothing at all, frequently appear in crops, or in rapid suc- 
cession, and may torture a patient for a considerable length of time. Their 
exact cause is unknown, but they seem to depend upon some depraved state 
of the blood in the general system, they frequently appear during the recon- 
valescence from severe illness, and at times as epidemics. 

Therapeutics Hints. 

Never use the lancet nor allow it to be used, because it never does any 
good, but always harm, as it increases the inflammation and protracts the 
healing process. 

For large boils, compare Apis, Crotal., Hepar, Laches., Lycop., Me? cur. , 
Nitr. ac, Silic, Stramon. 

For small ones: Arnica, Bellad., Nux vom., Sulphur. 

For a disposition to boils: A? sen., Calc. carb., Lycop., Nux vom.,Phosph. 
ac, Plumbum, Silic. and Sulphur. 

Carbunculus, Carbuncle 

The carbuncle is a phlegmonous dermatitis, and commences with severe 
pains in the part affected, which are mostly of a burning character, and con- 
tinue to be so through the whole course. The painful spot commences to 
swell, to harden, to discolor; it generally assumes a purplish hue. After five 
or six days numerous little holes form in the swollen and discolored place, 
from which a yellowish mattery substance projects. The swelling and hard- 
ness still continue to increase in circumference. Only a little pus is dis- 
charged from the small holes. They, however, gradually widen and coalesce, 
until by degrees a considerable portion of the cutis is entirely destroyed; or 
the epidermis is raised in the form of a gangrenous blister, which finally 
breaks. We now observe the necrosed cellular tissue underneath; the pus 
discharges more copiously, and with it large pieces of destroyed tissue slough 
off. The loss of substance sometimes amounts to several square inches. This 
process is always attended with considerable fever, and is quite apt to assume 
an adynamic character. When complicated with cerebral symptoms, which 
are the consequence of the absorption of the pus by the blood, it may ter- 
minate fatally. In favorable cases new granulations appear at the bottom 



THERAPEUTIC HINTS TO CARBUNCUUJS. IOI5 

of the wound, and by a slow healing process the whole lost substance is finally 
restored. Predisposition to carbuncles is found, especially in diabetes mel- 
litus, and Bright' s. 

Carbuncle differs entirely from furuncle. It is of a much more destruc- 
tive character, appears principally on the nape of the neck, or along the 
spine, on the forehead, or buttocks, and chiefly attacks aged persons, while 
furuncle is never associated with gangrenous destruction of substance, it 
appears here and there and everywhere, and attacks all ages alike. 

Therapeutic Hints. 

No knife. But compare: 

Anthrac. When the burning pain is violent and not relieved by A? sen. ; 
cerebral symptoms; absorption of pus by the blood; gangrenous destruction. 
A carbuncle on the back of a man, some sixty years of age, had attained 
the size of nine inches in length, and five inches in its greatest width. There 
was sloughing, abundant discharge of ichorous, terribly smelling pus, and 
poisoning of the blood by absorption of pus. Arsen. had no beneficial effect; 
Anthrac. relieved at once. Ever since then I have given Anthrac. in several 
cases, where there were symptoms of the same destructive character, with 
the same beneficial result. 

Apis. When the erysipelatous inflammation extends further and further. 

Arsen. Great burning; great restlessness; great thirst, drinking but 
little at a time; great debility; all the symptoms are worse in the night, and 
better from external warm applications. 

Bellad. Bright redness; throbbing pain; drowsiness, with inability to 
go to sleep. 

Bufo. At the commencement very efficient. 

Card. veg. Dark, blackish appearance; fetid odor; hippocratic face; 
blood poisoning. 

Hepar. 

Kreosot. 

Laches. Bluish, purplish appearance; inability to bear any bandage 
around the neck; cerebral symptoms. 

Nitr. ac. 

Rhus tox. Great restlessness; feels somewhat relieved of the violent 
pain as long as he is in motion. 

Secale. Cannot bear external warmth. 

Silic. During the process of ulceration; it seems to clear the wound of 
its decayed masses, and to promote healthy granulation. 

Tarant. Cub. 

Psoriasis. 

It consists of a chronic dermatitis, with infiltration of the corium and 
a morbid condition of the epidermis. The effusion upon the corium is not 
abundant enough to raise the epidermis into vesicles. It causes a mere 



IOl6 LICHEN. 

hyperemia of the skin, in consequence of which the papillary layer produces 
a sickly epidermis, which soon loosens and drops off in scales. Its causes 
are quite obscure. In some families it is hereditary. Quite young children 
and quite old persons are seldom attacked by it This affection commences 
in small, red, somewhat elevated, roundish spots, like drops, which are soon 
covered with dry, oblong, white scales — Psoriasis guttata. When the spots 
increase in number, they necessarily coalesce as they grow, and form large 
irregular surfaces, which are covered with scales of various thickness and 
adhesiveness — Psoriasis diffusa of Willan. They sometimes accumulate 
in round patches. While on the periphery new spots still appear, those in 
the centre dry up, and this gives rise to a circular eruption — Psoriasis 
aunulata (ringworms). Or, several of such circles meet, their peripheric 
lines are broken off by already healed up centres, and now they form various 
figures, parts of circles, straight lines, etc. — Psoriasis gyrata In some 
cases this morbid process continues for a long time, and causes the skin to 
become thickened, rigid and cracked. This takes place especially in the dif- 
fuse and irregular forms; then it is called Psoriasis inveterata. These dif- 
ferent names are not to be understood as indicating different varieties, but 
forms and stages of the same cutaneous affection. The favorite places for 
psoriasis are the extensor sides of the extremities, especislly the knee and 
elbow. In many cases the disease is confined to these localities. Frequently 
it appears symmetrically on both sides of the body, similar to eczema. Some- 
times it is found on the eyelids, lips, prepuce, scrotum and labia majora. 
The so-called Psoriasis palmaris and plantaris, by which the redness and 
infiltrated surfaces of the palms of the hands and of the soles of the feet are 
covered with dry scales, belongs to eczema, and its circumspect form is 
always of syphilitic origin. 

Therapeutic Hints. 

Compare Arsen., Calc. card., Clemat., Corall., Cuprum, Fluor, ac, Hy- 
droc, Ipec, (F. Frederick) Iris vers., Mercur., Nitr. ac, Petrol., Phosphor., 
Phosph. ac, Phytol., Psorin., Selen., Sepia, Silic, Sulphur, Tellur. 

Ringworms — Baallinum ( Tuberculi?ium.) 

Lichen. 

One form, Lichen simplex, consists of little red papules, of the size of 
a millet seed, usually appearing on the outer parts of the forearm, sometimes 
on the back of the hands, on the neck and thigh. They appear mostly in 
summer time and are accompanied by itching. 

The other form, Lichen planus, consists of dull red, flat-topped papules 
of the size of a millet seed, at first of a shiny appearance, but later covered 
with thin scales; their centre presents an umbilicated depression, the opening 
of a hair-follicle, and after their disappearance they leave at times a darkish 



PRURIGO. IOI7 

stain or a little pit. They appear singly and in groups, and are found espe- 
cially on the forearms, wrists, thighs, abdomen and legs, below the knees. 
The Lichen ruber of Hebra is commonly associated with marasmus. 

Therapeutic Hints. 

For Lichen simplex Kippax recommends: Alum., Amm. mur., Anan- 
ther., Ant. Crud., Arsen., Be/lad., Bovista, Bryon., Castanea vesca, Calad. y 
Iod. of sulphur, Kreos., Ledum, Mercur., Nabulus alb., Natr. carb., Nux 
Jugl., Plaui. maj., Phytol., Rumex, Sepia, Sulphur, Tilia. 

For Lichen planus: Ant. crud., Agar., Arsen., Chin, ars., Iodium, Iod. 
of sulphur, Kali bichr., Ledum, Nux jugl., Potass, iod., Sarsap., Staphis. 

Prurigo, Pruritus. 

Instead of conical pimples, as found in lichen, prurigo exhibits flat 
papules, which have the same color as the surrounding skin. When broken 
they discharge a small drop of a clear fluid, and are attended with an intol- 
erable itching. Want of personal cleanliness, of the proper change of 
clothing, and poor and unwholsome food are probably its most frequent 
causes. Hebra asserts that it is found only in the poorer classes of the peo- 
ple. With the exception of the first years of childhood it is found in all ages, 
and more frequently in men than in women. The flat papules, which at first 
appear singly, and which may even be difficult to detect by sight, as they do 
not differ in color from the surrounding skin, cause a most terrible itching, 
which incites the person to scratch. Hereby the papules become denuded of 
their epidermis; they bleed, and the exuding blood forms dark crusts upon 
the scratched localities. Thus, it closely resembles in appearance the torn 
surface from scratching, in consequence of itch or lice. Prurigo, however, 
has favorite localities, differing from either itch or lice. While the acarus 
prefers to locate between the fingers, in the bends of the limbs, and on the 
belly, and lice take their abode in preference where the shirt lies in folds, on 
the neck, around the waist, etc., prurigo is found principally on the exten- 
sor sides, especially of the lower limbs and on the back; a feature decidedly 
distinguishing prurigo from itch. The finding of the acarus or of lice would 
settle the question. But even then there might be a complication between 
prurigo and itch. The spotted appearance of the skin is nothing but the 
necessary consequence of the violent and continued scratching. The skin 
being continually torn, simple crusts not only form, but the surface com- 
mences to fester and to cicatrize. 

Milder cases of prurigo, where the disease is confined to the lower ex- 
tremities, are called prurigo mitis; graver cases are called prurigo formicans. 
Those which are confined to the anus, penis, scrotum and vulva, prurigo 
pudendorum, are related to eczema. 

The disease has its remission during spring and summer and its exacer- 
bations during fall and winter. 



IOl8 SCABIES. 

The effects of prurigo upon the general organism grow the more appar- 
ent the longer the disease lasts. The constant unbearable itching, which 
destroys all comfort, rest and sleep, wears the patient out, and has led some 
to utter despair and suicide. There is also combined with this disease a re- 
markable tendency to rapid serous exudations into the serous membranes of 
the brain and lungs, a tendency to aberrations of the mind or to tuber- 
culosis. 

Pruritus is a hyperesthesia of the cutaneous nerves, frequently a reflex 
symptom, without any eruption, or an itching of the skin in consequence of 
some foreign material, like bile, coursing in the blood and irritating the cu- 
taneous nerves, as in jaundice. 

Therapeutic Hints. 

Arsen., Calc. carb., Carb. veg., Dolichos prur., Graphit., I odium. Ly cop. , 
Mercur., Nezer., Nitr. ac,, Rumex crisp, (the itching is made worse by cold 
and better by warmth — H. Bernard-Hardenpont), Sepia, Sulphur. 

The pruritus of pregnant women has been relieved by the smoking of a 
cigar. 

Scabies, Itch. 

Itch, namely, acarus-itch, is a dermatitis, which is caused by a parasite 
called acarus scabiei seu sarcoptes homiuis. This insect burrows itself into 
the skin in order to find shelter and to deposit its eggs. This causes the in- 
flammation, which produces papules, vesicles and pustules. It is always at- 
tended with great itching, especially at night, when these animals are the 
liveliest; leave their holes and pay each other visits. One pregnant female 
acarus, if it be transplanted to another person, is sufficient to infest this 
person with the itch. Her eggs ripen in about eight or ten days; the 
youngsters creep out and do exactly as the old ones did; the mischief is done. 
Infection takes place, therefore, most readily if one happens to sleep with 
another who has the itch; but also by shaking of hands, by clothing, by 
using the same towel, etc. , the female acarus may be transplanted. The fact 
makes itself known first by an intolerable itching on those parts, which the 
acarus seems decidedly to prefer, namely, the hands, especially between the 
fingers, the cleft of the nates, the bends of the extremities, the abdomen, and 
the genital organs, never the face. It seems that this terrible itching is 
caused not only by the action of the insect in burrowing itself into the skin ; 
but also by an acrid juice, which it probably secretes. The objective signs 
which now follow are the above-mentioned pimples, vesicles and pustules, on 
account of which the books speak of a scabies papulosa, vesiculosa, and 
pustulosa. The most characteristic signs of acarus itch are, however, the 
little furrows which are dug by the insects. They present dotted, irregular 
streaks, which have a great similarity to little scratches of a needle. At 
their commencement there is generally a vesicle, seldom a papule or pustule; 
at their end, a little way from the vesicle, the insect sits, appearing as a 



GENERAL THERAPEUTIC REMARKS. IOig 

whitish speck. By carefully entering the small channel with a fine needle 
tne perpetrator may be pierced and extracted. 

Itch never heals spontaneously, and the more the insects multiply, the 
worse it grows. The original irritation caused by the insects, and the ad- 
ditional one by scratching, causes the whole eruption to assume the form of 
eczema and impetigo, with vesicles, pustules and crusts of different sizes. 

General Therapeutic Remarks. 

The old school considered it a great triumph when, in the year 1834, by 
M. Renucci, a young Corsican in Paris, who had learned in his native island 
the art of extracting the little animal, the question about the nature of itch 
seemed to be settled. Hahnemann's psora-theory had thus been exploded 
by a needle in a Corsican' s hand, and with it, all Homoeopathy! They 
simply forgot, in their heart's delight, that before that time many other 
cutaneous eruptions were considered as itch; amongst them, as Hebra him- 
self supposes, prurigo, with its undoubted metastases to inner organs. If 
we now take a glance over Hahnemann's masterly picture of what he calls 
psora, we shall at once perceive that, under psora, he did not understand 
acarus-itch solely, but gave a tout ensemble of chronic cutaneous affections 
in general. The child had to have a name, and psora was as good a 
name as eczema, impetigo, prurigo, or any other. Thus the needle, 
although it found the acarus, altogether missed Hahnehmann's psora. 
It is just as true to-day that a suppression of cutaneous eruptions, 
of various kinds, will be followed by disastrous consequences upon 
the general system, as it was true when Hahnemann and others observed it. 
Instead, then, of desiring to have Hahnemann's psora theory wiped out of 
the pages of Homoeopathy as a disgraceful spot, we ought to be proud of our 
old master's keen observations. But then we must understand him rightly. 
I admit that, in recent cases of acarus-itch, the killing of the animal is the 
shortest procedure to cure, without detrimental effects upon the organism. 
This end may be attained not only by the external application of sulphur and 
mercurial salves, but also by Peruvian balsam, or the twigs of the balsam poplar 
tree, populus balsamifera (X.)> Tacamahac (Ind.), which secretes a kind of 
resinous substance on the pedicles of its leaves and around its twigs. But as 
it is an undoubted fact that itch never heals spontaneously, and as we have 
likewise undoubted facts that it has been cured solely by the internal appli- 
cation of homoeopathic remedies, it seems that those who contend that even 
acarus-itch in the course of time is not altogether a mere local, cutaneous 
trouble, are after all deserving some credit. All parasites, no matter whether 
animal or vegetable, can grow only upon a suitable soil; if this soil be made 
insupportable to them, they die or leave, and this is as good as killing, re- 
garding the riddance of the intruders, but it is infinitely better for the pa- 
tient, as by this means the organism is not injured, but brought into a healthy 
state. 



1020 special hints. 

Special Hints. 

Arsen. Inveterate cases; eruption in the bends of the knees; pustulous 
eruption; burning and itching; better from external warmth. 

Card. veg. Eruption dry and fine, almost over the whole body, worse 
on the extremities; itching worse after undressing; dyspeptic symptoms; 
belching of wind and passing flatus; after the abuse of mercurial salves. 

Caustic. After the abuse of Sulphur and Mercury; yellow color of 
the face; warts on the face; involuntary discharge of urine when coughing, 
sneezing or walking; sensitiveness to the cold air. 

Hcpar. Fat, pustulous and crust} 7 itch; also after previous abuse of 
mercury. 

Mercur. Fat itch, especially in the bends of the elbows. 

Psorin. Inveterate cases; with symptoms of tuberculosis; also in 
recent cases; eruption in the bends of the elbows and around the wrists; 
repeated outbreaks of single pustules, after the main eruption seems all gone. 

Sepia. After previous abuse of Sulphur; itching worse in the evening; 
especially in females. 

Sulphur. Main remedy; voluptuous tingling-itching, with burning and 
soreness after scratching. 

Sulph. ac. When itchiness of the skin and single pustules appear 
every spring, after an imperfectly cured itch. 

Prairie Itch, Prurigo Contagiosa. 
" Is an acute inflammation of the skin, appearing in new districts, where it 
may be for a time endemic. It may be preceded by the premonitory sy mp- 
toms of malaise, headache and slight febrile disturbance; or its onset may be 
first marked by the appearance of erythematous points, covered with small 
transparent vesicles, varying in size from a pin's head to a mustard-seed, and 
situated for the most part on the neck, shoulders, back and outer surface of 
the limbs. An intolerable nightly itching accompanies the eruption, creating 
an almost irresistible desire to scratch the parts. The scratching obliterates 
the vesicles, and gives rises to scratch-marks, and to the secretion of an ex- 
ceedingly acrid, irritating fluid, which oftentimes indefinitely prolongs the 
disease. Large blackish crusts covering suppurating ulcers are an occasional 
result. Furuncles quite frequently complicate the trouble." (Kippax.) 

Therapeutic Hints. 

Rumex crisp. Principal remedy. (Searle.) Diluted lye-of- wood ashes 
locally. 

Rhus tox. and Ledum may be studied. (Kippax.) 

Burns and Scalds. 

Injuries to the skin or flesh caused b3* the action of fire or heated solid 
bodies are called Burns; injuries by the action of some hot fluid or steam, 
are called Scalds. Both may vary greatly in degrees of intensity and danger, 
from a mere superficial dermatitis to a complete destruction of the parts in- 



THERAPEUTIC HINTS TO BURNS AND SCALDS. 1021 

volved; they may be confined to only a small spot, or extend over large 
surfaces, or may reach the internal mucous membrances by inhalation or 
deglutition, or may involve particular sensitive parts of the body, such as 
the genitals, or places where large trunks of nerves or blood-vessels lie close 
to the surface, for instance in the region of throat and neck. 

Upon all these different possibilities depends the more or less pronounced 
constitutional effect of the injury and its danger. The shock is sometimes 
terrible, manifesting itself in a sudden sinking of vital power, cold extremi- 
ties, vomiting and anxiety. In superficial and not widely extended injuries 
these symptoms are wanting, and it is more the intense burning pain in the 
parts involved, that cause distress; but even in lighter cases fever and sleep- 
lessness may be a speedy consequence. Severer burns are followed by sup- 
puration, ulceration, sloughing, attended by fever, and sympathetic affections 
of the bowels, such as colic, diarrhoea, intestinal haemorrhage. The destruc- 
tion of two-thirds of the entire cutaneous surface is considered as fatal; but 
death ma} r also ensue from the shock, or subsequent ulceration, sloughing 
and hectic fever, or haemorrhage. 

Therapeutic Hints. 

Blisters must be emptied by pricking with a fine needle, or sewing a 
thread through them, so that the epidermis may remain intact. 

To "draw the fire out," several applications have proved efficacious. 
Pure alcohol will do it in many cases. An alcoholic solution of Cantharides, 
3d dilution, acts frequently like a charm; so does a like solution of Causticum, 
or Urtica urens. If there be bicarbonate of soda, the common baking powder, 
close at hand, a paste made of it and applied quickly, has also been found of 
excellent use. But castile soap, or any other common soap, made into a paste 
by scraping and mixing with warm water, is indeed one of the best external 
applications, because it is most always at hand. So may sweet oil, either 
alone or mixed with a few drops of the 3d dilution of Cantharides, or with 
equal parts of lime water, act very beneficial. Sometimes a mixture of sweet 
oil and chloride of lime made to a salve has relieved where Cantharides and 
soap were of no use. 

It is of great importance that the air should be excluded from the parts 
involved. Raw cotton, not glazed, and free from seeds, is excellent for this 
purpose, as it is light, soft and pliable, easily adapting itself to an} T part. 
Some physicians moisten its surface which is intended to come in contact 
with the burn or scald with the tincture of Calendula, or of Cantharides or 
of another of the articles mentioned, before applying it. 

Special Hints. 
Aeon. Shock, fever, restlessness, sleeplessness. 
Arnica. Stays abundant suppuration. 
• Arsen. Great restlessness, sinking of strength; colic and diarrhoea. 
Internal burns. 



1022 CHILBLAINS. 

Ca?ithar. Internal burns. 

Card. veg. Shock, with symptoms of collapse. 
Caustic. Internal burns. 
Chamom. Colic; convulsions. 

Chi?ia. Profuse suppuration, weakness, hectic fever. 
Coffea. Nervous excitability and sleeplessness. 
Kreos. Discharge fetid and wound bluish. 
Laches. Wounds do not heal, take a purplish aspect. 
Opitim. Shock, tendency to convulsions, especially in children; sleep- 
lessness. 

Sapo. Internal burns, most important. 
Urtica urens. 

Chilblains, Frostbites. 

Like heat, so does intense cold produce inflammatory affections, most 
frequently on the least protected parts of the body, the ears, nose, fingers and 
toes. But this inflammation is of a secondary nature, and sets in when heat 
and circulation of the frosted parts have been restored too hastily by the 
application of external warmth, and is called Chilblains or Frostbites. Here, 
too, as in burns, the injury may be superficial or involve deeper structures. 
The parts become swollen, look dark red and have a sensation of tingling, 
burning and itching; there form vesicles upon the outside, which burst and 
produce unhealthy looking sores, and gradually a more or less deeply ulce- 
rated surface. Even gangrene may result from this cause. A peculiarity of 
frostbites is, that, after healing or spontaneously disappearing, they frequently 
return again at the next cold season, or become troublesome again during 
the hot weather. 

Therapeutic Hints. 

A frozen part of the body must not be exposed to external heat. Cov- 
ering or gentle rubbing with snow, or immersion into cold water in a cold 
room are the first best things to be done for its restoration. Hering has 
recommended as a preventive the rubbing with Camphor spiritus of the least 
protected parts before the exposure to intense cold; the same remedy may 
be applied as a restorative when snow or cold water have ' ' drawn out the 
frost " as far as they can. 

Special Hints. 

Agaricus muse. Toes or fingers are red and swollen and burn and itch 
intensely. 

Arnica. Parts are blue, red, swollen. 

Arse?i. After handling of ice, the pain is relieved by external warmth; 
bluish-redness of the sides of the feet; vesicles turn blackish; tendency to 
gangrene. 



ANOMALIES IN THE SECRETIONS OF THE SKIN. IO23 

Bellad. Bluish-red inflammation; pain burning, or stinging, or creep- 
ing, tingling, worse at night and on moving. 

Canthar. Externally, if Ca?nphor does not relieve. 

Card. veg. If Arsen. is not sufficient. 

Frag aria vesca. Pain from chilblains during hot weather. 

Hepar. Very painful and suppurating. 

Kali card. Inflammation with aching, cutting pain; bluish appearance. 

Laches. Parts swollen become bine and black. 

Natr. mur. " Intense burning and tenderness of the soles of the feet, 
painful when walking, with stinging vesicle on the tip of the tongue and sen- 
sation as if a hair were lying on the tongue. ' ' (Gilchrist. ) 

Nitr. ac. Parts swollen, itching and painful; worse during any slight 
increase of cold weather; fetid sweat of feet. 

Nux vom. " Superficial inflammation, with bright red swelling, burn- 
ing and itching, or when the tumefied part cracks and bleeds easily." 
(Helmuth.) 

Petrol. "Burning and itching like fire; heel painfully swollen and 
red; feet tender and bathed in foul moisture. ' ' (Lilienthal. ) Popular reme- 
dies of the same nature are: Cosmoline, Vasaline and Coal-oil. 

Phosphor. When the pain is very intense. 

Pulsat. Swollen, red and bluish; worse in warm weather and better 
from cold applications. 

Rhus tox. Burning, itching pain, worse in afternoon and during rest. 

Ruta. Burning pains in the bones after frostbites. (Hering.) 

Secale. When the pain is worse in the warmth and better in the cold; 
gangrene. 

Sulphur. ' ' Thick, red chilblains on the fingers. ' ' (Hering. ) 

Zincum. " Chilblains itch and smell. " (Hering.) 

V. ANOMALIES IN THE SECRETIONS OF THE SKIN. 

The secretion of gaseous substances is either augmented, for example, in 
fevers, when the temperature of the body is considerably raised, and in a hot 
atmosphere; or it is diminished, when the air is damp and its temperature 
low. In disease, a diminution of gaseous secretion has been ascertained by 
actual measurement only in diabetes mellitus. 

The secretion of watery substances, which is called perspiration or sweat, 
may be promoted in any healthy person by drinking large quantities ot 
water, and covering with a thick blanket, by strong exercise of the body, by 
the heat of the weather, etc. In diseases it is sometimes entirely wanting, 
at other times, a very prominent symptom, for example, in pneumonia, in 
some forms of rheumatismus acutus, etc. Some persons are much more in- 
clined to sweat than others; an excessive inclination to sweat is called 
Hyper idrosis. It seems that repeated sweatings increase the inclination to it. 
When the fluid which is secreted in the sudorific glands cannot pass freely 



1024 SUDAMINA. 

upon the surface, either because the sudorific ducts are stopped up, or be- 
cause they are too narrow to give vent to all the fluid which is produced 
within the glands, we observe the fluid to collect under the epidermis, and 
*o raise it into numerous little vesicles, which contain a perfectly trans- 
parent fluid of an acrid reaction. This eruption is called 

Sudamina, or Miliary Rash. 

The stoppage of the outlets of the sudorific glands occurs most frequently 
in diseases in which there has been great dryness of the skin previous to the 
outbreak of the sweat, as, for example, in the first weeks of typhus. The 
appearance of the eruption has no influence upon the course of the disease; 
it is observed as well in critical sweats as in those which break out sometimes 
when the disease takes a bad turn, and may even appear during the last 
struggles of agony. When the transparent, minute vesicles appear upon a 
naturally colored skin, it is called miliaria alba, when upon a skin which is 
reddened by hyperemia or hseinorrhagic effusions, it is called miliaria rubra, 
As a symptom it may indicate Arsen., Bryon., Calc. carb., or Ipec. 

Prickley heat is likewise a miliary rash, consisting of numerous pin- 
head-sized, reddened papules, or vesico-papules, in consequence of a disordered 
action of the sweat-glands, covering the trunk, arms, neck and even, at times, 
the face. It occurs during the hot weather, and is often very annoying on 
account of its stinging-itching, but usually disappears when cooler weather 
sets in. 

Quite frequently do we find partial hyperidrosis on the palms of the 
hands, on the soles of the feet, under the arm-pits and on the genitals. The 
sweat of the feet, in the axillae and on the genitals, is often excessively offen- 
sive, which seems to have its cause in a decomposition which the sweat, the 
sebaceous secretion and the softened and loosened epidermis undergo. The 
suppression of these partial sweats has been considered from olden times as 
very detrimental to health, causing spinal affections and different other com- 
plaints. In later times this has been reversed; now they sa5 7 : intercurring 
diseases stop this partial sweating. Ma} 7 be; may be not. So much is cer- 
tain, and I have observed many a time that the cessation of partial sweats 
stands in closest relation with various general complaints, and that the 
patient does not get better until the foot-sweat or axilla-sweat, etc., is re-es- 
tablished. 

Foot-Sweats. 

"Bar. carb. Fetid foot-sweat, with callosities on the soles which are 
painful on walking; soles feel bruised at night, keeping one awake, after ris- 
ing and walking. 

Calc. ost. Foot-sweat which makes the feet sore; feet feel cold and 
damp, as if she had wet stockings: burning in the soles. 

Canthar. Temperary cold sweat on feet; smells like urine. 

Carb. veg. Foot-sweat excoriating toes; toes red, swollen; stinging, as 
if frosted; tip of toes ulcerated. 



FOOT-SWEATS. IO25 

Graphit. Profuse foot-sweat, not fetid as in Sepia or Silic. , but the most 
moderate walking causes soreness between the toes, so that the parts become 
raw; spreading blisters on the toes, thick and crippled toe-nails. (Jahr 
gives fetid feet under Graphit. ) 

Helleb. Humid, painless vesicles between the toes. 

Iodnm. Acrid, corrosive foot-sweat ; cedematous swelling of the feet. 

Kali carb. Profuse fetid foot-sweat ; swelling and redness of the soles; 
chilblains; stitches in the painful and sensitive corns. 

Lac. ac. Profuse foot-sweat, but not fetid {Graphit.) 

Lycop. Profuse and fetid foot-sweat, with burning in the soles; one foo} 
hot, the other cold, or both cold and sweaty; swelling of the soles; they pain 
when walking; fissures on the heels. 

Mur. ac. Cold sweat on the feet, evening in bed; swelling, redness and 
burning of tips of toes; chilblains. 

Nitr. ac. Foul-smelling foot-sweat ; chilblains on the toes. 

Petrol. Feet tender and bathed in a foul moisture ; feet swollen and 
cold; hot swelling of the soles, with burning; heel painfully swollen and red; 
chilblain; tendency of skin to fester and ulcerate. 

Plumbum. Fetid foot-sweat; swelling of the feet. 

Podoph. Foot-sweat evenings. 

Sepia. Profuse foot-sweat or very fetid, causing soreness of toes; burn- 
ing, or heat of the feet at night; crippled nails. 

Silic. Offensive foot-sweat with rawness between the toes; itching of 
soles, driving to despair. 

Squilla. Cold, foot-sweat; sweat only on toes; soles red and sore when 
walking. 

Sulphur. Sweating and coldness of the soles; burning soles, wants 
them uncovered. 

Thuja. Fetid sweat on toes, with redness and swelling of the tips; 
nets of veins, as if marbled, on the soles of the feet; suppressed foot-sweat; 
nails crippled, brittle or soft. 

Zincum. The feet are sweaty and sore about toes; also fetid; chilblains 
from cratching and friction ; the suppression of sweat causes paralysis of the 
feet. 

Jahr gives the following: 
Foot-sweat. — Aeon., Amnion., Baryta, °Calcar., Carb. veg., Coccul., Cuprum, 
Cyclam., Droser., Graphit., Ioduin, °Kali. Kreos., Laches., °Lycop., 
Magn. mur., Mercur., Natr. mur., Nitr. ac, Nux jug., Petrol., Phosphor., 
Phosph. ac, Plumbum, Pulsat., Sabad., Sabi?ia, °Sepia, °Silic., Squilla* 
Staphis., °Sulphur, Thuja, Zincum. 

corrosive, Iodum, Lycop., Nitr. ac, Silic, Zincum. {Carb. veg.) 

, fetid. Amnion., Baryta, Cyclam., Graphit., Kali, °Nitr. ac, Nux 

jug., Phosphor., Plumbum, Sepia, Silic., Zincum. 
cold, Coccul., Droser., Ipec, Lycop., Afercur., Squilla, Staphis., Sul- 
phur. (Canthar.) 

65 



1026 FOOT-SWEATS. 

night (at), Coloc. (Evening, Mur. ac, Podoph.) 

suppressed, ° Cuprum, Kali, °Natr. mur., °Nitr. ac, ° Sepia, °Silic. 

{Apis, Pulsai., Rhustox., Thuja, Zl?icu??i.) 

soles of feet (on), Aeon., Arnica, Kali, Natr. mur., Nitr. ac., Petrol., 

Plumbum, Saba a 1 ., Si lie, Sulphur. 

toes (between the), Aeon., Arnica, Clemal., Cyclam., Ferru?n, Kali, 

Sepia, Silic., Squill a, Tar ax., Thuja. 
To this we may add: 

profuse. Carb. veg., Graphit., Kali carb., Lac. ac, Lycop., Sepia. 

With much itching of soles, Silic, Sulphur. 

With burning, Calc ostr., Lycop., Mur. ac, Petrol., Sepia, Sulphur. 

With rawness, Graphit., Silic (Carb. veg.) 

With soreness. Bar. carb., Calcar., Carb. veg., Graphit., Iodu??i, Pet- 

rol., Sepia, Squilla, Zincum. 
With redness and swelling in the soles. Iodum., Kali carb., Lycop., 

Petrol., Squilla; in the feet, Plumbum ; in the tips, Mur. ac, 

Thuja; in the toes, Carb. veg. 

With pain on walking. Bar. carb., Graphit., Lycop., Squilla; at 

rest, Carb. veg. (stinging), Petrol, (pain in the heel of foot). 

With crippled nails. Graphit., Sepia, Thuja. 

moisture (rather than sweat), fetid, Petrol; cold, Calcar." 

(Dr. E. Fornias. ) 

A diminution of fluid secretion, causing great dryness of the skin, often 
attends marasmus senilis. Sometimes it is a disturbed innervation, and 
sometimes the consequence of skin diseases. Besides, there are cases of 
Anidrosis and even of half-sided Anidrosis, for which there is no explanation. 

A qualitative change in the secretion of sweat takes place in icterus, 
which colors the linen yellow, and in suppressed urinary secretions, when 
the sweat contains urinary ingredients. 

The secretion of sebaceous substances, if diminished, causes great dry- 
ness and brittleness of the skin, if augmented (seborrhea), it forms crusts 
upon the scalp, especially in children, or on the cheeks, nose, eyelids, ears 
and nipples, especially in females who menstruate irregularly. A thicken- 
ing of it with the excretory ducts causes comedones, milium and atheromata. 

A Comedo has a dark surface from the dust and dirt outside, which 
has been mixed with it. 

A Milium is a collection of hardened sebum with the extended follicle; 
being covered by the epidermis it shows no dark, dirty point. 

A Molluscum is a greatly enlarged sebaceous gland, which is filled by 
thickened sebum. Being always united with a hair-follicle, with which it 
has a common outlet, the swelling or tumor generally shows a dark point 
and umbilical depression on its summit. The color of the skin over it is 
either normal in color or pinkish. It attacks mostly the face, but it may 
appear on other parts. Its contents can often be squeezed out. 

Internal remedies are: Silic, Calc. ars., Bryo?i., Kali hydr., Lycop., 
Natr. mur. 



INDEX. 



A 

Abdomen, 420 

Abdominal Disorders, Special Forms 

of, . 422 

Abscess of the Ankle Joint, .... 767 

Abscess of the Brain, 105 

Abscess of Cornea, 153 

Abscess, Peritonsillar 261 

Abscess, Retrotonsillar, 261 

Abnormal Collection of Gas in In- 
testinal Canal, 498 

Abnormal Largeness of the Head, . 123 

Abnormal Smallness of the Head, . 124 

Acarus Scabiei, 1018 

Accommodation and Refraction, . . 169 
Accommodative Asthenopia, . . . .173 

Acne Punctata, 253 

Acne Rosacea, 253 

Acne Syphilitica, 641 

Activity, 51 

Acute Infectious Diseases, 855 

Acute Miliary Tuberculosis, .... 948 

Acute Spinal Paralysis of Adults, . 735 

Acute Yellow Atrophy of Liver, . . 541 

Adaptation, . . 170 

Affections of Bronchial Tubes, . . . 327 
Affections of the Pulmonary Paren- 
chyma, 344 

Agenesia, 120 

Agraphia, 115 

Ague, 858 

Akinesis, 829 

Albuminuria, 587 

Alcoholism, Chronic, 62 

Alopecia, 131 

Alopecia Syphilitica, 642 

Alveolar Cancer of Liver, 545 

Amaurosis, 165 

Amblyopia, 165 

Amenorrhcea, 700 

Amnesic Aphasia, 115 

Amygdalitis, . 261 

Amyloid Degeneration of the Kid- 
neys, ... 600 

Amvloid Degeneration of Liver, . . 544 



Anaemia of Brain, 67 

* Anaemia, Progressive Pernicious, . . 840 

Anaemia of the Skin, 1004 

Anaemia (Symptomatic), 839 

Anaesthesia, 773, 798 

Anaesthesia of Larynx, 301 

Anaesthesia of the Trigeminus, . . . 977 

Analogy Between Bar and Eye, , . 182 

Anchylops, 134 

Anchylostomum Duodenale, . . . . 519 

Aneurisms of Brain, 121 

Aneurism of Thoracic Aorta, . . . 415 

Anidrosis, 1026 

Angina Catarrhalis, 263 

Angina Faucium, 263 

Angina Follicularis, 265 

Angina Granulosa, 265 

Angina Ludovici, 271 

Angina Pectoris, 412 

Angina Tonsillaris, 261 

Anteflexion, 676 

Anterior Nasal Cavity, 211 

Anteversion, 676 

Anthrax, 950 

Aorta, 415 

Aortic Opening, Constricted, .... 403 

Aortic Valves, Insufficient, 402 

Apathic Idioc}^, 50 

Aphasia, 115 

Aphthse '. . . 274 

Appendicitis, ...... ... 455 

Apoplexy, Pulmonary, 372 

Apoplexia Sanguinea, 109 

Apoplexia Sanguinsa, 104 

Apoplexia Serosa, 103 

Arthritis, 753 

Arthritis Deformans, 755 

Arthritis Sicca, 755 

Ascaris Lumbricoides, 515 

Ascites,' 529, 553 

Aspermatism, 656 

Astigmatism, 172 

Asthenopia, 173 

Asthma, Bronchial, 340 

Asthma Thymicum Koppi, 303 

Asthma Millari, 303 



I02i 



INDEX. 



Asylums for the Insane, 54 1 

Atony of the Bladder, 614 

Atrophy of the Brain, 120 

Atrophy of Liver, (Acute Yellow), . 541 

Atrophy of the Nerves, 772 

Atrophy of the Skin, 1003 

Atrophy of the Skull, 125 

Auditory Canal, 184 

Auditory Vertigo, 207 

Auricle, 184 

Auscultation, 284 

Auscultation of Chest, 315 

Auscultation of Cough, 326 

Auscultation of Heart, 387 

Auscultation of Voice, 323 

Azoosperniism, 656 

B 

Bacillus, Comma, 959 

Bacillus Diphtherias, 926 

Bacillus of Eberth, 892 

Bacillus, Klebs-Lceffler, 926 

Bacillus of Tetanus, 956 

Bacillus Tuberculosis, 948 

Bacteria, 855 

Balanitis, 626 

Baldness, 131 

Barrel Chest, ... 307 

Basedow's Disease, 178 

Basilar Meningitis, 91 

Bicuspid Insufficiency, 401 

Bilious Fever, 426 

Bladder, Diseases of, 607 

Blenorrhcea of the Bronchi, .... 329 

Blenorrhcea of the Lachrymal Sac, . 139 

Blepharitis Marginalis, 134 

Blepharospasm, 177 

Blood Icterus, 555 

Boil, ....'... 1014 

Brain and its Membranes, 67 

Break Bone Fever, 888 

Bright's Disease, 589 

Bronchial Asthma, 340 

Bronchial Catarrh, 327 

Bronchial Hemorrhages, 372 

Bronchial Tubes, 327 

Bronchiectasia, 329 

Bronchitis, 327 

Bronchocele, 279 

Bronchorrhcea, 329 

Broncho-Typhus, 897 

Bruised Head of a Child After Birth, 123 

Buboes, 625, 638 

Bunion, 771 



Burns, 1020 

Bursitis, 767 

C 

Calculi Vesicae, 612 

Camp Fever, 889 

Cancer of the Breast, 715 

Cancer of the Intestines, 509 

Cancer of the Larynx, 301 

Cancer of the Liver, 545 

Cancer of the Pancreas, 569 

Cancer of the Rectum, 510 

Cancer of the Spleen, 567 

Cancer of the Stomach, 439 

Cancer of Tongue, 258 

Cancer of the Womb, 687 

Cankers of the Mouth, 274 

Caput Succedaneum, • . . . 123 

Carbuncle, 1014 

Carbunculus Contagiosus, 950 

Carcinoma of Brain, 121, 122 

Carcinoma Fasciculatum, 545 

Carcinoma Hepatis, 545 

Carcinoma of Larynx, 301 

Carcinoma Testis, 648 

Carcinoma Ventriculi, 439 

Cardialgia Nervosa, 430 

Carditis, 407 

Caries, 760 

Catalepsy, 812 

Cataract, 167 

Catarrh, Biliary, 548 

Catarrh, Bronchial, 327 

Catarrh, Chronic Intestinal, .... 449 

Catarrh, Intestinal, 447, 469 

Catarrh, Laryngeal, 286 

Catarrh, Nasal, 213, 217 

Catarrh of Stomach, 425, 428 

Catarrhal Urethritis, 621 

Catarrh of the Uterus, 663 

Catarrhal Inflammation of the Rec- 
tum, 458 

Catarrhal Opthalmia, 140 

Catarrhal Nephritis, 589 

Catheterism of Middle Ear, .... 190 

Cephalalgia, 775 

Cephalalgia Rheumatica, 741 

Cellulitis, Orbital, 178 

Cerebro-Spinal Meningitis, 943 

Cervico-Occipital Neuralgia, .... 790 

Chalazion, 138 

Chancre, 626 

Checked Evolution of Psychical 

Development, 49 



INDEX. 



IO29 



Chemosis, 142 

Chicken-pox, 1001 

Chilblains, 1022 

Chiragra, 753 

Chloasmata, 554 

Chloasmata Uterina, 1003 

Chlorosis 841 

Cholsemia, 554 

Cholelithiasis, 549 

Cholera Asiatica, 959 

Cholera Infantum, 469 

Cholera Europcea, 468 

Cholera Morbus, 468 

Cholera Nostras, 468 

Cholera-Typhoid, 962 

Cholesteatoma, 12 1 

Chorea, 802 

Choroidea, 160 

Choroiditis, 160 

Chromotopsy 164 

Chronic (Edema, 370 

Chronic Myelitis of Erb, 730 

Chronic Rheumatism of the Joints, . 740 

Chronic Sore Throat, 265 

Cirrhosis, 539 

Clinical Thermometry, 855 

Coccyodynia, 737 

Cold in Head, 213 

Colica, 500 

Colica Renalis, 601 

Colloid Liver, 544 

Comedo, 253, 1026 

Conation, 51 

Condylomata, 637 

Condylomata in Larynx, 300 

Congestion of Brain, 69 

Congestion of Liver, 533 

Congestion of Lungs, 370 

Congestive Fever, 875 

Conjunctiva, 140 

Conjunctivitis Croupous, 151 

Conjunctivitis Diphtheritica, .... 150 

Constipation, .... 478 

Constriction of Left Auriculo-ventri- 

cular Opening, 402 

Consumption, 354 

Consumption of the Bowels, .... 509 

Convulsions, 800 

Convulsions of Children, 825 

Cornea, 152 

Corneitis, 152 

Coryza, . . 213 

Coxalgia, 763 

Coxarthrocace, 763 



Cramp, 800 

Cramp of the Stomach 430 

Craniotabes, . 124 

Cranium and Its Integuments, . .123 

Cretinism, 34, 49 

Crisis, 857 

Critical Days, 857 

Croup 292 

Croupous Conjunctivitis, 151 

Croupous Pneumonia, 345 

Crusta Lactea, . . 231 

Curvature of the Spine, 768 

Cyanosis, 836 

Cyclitis, 161 

Cystitis, 607 

D 

Dacryocystitis, 128 

Dandruff, 128, 1009 

Deafness, Nervous, 207 

Decubitus, 1004 

Delirium Tremens, 60 

Delusive Ideas, 34 

Dementia, 34 

Dementia Paralytica, 40 

Dementia Senilis, ......... 41 

Dengue, 888 

Dermatitis, 1004 

Diabetes Insipidus, 583 

Diabetes Mellitus, 576 

Diaphragm, Neuralgia of the, . . . 418 

Diaphragmitis, 416 

Diffuse Corneitis, 153 

Diffuse Nephritis, 589, 593 

Dilatation of Heart, 407 

Dilatation of (Esophagus, 282 

Diplococcus Pneumoniae, 943 

Dipsomania, 62 

Diphtheria, 925 

Diphtheria, Catarrhal, 927 

Diphtheria, Croupous, 927 

Diphtheria, Gangrenous, 927 

Diphtheritic Conjunctivitis, .... 150 

Diseases of the Prostata, 649 

Diseases of the Testes, 646 

Diseases of the Vesiculae Seminales, 651 

Dislocation of the Lens, ..... 169 

Displacement of the Womb, .... 676 

Distiachis, ... 134 

Diverticula, (Esophagus 283 

Diverticula of the Bladder, 608 

Dizziness, 74 

Dropsy of the Chest, 383 

Dropsy of the Pericardium, .... 397 



IO^O 



INDEX. 



Drops}' of the Peritoneum, 529 

Dropsy of the Scalp, 123 

Dry Catarrh, 3 2 9 

Drumhead, 184 

Dysentery, 460 

Dysmenorrhcea, 7°3 

Dyspepsia, 4 2 3 

Dysphagia Inflammatoria, . . . . 280 

Dyspncea, Laryngeal, 297 



JEar, The, 

Ear Wax Diminished or Increased, . 

Echinococcus-Cysts, 

Echinococcus-Cysts of the Spleen, 

Eclampsia Acuta, 

Eclampsia Gravidarum, 

Eclampsia Infantum, 

Ecthyma, 

Ecthyma Syphiliticum, 

Ectropium, 

Eczema, 

Eczema of Auricle, 

Eczema Capitis, 

Eczema of Face, 

Eczema Syphilitica, 

Embolism and Thrombosis, . . . . 

Embolism of Brain, 

Emotions, 

Empyema, 375 

Emphysema Pulmonum, 

Emphysematic Chest, 

Encephalitis, 

Encysted Tumor of Lids, 

Endocarditis, 

Endometritis, 

Enteralgia, 

Enteric Fever, 

Enteritis, 

Enteritis Catarrhalis, 

Entero-colitis, 

Entozoa, 

Entropium, 

Enuresis Nocturna, 

Epidemic Parotitis, 

Epididymitis, 

Epilepsy, 

Epistaxis, 

Epithelioma of Face, 

Epithelioma of Lids, 

Epulis, 

Erosions, Catarrhal, 

Erysipelas, 



182 
186 
547 
567 
823 
823 
825 
1012 
642 

134 
1008 
184 
125 
231 
641 
113 
113 
56 
378 
366 
308 
105 
138 
398 
663 
500 
892 
447 
447 
470 

514 
134 
616 

923 
624 

813 
225 

234 
138 
236 

274 
969 



Erysipelas Bullosum, 969 

Erysipelas, Habitual, 970 

Erythema, 1004 

Eustachian Tubes, 212 

Examination of the Abdomen, . . . 420 

Examination of Ear, 184, 1S0 

Examination of Liver, 533 

Examination of Nasal Cavity, . . . 211 

Examination of Thorax, 306 

Exanthemata, 973 

Exophthalmic Goitre, 178 

Exostosis, 760 

Exultatio Furiosa, 52 

Eyes, 133 

Eyeball, Fixed State of the, .... 177 

Eyeballs, Trembling of the, ... 177 

Eyeballs, Twitching or Quivering, . 178 

Eyelid, Tumors of, 138 

F 

Face 228 

Fatty Heart, 409 

Fatty Liver, 543 

Favus, 129 

Felon, 769 

Febrile Albuminuria, 587 

Fever, 855 

Fever, Break-bone, . 888 

Fever, Cerebro-spiual, 943 

Fever, Congestive, 875 

Fever, Enteric, 892 

Fever, Hay 224 

Fever, Intermittent, 858 

Fever, Gastric, 897, 426 

Fever, Nervous, 897 

Fever, Pernicious,' Intermittent, . . 875 

Fever, Pneumonic, 345 

Fever, Relapsing, 919 

Fever, Remittent, 875 

Fever (Rheumatic), 73*9 

Fever, Scarlet, 978 

Fever, Typhoid, 892 

Fever, Typho-malarial, 876 

Fever, Yellow, 877 

Fibroid Phthisis, 354 

Fibroma, Papillare of Larynx, . 300, 301 

Fig-warts, 637 

Fish-skin, 1003 

Fissura Ani, 511 

Fistula Lachrymalis, 139 

Fistula Recti, 460,512 

Fistula of the Teeth, 236 

Fixed Ideas, 34 



INDEX. 



1 03 I 



Flatulency 49S 

Folie Circulaire, . . . 54 

Follicular Inflammation, 274 

Fontanelles, 124 

Foot-sweats, 1024 

Fornix Pharyngis, -. . - 212 

Freckles, , 1003 

Frostbite, 1022 

Fremitus in Chest, 310 

Frenzy, 52, 53 

Frog, •. 260 

Fungi, 855 

Fungoid Growth on the Gums, . . . 236 

Furious Mania, 51 

Furuncles, ■••... 1014 

Furuncles of External Ear, .... 188 



G 



Gall-stones, - 549 

Gall-stone Colic, 550 

Gangraena Pulmonum, 371 

Gangrene of the Cheeks, 275 

Gastralgia, 430 

Gastric Fever, 426, 897 

Gastritis, 425 

Gastritis Caustica, 429 

Gastritis Toxica, 429 

Gastromalacia, 445 

Giddiness, 74 

Gin-drinker's Liver, 539 

Glaucoma, 162 

Gleet, 620 

Glioma, 121 

Glioma of the Brain, 122 

Glossitis, 257 

Glycosuria, 576 

Goitre, 279 

Goitre, Exophthalmic, 178 

Gonagra, 753 

Gonarthrocace, 765 

Gonococcus of Neisser, 619 

Gonorrhoea, 619 

Gonorrhoea of the Rectum, .... 625 

Gonorrhoea Spuria, . . : 626 

Gonorrhoea Vesicae, 625 

Gonorrhosal Ophthalmia, 142 

Gonorrhoeal Rheumatism, 625 

Gout, 753 

Granular Atrophy of the Kidney, . . 597 

Granular Ophthalmia, 144 

Granulated Liver, 539 

Graphospasmus, 802 

Gravedo, Nasal, 213 



Green-sickness, . 841 

Graves's Disease, 178 

Gumboil, 236 

Gummata, 644 

Gums, 235 

H 

Haematemesis, 443 

Haematogenous Cholaetnia, .... 555 

Haematoma Durae Matris, 104 

Haemato-pneumothorax, 386 

Haematothorax, 381 

Haematozoon of Laveran, 859 

Haematuria 584 

Haemometra, 675 

Haemophilia, 851 

Haemoptee, 372 

Haemoptysis, 372 

Haemorrhage, Choroid, 162 

Haemorrhage from the Stomach, . . 443 

Haemorrhage, Pulmonary, 372 

Haemorrhagia Intestinalis, 490 

Haemorrhage, Uterine, 691 

Haemorrhagic Infarctions, 372 

Haemorrhagic Infarction of the 

Spleen, 564 

Haemorrhagic Nephritis, 589 

Haemorrhoids, 490 

Haemorrhophilia, ... 851 

Hair, , 131 

Hair, Color of, 131 

Hay Fever, 224 

Head, 67 

Heart, 387 

Heart Clots, 406 

Heart, Fatty Degeneration, .... 409 

Heart Muscle, 407 

Heart, Nervous Affections, 410 

Helminthis, 514 

Hemicrania, 775 

Hemcratopia, , 166 

Hemiopia, 166 

Hepatitis Suppurativa, . . ... 536 

Hepar Adiposum, 543 

Hepatogenous Cholamiia, 554 

Hepatitis Vera Circumscripta, . . . 536 

Hernia, 4S4 

Herpes, 1005 

Herpes, Labial, 274 

Herpes Preputialis, 1005 

Herpes Tonsurans, . . 130 

Herpes Syphilitica, 641 

Herpes Zoster, 1005 



1032 



INDEX. 



Hiccough, 418 

Hip Disease, 763 

Hobnail Liver, 539 

Homoeopathic Asylums for the In- 
sane, 54 

Hordelum, 137 

Honey-comb Ringworm, 129 

House-maid's Knee, 767 

Hydatids of the Liver, 547 

Hydraemia, 838 

Hydroa 274 

Hydrocele, ... 646 

Hydrocephaloid, 68, 469 

Hydrocephalus Acutus, 91 

Hydrocephalus Acquisitus, .... 101 

Hydrocephalus Congenitus, .... ior 

Hydrocephalus Ex VacUs, 103 

Hydrocephalus Senilis, 103 

Hydrocephalus Acutus Sine Tuber- 

culis, 63 

Hydrometra, • 675 

Hydronephrosis, . 603 

H3 T dropericardium, "397 

Hydrophobia, 951 

Hydrops Cystidis Fellese, 551 

Hydrops Ovarii, 661 

Hydrorrhachis Congenita, 723 

Hydrosarcocele, 647 

Hydrothorax, 383 

Hyperaemia of Brain, . . ... 69 

Hypersemia of Liver, 533 

Hyperaemia of Lungs, 370 

Hyperaemia of the Spleen, 564 

Hyperaemia of the Skin, 1004 

Hyperaesthesia, 773 

Hyperaesthesia of Larynx, 302 

Hyperaesthesia of Retinae 167 

Hyperidrosis, . . 1023 

Hyperplasia of the Pineal Gland, . . 121 

Hypermetropia, 171 

Hypertrophy of the Brain, .... 119 

Hypertrophy of Heart, 407 

Hypertrophy of the Nerves, .... 772 

Hypertrophy of the Prostata, . . . 649 

Hypertrophy of the Skull, 123 

Hypertrophy of the Skin, 1002 

Hypertrophy of the Spleen, .... 566 

Hyperkinesis, 800 

Hyperuresis, 583 

Hypopion 153 

Hysteralgia, 690 

Hysteria, 806 



Ichthyosis, . 1003 

Icterus, 554 

Icterus Gravidarum, 556 

Icterus Menstrualis, 556 

Icterus Neonatorum, 556 

Idiocy, 34 

Idiocy, Apathic, 50 

Idiocy, Intellectual, 49 

Ileus, .... 488 

Imbecility, 34 

Impaired Hearing, 198 

Impetigo, ion 

Impetigo Contagiosa, 1011 

Impetigo of the Scalp, 125 

Impotence, 655 

Incontinentia Urinse, ....... 615 

Indigestion, 423 

Infantile Spinal Paralysis, 735 

Infectious Diseases, 855 

Inflammation of the Anterior Spinal 

Columns (Acute), 735 

Inflammation of the Auditor}* Canal, 188 

Inflammation of the Bowels, .... 447 

Inflammation of the Bladder, . . . 607 

Inflammation of the Breasts, . . . . 713 

Inflammation, Catarrhal, of Rectum, 458 

Inflammation of Diaphragm, . . . 416 

Inflammation of Dura Mater, . . . 104 

Inflammation of Heart- Muscle, . . 407 

Inflammation, Interstitial of Liver, 539 

Inflammation of Liver Capsule, . 536 

Inflammation, Follicular in Mouth, 274 

Inflammation of the Gums, .... 236 

Inflammation of the Nerves, .... 772 

Inflammation of Arm, 227 

Inflammation of the Orbit, .... 178 

Inflammation of the Pancreas, . . . 569 

Inflammation of the Pericardium, . 394 

Inflammation of Pleura, 374 

Inflammation of the Prostate, . . . 624 

Inflammation of the Renal Capsule, 605 

Inflammation of the Renal Pelvis, . 604 

Inflammation of the Spinal Marrow, 726 

Inflammation of the Spleen, .... 564 

Inflammation of the Stomach, Toxic, 429 

Inflammation, Syphilitic, of Liver, . 541 

Inflammation of the Throat, .... 271 

Inflammation of Tongue 257 

Inflammation of Tonsils 561 

Influenza, 922 

Ingrowing Toe Nails, 771 

Insanity, 34 



INDKX. 



I033 



Inspection of Larynx, 284 

Insolatio, 106 

Insomnia, 86, 90 

Insufficiency of Aortic Valves, . . . 402 

Insufficiency of Tricuspid Valve, . . 401 

Insufficiency of Mitral Valves, . . . 401 

Insufficiency of Pulmonary Valves, 401 

Insufficiency of Tricuspid Valve, . . 404 

Intellectual Idiocy, 49 

Intellectual Sphere, 34 

Interlobular Bmphysema, 366 

Intercostal Neuralgia^ 791 

Intermittent Fever, 858 

Interstitial Inflammation of Liver, . 539 

Interstitial Nephritis, 597 

Intertrigo, 1004 

Intestinal Canal, 447 

Intestinal Catarrh, 447 

Intestinal Catarrh of Infants, . . . 470 

Intestinal Haemorrhages, 490 

Intussusception, 487 

Invagination, 487 

Inversion of the Womb, 678 

Iris, 158 

Iritis, 158 

Irritability of the Bladder, 613 

Ischias Postica, 793 

Ischuria Vesicalis, 617 

Itch, 1018 

J 

Jail Fever, 889 

Jaundice, 549, 554 

Joints (Tuberclosis of the), 762 

K 

Keratitis , . . . 152 

Kidneys, diseases of, 569 

Kleptomania, 41 

Kraft-Ebling 35 

Kyphosis, 768 

L 

Labial Herpes, 274 

La Grippe, 922 

Lardaceous Kidney, 600 

Lardaceous Liver, 544 

Large White Kidney, 593 

Laryngeal Dyspnoea, 297 

Laryngeal Phthisis, 299 

Laryngitis, 303 

Laryngitis, Acute Catarrhal, . . 286, 292 



Laryngitis Chronica, 288 

Laryngoscopy, 284 

Larynx, . . . . , 284 

Left Auriculo- Ventricular Stenosis, . 402 

Lehrbuch der Psychiatie, 35 

Lens, 167 

Lentigines 1003 

Leptomeningitis, 93 

Leptomeningitis Infantum, ... 93 

Leptomeningitis Spinalis, 724 

Leucocythasmia, 837 

Leucoma Corneae, 154 

Leucorrhcea, 663 

Leukaemia, 837 

Leukomyelitis Posterior Chronica, . 730 

Lichen, 1016 

Liver, 533 

Liver Spots, 1003 

Lichen Syphiliticus, 641 

Lienitis, 564 

Lobar Pneumonia, 345 

Local Abnormalties of Chest, . . . 308 

Lockjaw, 956 

Locomotor Ataxia, 730 

Lumbago Rheumatica, 742 

Lumbo-Abdominal Neuralgia; . . . 792 

Lung Fever, 345 

Lupus, 233 

Lupus Syphiliticus, 642 

Lyssa, 951 

M 

Macula Corneae, 154 

Maculae Hepaticae, 554 

Macular Syphilide, 640 

Malacosteon, 758 

Malaena, 490 

Malaria, 859 

Malignant Pustule, 950 

Malum Cotunnii, 793 

Malum Pottii, 768 

Malum Senile, 755 

Mania, 51, 52 

Mania Furiosa, 51 

Mania Periodical, 54 

Marantic Thrombosis, 118 

Mastitis, 713 

Mastodynia, 792 

Measles, 974 

Medullary Cancer of Liver, .... 545 

Melanaemic Liver, Malarial, .... 533 

Melanoma, 121 

Melancholia, 56 



1034 INDEX 

Mellituria, 576 

Membrana Tympani, 184 

Meniere's Disease, 207 

Meningitis Cerebro Spinalis Epi- 

demica, 943 

Meningitis of the Convexity, . 93 

Meningitis Tuberculosa, 91 

Menorrhagia, 694 

Menstrual Anomalies, 694 

Menstruatio Difficilis, 703 

Mental Diseases, 33 

Meteorism of Abdomen, 498 

Metritis, 672 

Metrorrhagia, 691 

Micrococcus Erysipelatis, 969 

Middle Ear, 189 

Migrsena, 775 

Miliary Tuberculosis, Acute, .... 948 

Milium, 1026 

Milk Crust, 231 

Mimic Facial Spasm, 801 

Mind, 33 

Miserere, 488 

Mitral Insufficiency, ■ . 401 

Moist Catarrh of Middle Ear, ... 197 

Mogigraphia, 802 

Mollities Ossiurn, 758 

Molloscum, 1026 

Monomaniacs, 52 

Morbid Growths, Uterine, 686 

Morbilli, 974 

Morbid Winking, 177 

Morbus Addisonii, 605 

Morbus Anglicus, 756 

Morbus Maculosus Werlhofii, . . 850 

Morrhinismus, 65 

Mother's Marks, 130, 1002 

Mouth, 235 

Multiple Sclerosis, 728 

Mumps, 923 

Muscular Asthenopia, 173 

Muscular Rheumatism, 741 

Myalgia Cervicalis, 741 

Myalgia Lumbalis, 742 

Myalgia Pectoralis et Inter-Costalis, 741 

Myalgia Rheumatica, 741 

Myalgia Scapularis, 742 

Myelitis, 726 

Myelomalacia, 728 

Myocarditis, 407 

Myopathia, 741 

Myopia, 171 

Mydriasis, 175 

Myosis, 175 



Myxoma of the Brain, 122 

N 

Nsevi Spili, • • • . . 1002 

Nasal Blennorrhcea, 213 

Nasal Catarrh, Chronic, 217 

Necrosis, 760 

Nephritis, 589 

Neoplasms of the Larynx, 300 

Neoplastic Formations in the Nerves, 772 

Nephralgia, . . ¥ 601 

Nephrolithiasis, 601 

Nerves, Inflammation of the, . . - 772 

Nervous Deafness, 207 

Nervous Fever, S97 

Nervous Sick Headache, 775 

Nervousness, 773 

Nettle-rash, 1007 

Neuralgia, 774 

Neuralgia, Cervico-brachial, .... 791 

Neuralgia, Cervico-occipital, .... 790 

Neuralgia of the Diaphragm, . . . 418 

Neuralgia of the Eye, 178 

Neuralgia Facialis, 784 

Neuralgia, Intercostal, ...... 791 

Neuralgia Ischiadica, 793 

Neuralgia of Larynx, 302 

Neuralgia, Lumbo-abdominal, . . . 792 

Neuralgia of the Mammae, .... 792 

Neuralgia Uteri, 690 

Neurasthenia, 810 

Neuritis, 772 

Neuromata, 121, 772 

Neurosis of Larynx, 301 

Neuro- etinitis, 164 

Night-blindness, 166 

Noma, 275 

Non-desquamative Nephritis, . . . 593 

Normal Sounds of Respiration, . . . 316 

Nose, 210 

Nosebleed, 225 

Nutmeg Liver, 534 

Nystagnus, 177 

Nymphomania, 53 

o 

Occlusion of Cerebral Arteries, . . 113 

Occlusion of Intestines, ...... 487 

Odontalgia, 238 

CEdema, Chronic, 370 

CEdema Glottidis, 296 

Oedema Laryngis, 296 

Oedema of Lungs, 370 



INDEX. 



I035 



Oesophagus, 2S0 

CEsopaphagitis, 280 

Old Sight, 170 

Oligemia, 839 

Oligocythemia, 837 

Omagra, 753 

Omodynia Rheumatica, 742 

Onyx 153 

Oophoritis, 658 

Opisthotonus, . . 957 

Opacity of Cornea, 154 

Opium Poisoning, 65 

Ophthalmia Catarrhalis, 140 

Ophthalmia Gonorrhceica, . . . 142, 625 

Ophthalmia Granulans, 144 

Ophthalmia Neonatorum, 143 

Ophthalmia Phlyctenularis, .... 146 

Ophthalmia, Purulent, 142 

Ophthalmia Tarsi, ........ 134 

Oplic Nerve, 164 

Orbit, 178 

Orchitis, 624, 647 

Osteitis, 760 

Osteomalacia, 758 

Otalgia Nervosa, 209 

Otitis Media, 193 

Otitis Externa, 188 

Otitis Media, Chronic, 197, 198 

Ovarian Cysts, 66 r 

Ovarian Dropsy, 661 

Ovaritis, 658 

Oxaris Vonnicularis, 514 

Ozena, 217 



Pachymeningitis, 104 

Pachymeningitis Externa, 104 

Pachymeningitis Interna, '104 

Palpation of Chest, 308 

Palpitation of Heart, 410 

Panaritium, 769 

Pancreas, Diseases of, 568 

Pancreatitis, 569 

Pannus, 144, 153 

Panophthalmitis, 160 

Papilloma of Larynx, 300, 301 

Papular Syphilide, 640 

Paracystitis, 607 

Paragraphia, 116 

Paranephritis, 605 

Paranoia, 34 

Paranoia Inventoria, 36 

Paranoia Reformativa 36 



Paranoia Religiosa, 36 

Paranoia Sexualis, 35 

Paraphrenias, 378 

Paralysis, 829 

Paralysis Agitans, 828 

Paralysis of the Bladder, 614 

Paralysis of L,arynx, 301,302 

Paralytic Chest, 3o7 

Paraphasia, , 116 

Paraphimosis, 620 

Parenchymatous Corneitis, .... 153 

Parenchymatous Metritis, 672 

Parenchymatous Nephritis, Acute, . 589 
Parenchymatous Nephritis, Chronic, 593 

Paronychia, 769 

Paresis of the Bladder, 614 

Parotitis, 923 

Parotitic, Epidemic, 923 

Parotitis, Metastatic, 923 

Parulis, 236 

Peliosis Rheumatica, 850 

Pemphigus, ior2 

Pemphigus Syphiliticus, 642 

Percussion, 311 

Pericardium, . . 394 

Pericarditis, 394 

Pericystitis, 607 

Perichondritis Laryngea, 298 

Peri-Hepatitis, 536 

Perinephritis . 605 

Perioophoritis 658 

Percarditis, 459 

Peritonitis, 526 

Peritonsillar Abscess, 261 

Perityphlitis, 455 

Perforation of the Diaphragm, . . . 418 

Pernicious Intermittent, 875 

Persecution, 34 

Personalities, Grand or Rich, ... 34 

Pertussis, 939 

Pestilentia, 972 

Petechial Typhus, 8S9 

Phimosis, 620 

Photosia, 164 

Phlebitic Thrombosis, . . , . . . 11S 

Phlegmonous Inflammation of lids, 133 

Phlyctenular Ophttalmia, . . . . . 146 

Phthisis Daryngis, 29S 

Phthisis Pulmonum, 354 

Pianists Cramp, S02 

Pigment Diver 533 

Piles, 490 

Pin Worm . . 514 

Plague, the, 972 



1036 



INDEX. 



Plasmodium Malariae, 859 

Plastic Iritis, 158 

Plethora, 839 

Pleura, 374 

Pleurisy, 374 

Pleuritis, 374 

Pleuritis Sicca, 376 

Plica Polonica, 132 

Pleurodynia Rheumatica, 741 

Pneumonia, Lobar, . 345 

Pneumonia, Catarrhal, 344 

Pneumonia, Croupous, 345 

Pneumonia from Embolism, .... 344 

Pneumonia, Lobular, 344 

Pneumonia, Serous, 344 

Pneumo-haemothorax, 381 

Pneumo-pyo-haemothorax, 381 

Pneumothorax, 381 

Pneumo-typhus, 897 

Podagra, 753 

Podarthrocace, 767 

Pollutions, Nocturnae et Diurnae, . . 652 

Polyarthritis Rheumatica, Acuta, . 739 

Polydipsia, 583 

Polyomyelitis Anterior, Acuta, . . . 735 
Polyomyelitis Anterior, Subacuta et 

Chronica, 736 

Polypanarthritis, 755 

Polypi of Ear, 206 

Polypi of Nose, 227 

Polypus of Rectum, 510 

Polyuria, 583, 598 

Pompholyx, 1012 

Porencephaly, 50 

Porrigo Devalcans, 131 

Porrigo Favosa or Lupinosa, .... 129 

Posterior Staphyloma, . .... 161 

Prairie Itch, 1020 

Preacher's Sore Throat, 265 

Presbyopia, 170 

Pressure Diverticula, 283 

Prickley Heat, 1024 

Procidentia, 677 

Proctitis, 458 

Prolapsus of the Uterus, 677 

Prostatitis, 649 

Prostatitis Gonorrhoica, 624 

Progressive Muscular Atrophy, . . . 758 

Progressive Pernicious Anaemia, . . 840 

Prolapsus Recti, 513 

Prosopalgia, . 784 

Proctalgia, 514 

Prurigo, 1017 

Pruritus, 1017 



Pruritus Vulvar, 712 

Prurigo Contagiosa, 1020 

Psammona, 121 

Pseudo-Croup, ... 286 

Psoriasis, 1015 

Psoriasis Palmaris and Plantaris, 604 

Psychiatrie, 35 

Pterigiutn, 152 

Ptosis, 175 

Ptyalism, 259 

Puerperal Convulsions, 823 

Pulmonary Affections, 344 

Pulmonary Apoplexy, 372 

Pulmonary Consumption, 354 

Pulmonary Tuberculosis, 354 

Pulsation of the Heart, 311 

Purpura Haemorrhagica, 850 

Purpura Rheumatica, 850 

Purpura Simplex, 851 

Purulent Inflammation of the Portal 

Vein, 553 

Purulent Nasal Catarrh, 213 

Purulent Ophthalmia, 142 

Pustular Syphilide, 641 

Pyelitis, 604 

Pyelonephritis, 604 

Pylephlebitis Adhaesiva Chronica, . 552 

Pylephlebitis Suppurativa, 553 

Pylethrombosis, 552 

Pyo-Pneumothorax, 381 

Pyothorax, 375, 376 

Q 

Quinsy, . 261 

Quivering of the Eyelids, 177 

R 

Rabies, 951 

Rachitic Chest, 307 

Rachitis, 756 

Ranula, 260 

Recessus Pharyngia, 212 

Red Softening of Brain, 113 

Refraction and Accommodation, . . 169 

Relapsing Fever, 919 

Remittent Fever, 875 

Renal Abscess, 601 

Renal Calculi, 601 

Renal Cirrhosis, 597 

Renal Colic, 602 

Renal Gravel, 601 

Renal Sclerosis, 597 

Retention of Urine, 617 



INDEX. 



IO37 



Retina, 164 

Retinitis Albuminuria, 597 

Retroflexion, 677 

Retro- Pharyngeal Abscess, . . ■ . 270 

Retro-Tonsillar Abscess, .261 

Retroversion, 677 

Rheumatic Iritis, 158 

Rheumatic Fever, ■ . . 739 

Rheumatismus Articulorum Acutus, 739 
Rheumatismus Articulorum Chroni- 

cus, 740 

Rheumatismus Muscularis, .... 741 

Rheumatismus Nodosus, 755 

Rickets, 756 

Ringworm, 1007 

Ringworm of the Scalp, 130 

Rcetheln, 994 

Rodent Ulcer, 234 

Rose Cold, 224 

Roundworm, 515 

Rubella, 994 

Rubeola, 974 

Round, Perforating Ulcer of Stom- 
ach, 435 

Rupia, 1013 

Rupia Syphilitica, 642 

Rupture, 4§4 

Rupture of the Diaphragm, .... 418 

Rupture of the Spleen, 567 



Sago-Spleen, 566 

Saliva, 259 

Salivation, 259 

Sand Tumor of the Brain, 121 

Sarcocele, 647 

Sarcoma of the Brain, 122 

Satyriasis, 53 

Scabies, 1018 

Scalds, 1020 

Scarlatina, 978 

Scarlatina Maligna Typhosa, . . . 981 

Scarlet Fever, 978 

Sciatica, 793 

Scirrhus seu Carcinoma Mammae, . . 715 

Scotomata, 166 

Scirrhus Ventricali, 439 

Scleritis, 157 

Sclerosis of Middle Ear, 197 

Sclerosis of the Posterior Spinal 

Columns, 730 

Sclerotica, 157 

Sclerotica-choroiditis Posteria, . . . 161 



Sclerotitis 157 

Scorbutus, 848 

Scrofulosis, 852 

Scrofulous Ophthalmia, 153 

Scurvy, 848 

Seasickness, 86 

Sebaceous Tumors, 138 

Seborrhcea Capillitii, 128 

Senile Dementia, 41 

Serous Iritis, 158 

Sight, 169 

Singultus, 418 

Shaking Palsy, 828 

Ship Fever, 889 

Skin, Diseases of, 1002 

Sleep, 86 

Small-pox, 995 

Softening of the Bones, 758 

Softening of Brain, 105, 113 

Softening of the Spinal Marrow, . . 728 

Softening of the Stomach, 445 

Soft Palate, 263 

Sore Throat, 263, 270 

Spasm, 800 

Spasm of the Bladder, 613 

Spasm of Glottis, 303 

Spasmodic Spinal Paralysis, .... 734 

Spasmus Facialis, 801 

Spastic Stenosis CEsophagi, .... 281 

Spermatocele, 648 

Spermatorrhoea, 652 

Sphere of Conation and Activity, . 51 

Sphere of Feelings or Emotions, . . 56 

Sphere of the Intellect, 34 

Spina Bifida, 723 

Spinal Anaemia, 718 

Spinal Apoplexy, 719 

Spinal Hypersemia, 718 

Spinal Irritation, 721 

Spinal Paralysis (Acute Atrophic), . 735 

Spinal Paralysis (Chronic Atrophic), 736 

Spinal Paralysis (Spasmodic), . . . 734 

Spirillium of Obermeier, 919 

Spleen, Diseases of, 563 

Splenitis, 564 

Spotted Fever, 943 

Squamous Syphilide, 641 

Squint, 176 

Stagnation Aktesiae, . 283 

Stagnation of Blood in the Brain, . 69, 71 

Staphyloma Cicatricial of Cornea, . 154 

Staphyloma Posterioris, 161 

Staphyloma Ulcerative of Cornea, . 154 

Stenocardia, 412 



io*8 



INDEX. 



Stenosis of Left Ariculo-ventricular 
Opening 

Stenosis (Esophagi, 

Stenosis of the Pulmonary Opening, 

Stenosis of Right Auriculo-ventricu- 
lar Opening, 

Sterility in the Male, 

Stomacace, 

Stomach, 

Stomatitis, 

Stomatitis, Catarrhal, 

Stomatitis Parasitic 

Stomatitis Ulcerosa, 

Stones in the Bladder, 

Strabismus, 

Stricture of the Oesophagus, .... 

Strictures of the Urethra, ... 

Struema, 

Strongylus Duodenalis, 

Stupidity, 

Stupor, 

St. Vitus' Dance, 

Stye, 

Spondylarthrocace, 

Subacute aad Chronic Inflammation 
of the Gray Anterior Spinal Horns, 

Sudamina, 

Summer-complaint, .... 68, 469, 

Sunstroke, 

Suppurative Catarrh of Middle Bar, 

Suppurative Iritis, 

Suppurative Nephritis, 

Supra-renal Capsules, Disease of, . . 

Sycosis, 

Syphilides, 

Syphilis, 

Syphilis Congenita sive Hereditaria, 

Syphilis Laryngis, 

Syphilitic Affections of the Bones, . 

Syphilitic Affections of the Mucous 
Membranes, 

Syphilitic Contractions of the Mus- 
cles and Tendons, 

Syphilitic Inflammation of Liver, . 

Syphilis of the Internal Organs, . . 

Syphilitic Iritis, 

Syphilitic Skin Diseases 

Syphilitic Tumors of the Brain, . . 

Syphilomata in Larynx, 



402 
281 

404 

404 
655 
2/5 
422 
272 
272 
272 
274 
612 
176 
281 
625 
279 

519 
34 
86 

802 

137 
768 

736 
1024 
470 
106 
198 
153 
60 r 
605 

637 
640 
629 

645 
300 

643 
643 

644 

54i 
644 
153 
640 
122 
300 



Tabes Dorsalis, 730 

Tape Worms, 516 



Teleangiectasis, 130 

Temperature, Normal, 855 

Tetanus, 956 

Tetanus Neonatorum, 957 

Tetter or Scald of Scalp, 125 

Teeth 237 

Thermic Fever, 106 

Thorax, , 306 

Thrombosis, 113 

Thrombus Neonatorum 123 

Thrombosis of Portal Vein, . . . 552 

Thread Worm, 514 

Thrush, 272 

Thrombosis of the Cerebral Sinuses, 117 

Thyroidal Perichondritis, 298 

Tic Doloreaux, 784 

Tinea, 130 

Tinea Favosa, 129 

Tinea Tarsi, ....'. 134 

Tinnitus Aurium, 208 

Tobsucht, 52, 53 

Tongue, 253 

Tonsils, 260 

Tonsilla Pharyngea, 212 

Tonsillitis, 261 

Torticollis Rheumaticus, 741 

Tootache, 238 

Torsion of the Bowels, 487 

Trachea, 284 

Traction Diverticula, 283 

Traumatic Iritis, 158 

Traumatic Pylephlebitis, 553 

Trembling, 827 

Trembling of the Eyeballs, .... 177 

Tremor, 827 

Tricuspid Valves Insufficient, . . . 404 

Trichiasis, 134 

Trichinosis, 522 

Trichina Spiralis, 520 

Tricocephalus Dispair, 519 

Trismus, 956, 957 

Tubercles of Brain, 121 

Tubercular Syphilide, 642 

Tubercular Tumors of the Brain, . . 122 

Tubercular Ulceration of Larynx, . 298 

Tuberclosis, Acute Miliary, .... 948 

Tuberclosis of the Joints, 762 

Tuberculosis Intestinalis, 509 

Tuberculosis, Pulmonary, 354 

Tumor Albus Genu, 765 

Tumors of the Brain, 120 

Tumors, Gnawing in Larynx, . . . 300 

TussisConvulsiva, 939 

Twitching of the Eyelids, 177 



INDEX. 



IO39 



Tympanitis Abdominals, 532 

Typhlitis, 455 

Typhoid Fever, S92 

Typhoid Fever, Abortive, 897 

Typho Malarial Fever, S76 

Typhus, 889 

Typhus Abdominalis, 892 



Typhus Ambulatorius, . 
Typhus Biliosus, . . . 
Typhus Exanthematicus 
Typhus Recurrens, . . 
Typhus Tumultuarius, . 
Tylosis, 



U 

Ulcerated Sore Throat, 

Ulceration of Cornea, 

Ulcers in Fauces, 

Ulcers in the Mouth, 274, 

Ulcus Rodens, 

Ulcus Varicosum, 

Ulcus Ventriculi Perforans Chron- 

icum, 

Uraemia, 

Urea 

Urinae Profluxia, 

Urinalysis, 

Urinary Casts, 

Urine, Examination of, 

Urticaria, 

Uterine Polypi, 

Uvula 



897 
920 
889 
919 
897 
134 



270 

154 
270 

275 

234 

ion 



435 

588 

57i 
583 
569 
574 
569 
1007 
686 
163 



V 



Vaccination, . 
Vaginismus, 

Vaginitis, . . 

Varicocele, . . 

Varicella, . . 
Varicose Ulcers, 

Variola, . . . 



998 
711 
711 
648 
1001 
ion 
995 



Varioloid, 995 

Variolois, 995 

Valsalva's Method, ... .... 190 

Vascular Naevus, 130 

Veneral Diseases, 619 

Verrucktheit, 34 

Vesicular Emphysema, 366 

Vertigo, 74 

Vibration of Voice, 310 

Vicarious Menstruation, 700 

Vomiting, 424 

w 

Warts on Lids, 138 

Water on the Brain, 93 

Waxy Kidney, 600 

Waxy Liver, 544 

Weak-mindedness, 50 

Wens, 130, 138 

White Softening of Brain, 113 

White Swelling, 762 

White Swelling of the Knee. . . . 765 

Whitlow, 769 

Whooping-cough, ....••.. 939 

Winking, Morbid, 177 

Word Blindness, 115 

Word Deafness, 115 

Worms, Intestinal, 514 

Worms, Tape, 516 

Writers' Cramp, 802 

Wry Neck, 741 



Yearly Cold, . . 224 

Yellow Atrophy (Acute) of Liver, . 541 

Yellow Fever, 877 

Yellow Softening of Brain, 113 



Zona, 1005 



1*1 






I* 






